Elbow care

Hey all,

Iv'e been struggling with chronic elbow issues pretty much from the start of my training because I loved it so much that I did not want to take it slow. As has been said numerous times on this forum, doing that is terribly stupid. Anyway I've spent loads of time trying to piece together some stuff on this forums on the correct way to treat my elbows and I figured I would compile some of the better posts so others don't have to do the searching themselves. I also have a few questions I'll ask at the end.

First, all new to joint pain, or even just training in general, should read this sticky on training with chronic injury:

http://www.gymnasticbodies.com/forum/viewtopic.php?f=17&t=1560

Here is Coach's elbow series for iron cross training which is important for strengthening the elbow. It can be found in this post:

http://gymnasticbodies.com/forum/viewtopic.php?f=17&t=1988#p12726

The elbows and biceps need to be gradually prepared prior to beginning strenuous iron cross training. Generally I begin athletes with the series listed below. During all of these steps pressure should be felt on the biceps. If this pressure is not felt, then continue working that variation until you are strong enough to execute it correctly.

Elbow Preparation Series for Iron Cross Work:

1) XR support hold - Focusing on elbows locked and straight is critical here.

a) It is also quite acceptable to insert both XR support swings and XR swinging supports into this phase. 10 repetitions of large XR swinging supports can be especially challenging, as well as a lot of fun , while struggling to maintain the correct position.

2) XR L-sit.

3) XR 1/2 press - During this element, the athlete will press up as high as possible into a half press HS maintaining completely locked elbows and rings turned out at all times. Do not attempt to press higher than it is possible for you to maintain the correct arm/elbow position. Please note that this is an essential element in this progression.

4) XR HS - There should be a substantial degree of pressure on the biceps during a correctly performed XR HS. If this pressure is not present, in all likelihood either the elbows are bent or the rings are not turned out.

5) XR Planche variations - Some individuals may find that they are physically strong enough to proceed directly from XR HS work to the iron cross training as planche training can be a time consuming proposition. However for those who see it through, achieving a solid planche prior to beginning serious iron cross work will pay substantial dividends in the long term.

6) XR Iron Cross work.

Simultaneously alongside with the above progressions; the athlete may also engage in elbow supported iron cross static holds and iron cross pulls.

Here is a slideshow on tendinopathy that I found awhile back that is simply fantastic:

http://www.authorstream.com/Presentatio%20...%20owerpoint/

The thread I originally started with it comes with bonus information from Slizzardman on how to make your own heat lamps which is awesome!

http://www.gymnasticbodies.com/forum/viewtopic.php?f=17&t=6171

Here is another post from Coach. He is recommending heat and slow negatives and he also advocates isometrics earlier in the thread. It can be found at:

http://www.gymnasticbodies.com/forum/viewtopic.php?f=16&t=3050

The recommendations for slow negatives are absolutely correct.

Heat is also very beneficial for tendonitis; if the location permits direct application.

Previously I had an athlete who struggled with achilles tendonitis for several years. Icing produced no results. Slow negatives provided a measure of relief as long as we were careful to strictly control the volume of his training. Then on an ultra marathoning site I came across their preference for heat in treating achilles tendonitis. Upon following this protocol, within one week, the tendonitis was resolved.

The treatment itself was simple. Take a reusable hot/cold pack. Drop it into a pot of boiling water. If memory serves, I believe that the time used to heat the pack for this particular athlete was two and a half minutes. Remove the hot/cold pack and check the temperature. If necessary, let the hot/cold pack cool until the heat is bearable. It should be very hot, but not enough to cause burning or extreme discomfort. Let the hot/cold pack remain in place until it cools. At first the treatments were several times a day for a week, then these tapered off to once per day and finally when and as needed.

Yours in Fitness,

Coach Sommer

The following is a quote from Slizzardman, regarding general elbow training. It can be found at:

http://www.gymnasticbodies.com/forum/viewtopic.php?f=17&t=5128&start=15

For general training of the inner elbow: Pull ups train the upper part of the inner elbow (radiobrachialis) and chins train the lower part, but you have to have very strict form and really close the arm angle to work the muscles correctly. DUmbbell or barbell wrist curls and reverse curls are a great too, and if you can do these with a thicker grip (fat gripz or something homemade) that would be even better. Hammer curls are important too. Those are the basics for the inner elbow. Thick bar grip work will help a lot and XR bicep curls can really do a lot of good as well. You need higher reps for the most part in these exercises, and increase the weight slowly. Very , very slowly. You should really run at least 4 week SSC for these, and possibly full 8-12 SSCs. It is very important that you do some sort of soft tissue work after each workout for the shoulders, biceps and forearms. Chest would be nice too, and I recommend that, but do what you have time for and know how to do. This is just a basic list, but basics keep you healthy.

The next link is just a pretty good thread to read through. A couple of guys are discussing what worked and did not for them. Pay special attention to Slizzardman's posts of course.

The following video is a Elbow and Wrist prehab routine posted by Mr. Brady. It was stickied by Dillon because he had personal experience with this routine removing his elbow pain.

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This next link is of a thread in which Slizzardman really gives good information on the massage and stretching aspect of treatment:

http://www.gymnasticbodies.com/forum/viewtopic.php?f=17&t=5400

Slizzardman also has a great video on planche leans for bicep and elbow conditioning.

vaH_HUMooyM

When working on the planche leans it is very important that your body position is correct. The following link is a discussion in which Dillon describes and shows the correct way to perform leans. Remember, DO NOT rush the planche leans. Take your time and it will be of great benefit.

http://www.gymnasticbodies.com/forum/viewtopic.php?f=13&t=6448&start=15

In short, general joint rehab consists of

-Slow (and somewhat painful) eccentrics and possibly some volume work

-ice/heat, but mainly heat

-massage

-prehab specific exercises

-supplements(unfortunately I don't remember where exactly I saw the recommendations for supplements but I remember that some people recommend Vitamin C, fish oil, and Glucosamine + MSM)

And finally I have a few questions. The first is how much volume/sets and reps/holds should be used for the eccentrics (and volume work if there is any) and statics?

Should XR support holds be used in rehab if they are not painful? or is there a chance they are still too stressful despite the lack of pain.

My final question is mainly directed to Slizzardman: You/he recommended diamond pushups for muscle-up conditioning ( http://www.gymnasticbodies.com/forum/viewtopic.php?f=13&t=6647 ), The muscle-up transition is the thing that was/is the most painful for my elbows, therefore would you recommend diamond pushup negatives as rehab for the elbow? I am capable of a good amount of regular diamond pushups and when I did negatives on my knees yesterday focusing on the slow controlled movement I could definitely feel it in my elbows. This morning I could still feel it in my elbows, but it was not too painful. Did I overdo it even with that, or should I keep it up?

Thanks for your responses!

how much volume/sets and reps/holds should be used for the eccentrics (and volume work if there is any) and statics?

Should XR support holds be used in rehab if they are not painful? or is there a chance they are still too stressful despite the lack of pain.

My final question is mainly directed to Slizzardman: You/he recommended diamond pushups for muscle-up conditioning ( viewtopic.php?f=13&t=6647 ), The muscle-up transition is the thing that was/is the most painful for my elbows, therefore would you recommend diamond pushup negatives as rehab for the elbow? I am capable of a good amount of regular diamond pushups and when I did negatives on my knees yesterday focusing on the slow controlled movement I could definitely feel it in my elbows. This morning I could still feel it in my elbows, but it was not too painful. Did I overdo it even with that, or should I keep it up?

Well, volume is tricky. You don't need very much, because eccentrics do lots of damage. The main purpose of these is to continually stimulate accelerated healing in the connective elements of the muscles. I certainly wouldn't do more than 10, but I would do them literally every single day. You are much better off doing less and doing them 1-2x per day, because you want constantly accelerated healing.

You may need to do your diamonds on stairs or even a wall right now, but if the pain is like a 6 out of 10 then you are ok on the knees. Just do 2-3 reps of SLOW negatives. Like 5-10 seconds. You will find that the slower you go the less painful they sometimes are, but don't go slower than 10s. I'd prefer more of a 5-6s negative. You can probably get away with doing that 1-3x per day. Every other day I'd consider only doing 1 set regardless of how good it feels. I would only do 1 set per session. Remember, this is not about strength but recovery! You will benefit greatly from transitioning your thinking in this way regarding almost everything that you work for strength. You should never be pushing the limit, you should be doing the opposite: Do the same thing until you no longer get benefits from it and THEN make it a little bit harder so that it is moderately challenging and then do it all over again; keep doing the same thing until you get no further benefit. This is how you will avoid almost all training injuries. This is also the essence of Coach's SSC.

Thanks for the response!

Sounds pretty straightforward, will definitely be "making haste slowly" from now on. I was just a little to eager...sigh.

Since so little is needed, do pushup position XR supports have a place in rehab or would that be pushing it until I'm well on my way towards being injury free?

Definitely, if they don't bother you.

Sorry to rewaken this thread. I have been suffering from achilles tendinopathy at the insertion point of my calcaneus for about a year and a few months now. I am wondering if you all have any advice in treatment? I have heard of eccentric heel drops on the floor because over-stretching on a step is more suited to mid insertional tendinosis. 

Coach and Joshua any light you could shed on this would be beyond incredible.  

Just to clarify the treatment conducted was was entirely composed of placing a hot pack on the spot of pain until it cooled?

Background on my injury. It affects both of my achilles insertion points but my left side more because it is my more dominant/planting leg. I am pretty sure this is an overuse/tight gastrocnemius injury and am working on stretching and massaging.  

Thanks for everyone's advice and time!

If it's pain at the Achilles' insertion it's more likely retrocalcaneal bursitis not Achilles tendinopathy.

Dear friend it is not the bursa. I have been to "leading" orthopedic sports doctor in Miami. Waste of money.  All they prescribe is physical therapy. it is achilles tendinosis, i can play with my bursa all day and no pain is felt. It is more to the side of the heel cup. When you place your foot on the floor right on the edgessss.

Be glad that all they did was recommend physical therapy. would you prefer they give you an injection and risk further rupture/tears? Would you prefer surgery? would you prefer medication that will only cover your symptoms? Doesn't sound like a waste of money, sounds like the appropriate recommendation. Did you do PT? That would certainly be the best option IMO.

What was the diagnosis the surgeon gave you, the diagnosis he/she wanted the therapists to work on?  Did you do the therapy?  Sounds like an overuse injury, did you cut back on activities that bother you and slowly reintegrate them when pain free?  

My point is, if you've had pain that's been persistent for over a year and you've been doing the appropriate therapy (physical, medical, surgical, whatever...) it's time to rethink the diagnosis.