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Old 06-23-2009, 08:02 PM   #21
Steven Low
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Re: inside elbow pain / pullups

The tendon and fascia are kind of contiguous in that they kind of merge with each other down the forearm. So it's helpful to hit the whole area as the increased bloodflow will help everything.

That's why I said in the prescription to massage EVERYTHING in between the shoulder and the wrist to get the blood flowing.
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Old 06-25-2009, 05:45 AM   #22
Rob Beer
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Re: inside elbow pain / pullups

Pascal,
As one who has dealt with the same condition on and off for ten years, I empathize with you. Moreover, as an orthopedic surgeon, let me summarize a treatment algorithm and offer some information on a new type of treatment.

First of all, in the chronic form, the pain in your elbow (we are assuming it is medial epicondylitis-- or common flexor tendinosis) is a degenerative condition of the tendon that results from overuse. Like yourself, mine developed from doing pull-ups. Tendons attach muscle to bone and this "common flexor" tendon attaches the wrist flexors, among others, to the humerus at the medial epicondyle. Just at the point where your elbow hurts.

Again, in the chronic form, meaning you have had it for several months, it represents a tougher nut and can take a long time to heal since the blood supply is not great. Here's my tx algorithm:

1. Relative rest- avoid things that cause your elbow pain, but continue to stretch, perform other exercises that do not bother it
2. NSAIDs- this is somewhat controversial with chronic tendinosis, since it isn't an inflammatory condition, these shouldn't help much, plus they might prolong healing. Nonetheless, if you can't even open a door without pain, I usually recommend a short 2 week course to see if they offer any relief.
3. Physical therapy modalities such as iontophoresis (topical steroid essentially), ultrasound, etc. may provide short term relief, but in general they do nothing to speed recovery and return to activities
4. Cortisone shot. Most of the studies out there indicate that cortisone shots provide short term relief, but there is no difference when you look at like patients 8 weeks out, i.e. the ones who didn't get a shot felt the same as those that did. Steroid does weaken the tendon in the weeks following, so avoid strenuous exercise for 2-3 weeks should you choose to get a shot.
5. Autologous blood injection/platelet rich plasma therapy-- these relatively new modalities involve taking a few cc's of your own blood and either injecting the tendon right off, or spinning down the blood to recover the platelet rich plasma and injecting that into the tendon. There is no good level I evidence that this works better than anything else, but there are a few series that have been published that indicate it might be beneficial. More intensive studies are underway.

The summary is that the tincture of time, coupled with light use of the arm and stretching the involved tendon usually result in relief in several months. Frustrating, yes. In my experience though, one thing is certain, if you think 150 pull up workouts are critical to your well being, then be prepared for a resurgence of your elbow pain.

Last edited by Rob Beer : 06-25-2009 at 05:49 AM.
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Old 06-26-2009, 02:39 PM   #23
Don Hollinger
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Re: inside elbow pain / pullups

Has anyone tried “prolotherapy” ? They inject an irritant directly into the tendons and stimulate the body’s natural healing.

http://www.prolonews.com/tendinosis_prolotherapy.htm

I also got my medial epicondylitis by doing pull-ups.

So, to reduce the stress, I rigged up some pulleys to make a cobbled “gravitron”, and now, even with minus 70 lbs, my pull-ups still hurt the elbows, so I have stopped them. Even a 100 lb dead lift hurts.

I am thinking about trying “prolotherapy”. The web search I’ve done indicates that it is worth trying, but I'd like some feedback from this forum.

Thanks,

Don
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Old 06-27-2009, 01:00 AM   #24
Rob Beer
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Re: inside elbow pain / pullups

Prolotherapy, PRP, autologous blood injection, dry needling-- all of these forms of therapy attempt to stimulate a localized inflammatory reaction-- which is the first step in the healing cascade. There is no definitive evidence that any of these therapies work better than just relative rest and time. (That said, I would try to get the PRP if you can find a doctor that offers it.)
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Old 06-27-2009, 08:54 AM   #25
Steven Low
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Re: inside elbow pain / pullups

If you wanna try it, go for it.

Sometimes random stuff helps. Stuff like E-stim, ultrasound, etc. have all been proven in peer related studies along with what Rob said above to be ineffective. But like glucosamine and chondroitin sulfate they help SOME people. No clue why.. but if it helps YOU then you might as well try it, eh?

Maybe it's the placebo effect
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Old 06-27-2009, 08:42 PM   #26
Chris Puckett
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Re: inside elbow pain / pullups

did the same thing on the 3/5/7 pu wod. went too heavy during the weighted portion and they turned into LSP, long slow pullups. My right bicep is sore like its "pulled", and has been for a week. I have massaged and iced a bit, and now its looking like some time off from the pullups is needed. Guess I can heavy squat and run, focus in on the diet.
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Old 06-28-2009, 03:27 PM   #27
Steven Low
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Re: inside elbow pain / pullups

Quote:
Originally Posted by Chris Puckett View Post
did the same thing on the 3/5/7 pu wod. went too heavy during the weighted portion and they turned into LSP, long slow pullups. My right bicep is sore like its "pulled", and has been for a week. I have massaged and iced a bit, and now its looking like some time off from the pullups is needed. Guess I can heavy squat and run, focus in on the diet.
You overdid it.. probably destroyed some muscle fibers

Correct that you need to rest
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Old 06-28-2009, 03:31 PM   #28
Chris Puckett
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Re: inside elbow pain / pullups

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Originally Posted by Steven Low View Post
You overdid it.. probably destroyed some muscle fibers

Correct that you need to rest
yeah, thats what I figured. Planning to run, lose some weight, and do back squat a few times a week. having the "rest" allows me to do other things, went to the skatepark and skated a bowl for the first time this year.

does having torn muscle fibers change anything from your first post for recovery?
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Old 06-28-2009, 04:07 PM   #29
Steven Low
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Re: inside elbow pain / pullups

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Originally Posted by Chris Puckett View Post
yeah, thats what I figured. Planning to run, lose some weight, and do back squat a few times a week. having the "rest" allows me to do other things, went to the skatepark and skated a bowl for the first time this year.

does having torn muscle fibers change anything from your first post for recovery?
This is a tendonitis (well, technically tendonosis thread).

Yours is a muscular problem which means you need to work back into it slowly, and muscular problems usually have a different prescription for healing than bones/tendons/ligaments with regards to icing and heating.

You shouldn't necessarily follow any of the advice in this thread.

If there's edema/swelling still then ice is probably your best bet.

Light exercise to provide blood flow to start healing the muscles + some stress to stop atrophy. Cycling, for example, would probably be a good idea. Air squats as well. MAYBE burpees if your triceps are alright. Along the lines of cardiovascular work + some strength for the legs will probably help
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Old 08-03-2009, 02:20 PM   #30
Jon Friedland
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Re: inside elbow pain / pullups

2 Months after my first post on this thread I am sort of where I was then only a bit smarter and more patient. I tried ramping up pullups a few times like some others here only to have the pain recur. I am now starting back up but in no hurry to get back to full hanging pullups. Am going with feet on the ground type pullups. Still annoying but this thread has helped me to realize I have a chronic issue that just needs to be managed.
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