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Old 06-27-2009, 06:27 AM   #1
Brad Davis
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Chronic Golfer's Elbow -- Q for Steven and Others

I've been unsuccessfully dealing with golfer's elbow for the last 23 months. My approach has been to rest until it seems completely gone and then start a pull-up progression at 3-5 reps and work up. At about 10 reps, it comes back. I've done this several times already so I want to try something different this time.

At this point, I have rested it for about 2 months and I think the pain is totally gone. If I poke around enough, I might feel a little something, but I could probably do that with a healthy elbow.

My question is how to apply some of the following, which has been posted numerous times by Steven Low. Any advice, critiques, and suggestions will be very much appreciated.

Quote:
1. Rest. Especially if it's JUST mild overuse. If it's chronic then pure rest may not help.
2. Ice after any use & when sore. 15-30 mins per sessions for couple times a day. Direct ice massage ON the skin works the best.
3. Light stretch, not painful for agonists; strengthen antagonists. So stretch flexors, strengthen extensors *until* pain subsides (medial epicondylitis -- opposite for lateral epicondylitis). Then strengthen everything (my pref = rice bucket)
4. Self massage... cross friction and myofascial release the whole area inbetween both joints that surround it (shoulder to wrist for medial epicondlyitis; ankle-hip for something knee; etc.). As much as possible... at least 30 mins a day if not more. Also, tennis ball/golf ball areas & foam roll
5. Anti-inflammatories/NSAIDs. Fish oil is a good one.
6. Stay away from painful exercises. Period. It hurts, don't do them. Should be obvious but people don't listen.
7. Light eccentric exercises tend to help ESPECIALLY if the muscle(s) aggravated cannot smoothly do it.
8. + joint/cartilage health supplements like glucosamine & chondroin sulfate, MSM, shark, etc. Might be a good idea to start eating the cartilage and tendons off your meat too.
Now to try and form these into a protocol for the particulars of my situation. Please let me know if this sounds correct.

Item 3 at the "then strengthen everything" part: Would simple DB wrist curls and DB reverse wrist curls work for this? (thinking about the available equipment--if "rice bucket" is better, what's the exact protocol and how does this work extensors?) What kind of protocol--sets, reps, and frequency--should be used? Start with a 5 lb DB and do 3 sets of 15 each day? Do that for a week and increase to 8 lb, 10 lb, or whatever DB I can find that's next, and repeat? If the GE hurts, even a little, then stop--per Item 6.

The "light stretch" was typed before the "then strengthen everything" part--does that mean that light stretching should not be used in my program? If it is to be used, then when--after the exercises but before the ice massage?

Item 2: After each Item 3 workout ice massage for 15 min. Ice at least one other time per day.

Item 4: Does this apply at this point in my recovery or is this only when pain is still there? If I restart massage today, my GE will be hurting today. Does that conflict with the "if it hurts" part of Item 3 & 6? That would throw me back before the "until the pain subsides" part of Item 3. Does that mean I should not do the exercises in Item 3 until later?

Item 5 and 8: Fish oil, 1 tablespoon per day for something like 5000mg of DHA/EPA. Glucosamine/Condroitin also, per the dose on the osteo-biflex bottle. OTC NSAIDS kill my stomach, so those won't be included.

Item 7: Where do these fit into the program along with Item 3? Item 3 exercises include concentric and eccentric parts, so are these already included in Item 3?

Thanks in advance.

Last edited by Brad Davis; 06-27-2009 at 06:43 AM..
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Old 06-27-2009, 07:14 AM   #2
Brad Davis
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

Forgot part of #3. How hard should one go at the exercises? As hard as can be maintained without causing the GE to act up?
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Old 06-27-2009, 09:02 AM   #3
Steven Low
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

3 - curls are fine. Start very light... only eccentrics for the flexors and strengthening extensors. Eccentrics tend to be good for tendonitis..

If you get past 10 lbs you can probably try to return to normal activity as long as you're not overdoing it....

2 - sure

4. Along with ice, massage is probably THE modality that will help the most. Obviously you don't wanna be extremely intense on it, but if you can work out the kinks and get deep enough to stimulate good blood flow to the area you will find out it helps immensely

Massage is definitely more important than exercises

5. Don't need NSAIDs... just for the pain if it's too bad. Won't really help with healing. I will clarify this.

7. These are what you want to do with yours as I stated above. Going to rewrite this a bit.
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Old 06-27-2009, 10:28 AM   #4
Brad Davis
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

Thank you very much, Steven.

Some follow-ups to make sure I'm understanding correctly. I really want to do this right this time. Your advice so far is about what my orthopedic surgeon recommended, FWIW. His advice was hurried, though, so I never quite understood the program. (therefore gave it up quickly)

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Originally Posted by Steven Low View Post
3 - curls are fine. Start very light... only eccentrics for the flexors and strengthening extensors. Eccentrics tend to be good for tendonitis..
So I'd take a single DB and use the off-hand to lift the weight to the top and then lower it at a steady speed, say in 3 sec., and repeat. Repeat with the other hand. Right?

Quote:
If you get past 10 lbs you can probably try to return to normal activity as long as you're not overdoing it....
How would I define "get past 10 lb"? I can probably do sets of 15-20 of wrist curls and reverse write curls with 10 lb now and probably could've at any point so far.

What's the recommended sets, reps, and frequency for the exercises?

Quote:
4. Along with ice, massage is probably THE modality that will help the most. Obviously you don't wanna be extremely intense on it, but if you can work out the kinks and get deep enough to stimulate good blood flow to the area you will find out it helps immensely
How exactly does one do this? Take a tennis ball or something similar, put it on a level surface, bear the GE area down on it and roll it up and down the forearm and transversely also? I hesitate to use the thumb on my off-hand to do the massaging because my right thumb gets irritated very easy. I already hit a spacebar about 8e43 times/day and this sends it over the edge.

Quote:
Massage is definitely more important than exercises
So if the massage makes the area sore, does that mean that I skip out on the exercises until the soreness goes away?

What about the "light stretches"? Where do they fit into the program, exactly? Between the massage and ice? Between the exercises and ice?
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Old 06-27-2009, 10:47 AM   #5
Rene Forestier
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

From my experience with Golfers' Elbow...ice massage frequently, I used Ibu last flare-up, but I'll avoid it in the future based on KStar's recommendation, friction massage, thorough forearm warm-ups, TRY to avoid painful movements/grips, and wait for it to burn out.

Rest doesn't help it at all.

Fish oil is important, and you could play with a nightshade-free diet...it may help.
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Old 06-27-2009, 12:32 PM   #6
Rene Forestier
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

I forgot to add ART to my list above...VERY helpful.
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Old 06-27-2009, 12:39 PM   #7
Gabriel desGarennes
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

FIIIIIIIIIIIIIISH OIIILLLL
. I can't really stress it enough. I battled with inflammation issues with workouts for years until i went to the nutrition cert and started taking enough fish oils. Everything went away, my chronic tendonitis, my itbs, my low back pain. GOD BLESS FISH OIL... and costco
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Old 06-27-2009, 01:05 PM   #8
Brad Davis
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

Thanks Rene and Gabriel.

Rene, want to hear a funny aside? My overall inflammation issues improved dramatically last September when I dropped Paleo and started eating lots of mediterranean food which includes craploads nightshades and some dairy. I also re-introduced sprouted grain bread during that time. I also dropped IFing. (IFing is thought to help with inflammation.) All inflammation issues but GE went away during the fall and stayed away until I hurt my knee in March. OVerall, inflammation has pretty much disappeared. I KNOW there is NO causation proved here, but I find the correlation amusing. I had avoided wheat, legumes, dairy, and nightshades like the plague during the year before and my knees, elbows, wrists, shoulders, fingers, and about everything were acting up so badly that I was on the verge of going to a MD about it--to get checked for arthritis.

Gabriel, I've been taking fish oil for a long time. I think it helps, but it seems to be marginal for me. Have you tried dropping it for a couple of months to see if your inflammation gets worse? I wonder sometimes about all of our perceptions of what does what.

Last edited by Brad Davis; 06-27-2009 at 01:22 PM..
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Old 06-27-2009, 11:15 PM   #9
Rob Beer
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

"I wonder sometimes about all of our perceptions of what does what."
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Old 06-28-2009, 04:02 PM   #10
Steven Low
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Re: Chronic Golfer's Elbow -- Q for Steven and Others

Quote:
Originally Posted by Brad Davis View Post
Thank you very much, Steven.

Some follow-ups to make sure I'm understanding correctly. I really want to do this right this time. Your advice so far is about what my orthopedic surgeon recommended, FWIW. His advice was hurried, though, so I never quite understood the program. (therefore gave it up quickly)


So I'd take a single DB and use the off-hand to lift the weight to the top and then lower it at a steady speed, say in 3 sec., and repeat. Repeat with the other hand. Right?

Correct. 5-7s for negatives tends to be good

How would I define "get past 10 lb"? I can probably do sets of 15-20 of wrist curls and reverse write curls with 10 lb now and probably could've at any point so far.

What's the recommended sets, reps, and frequency for the exercises?

Depends on the severity of the tendonitis.

At least you're not bad that light weights aren't hurting you so that tells me you can probably recover easier


How exactly does one do this? Take a tennis ball or something similar, put it on a level surface, bear the GE area down on it and roll it up and down the forearm and transversely also? I hesitate to use the thumb on my off-hand to do the massaging because my right thumb gets irritated very easy. I already hit a spacebar about 8e43 times/day and this sends it over the edge.

The other hand is what works the best... cross friction or myofascial but those use the thumb. If you can't do it to yourself get someone else to do it (aka physical therapy....).

ART/graston technique may also be helpful.


So if the massage makes the area sore, does that mean that I skip out on the exercises until the soreness goes away?

Do the massage after your prehab work... but yeah if it's too sore then allow some day(s) to rest afterwards. Like working out.

It's a good sign if it's sore though that means you're working the tissue well, and usually a sign of healing/inflammatory process


What about the "light stretches"? Where do they fit into the program, exactly? Between the massage and ice? Between the exercises and ice?

Exercises, massage then ice. Or you can do massage, exercises, ice. Doesn't really matter.

You can do massage at any point during the day so if you get in 2-3 sessions or more that's great. Same with the ice.
Anyway, here's the updated version (on my blog)

wfs
http://eshlow.blogspot.com/2009/06/on-tendonitis.html
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Last edited by Steven Low; 06-28-2009 at 04:26 PM..
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