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Strength List: Sore Elbows

Date: Wed, 28 Oct 1998
From: <staley@myodynamics.com>
Subject: Strength_List: Dianna Linden on Elbow Problems

Hello all,

I've noticed all the recent buzz re: elbow problems, particularly in the
last issue, so I asked my colleague Dianna Linden, an elite-level
soft-tissue therapist who has worked wonders on several of my athletes,
to add her impressions (Dianna is not a subscriber to this list). I hope
her input is useful.

Date: Mon, 26 Oct 1998
From: "Steven"
Subject: Strength_List: Sore Elbows

Anyone with any advice for sore elbows (besides rest, I am four weeks out
from a meet)? The pain began with heavy squatting and is now being felt
during benches and tricep work. Anyone with any suggestions? never had
this problem before. thanks.

Hi Steve;

You've gotten some good advice so far from a number of folks, lets see if
I can add something useful to your bag of tricks:

It's hard to talk specifically to your sore elbow problem without knowing
more about precisely where it is, better yet, without actually palpating
the tissues for schmutz, aka adhesions, which are often the culprit in
inflamed tendons due to overuse in sport or micro trauma unnoticed and
exercised upon until it's turned to macro trauma. Those are very common
causes of pain from training. I'm guessing there's something like that
involved in your sore elbows.

Of course the best thing is to go and get an actual diagnosis from a
Sports doc with strength training knowledge so his/her diagnosis could be
accompanied with good (as opposed to lame) advice for a quick recovery.
Short of that, try these suggestions and see if you get a quick
improvement. If not, go see a medical professional rather than let an
acute condition become chronic.

Wade's advice to ice it and stretch it and change your positioning on the
bar is good. To that I would add, ice it for a minimum of 5 minutes, max.
15 min. every 1-11/2 hours until the inflammation cools down, up to 5 or
so times per day, esp. for the first 2-3 days after the injury makes itself
fully known. Continue to ice it, at least, after each workout while you
still feel any discomfort. This is true for any injury in the gym, no
matter how small. Ice will stop it in it's tracks and speed up the healing
considerably.

Part of what makes ice so useful is what happens in the tissues when you
take it off, so make sure you leave at least an hour between icings for
the nutrients and proteins to rush in with the reflexive vasodilation which is
occurring then. The tissues have had the inflammation and edema reduced by the ice and can more readily use the nutrients received then for repair.
Icing for just 5 minutes is far more beneficial than doing nothing in
promoting repair of damaged tissues.

Stretching is usually not recommended for adhesions as a first order of
rehab protocol, but in general, is an important aspect of your training
regime. It should be done when the tissues are warm, after the strength
training session is optimal. If you stretch tissues too much before you
work them they are temporarily weakened by the stretching and therefore
susceptable to tearing under load once again. Not a plan.

Keith and Bob gave you specific suggestions re: your form and exercise
choices for sore elbows. Rule of thumb: when injured, if it hurts, modify
your position, exercise, intensity until you do not feel it at all or
don't do the exercise which involves that part at all until it is healed.
Forearms are involved in so many exercises that I could see why you might
not want to back off entirely at this point. Just don't train thru any
pain in that location, you would definitely be re-injuring it every time you
do. Consider that an exercise which does not stress one persons elbow might cause pain in another, so try the suggestions, but let your own pain be your red light and experiment with what ever will allow you to train the desired body part, pain free.

Wrist db extension exercise for lateral epicondylitis rehabGenerally, if it is medial or lateral epicondylitis, aka golfer's or
tennis elbow, as a massage therapist, I use deep transverse friction massage at the site of the lesion to roust the adhesions out of there, ice it, ask my
clients to continue the icing, and instruct them to do very light wrist
extension, flexion strengtheners depending on which muscles, tendons are
involved in the inflammation. After specific gentle strengthening,
combined with the cross fiber friction, the pain should be considerably reduced right away and soon gone.

Then one can resume the sport which caused the overuse or trauma at the
level done previous to the injury with those parts specifically
strengthened to be able to now handle that load. The exercise form and
choice might need to be altered to prevent recurrence, as well.

You can try the deep transverse friction massage yourself by wrapping an
ice cube with a paper towel over 1/2 of it so you can hold it without
freezing your fingers. Place it exactly on the painful spot, hold it until
it quits aching and is numb, then rub it to and fro across the fibers of
the tendon, moving the skin along with the underlying tissues for 60
seconds, back and forth for as long as you can stand, cause this will hurt
if you're doin it right. On a 10 scale of painfulness, don't take it above
8. 5-8 is probably a reasonable level of intensity for the first session.
It gets less painful and the area is usually smaller where it is painful,
as it improves. If you do 4 sets of 15 reps across the spot that should do
it for the first session. In 2 or 3 days you can repeat the treatment. 2
minutes on any one spot is the max I have asked a client to endure. It is
not to be done every day because the tissues are being purposefully
irritated and adhesions broken up, so they need recovery time.

This protocol was developed by the English Orthopedist, James Cyriax and,
in my experience, is very effective in speeding up recovery of tendonitis.
It can be applied to elbows, knees, shoulders, ankles, groins, plantar
fascia, Achilles, wrists, fingers, but you need to know which way the
muscle fibers go, so your mechanical movements are across the fibers. Wrists must be worked on a stretch because they are sheathed tendons. The Achilles is partially sheathed so must be worked on a stretch as well. Go for the painful spot, rub across it with some pressure taking the stroke into the underlying tissues with the ice cube.

Forearm db curls, wrist flexion exerciseThe second treatment should be much less sensitive so you can work on it
for as long as 2 minutes. Follow it with a general icing for 5-15 min. Do
it after your workout. Train exercises that involve the forearms very
lightly, if at all, the next day. Then on the following day do forearm curls
and/or extensions in the 10-15 rep range(x3), ie with very light weights, eccentric emphasis, as long as there is no pain in the action, and after you complete your workout.
Apply the deep transverse friction massage again, ice. If you can use
NSAID anti inflammatories with out negative side effects along with your treatment, go for it.

Usually an acute lesion is worked out within 3 to 6 treatments performed
twice a week, sometimes one will knock it out if it is fresh and doesn't
involve too much tissue and the athlete does not go out and re injure it.
Eat plenty of protein and supplement with the glucosamine, efas, probably some anti-oxidants. What else? Did I leave something out? If so, can't think
what it would be.

This was long. Hope this helps. Good luck in healing it completely before
your meet. Let us know how you do.

Respectfully,

Dianna Linden
di@diannalinden.com

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