T Nation

Chronic Golfer's Elbow


#1

Hello everyone,

I am struggling with chronic golfer’s elbow on both sides since November 2016. It started during Chin Ups and in the beginning I basically ignored it. It was only a light pain during the first rep and later gone, so I thought it was probably nothing serious. As this pain was not disappearing, I substituted the Chin Ups for another exercise but this only solved the issue for a short time and soon this exercise started to make problems as well. As I started to have pain outside the gym as well, I decided to take a gym break. I took an approximately 3 months break but resting didn’t improve things, so I went to a physiotherapist.
This actually helped a lot and when I didn’t feel pain anymore in my daily life, I decided to slowly start in the gym again. However, back exercises were still not possible. Dumbbell Rows with 10kg already seemed to irritate the elbows. I tried different exercises in the hope that one of them is unproblematic, (always low weights that weren’t demanding) but it in a couple of weeks, I was back to where I was before the physiotherapy and felt the elbows again also outside the gym. I stopped the training again and did again the exercises the therapist showed me. Lot of forearm stretching and transverse friction (none of it causes any pain or discomfort). It improved again but I am not getting rid of it completely. I am having the feeling that I reduce it to 20% or so, where it isn’t causing problems in daily life, but then I am stuck. It is just not getting good enough to hit the gym again.

Has anyone advise on this issue? Some secret exercise that magically cures it? I read about things like vodoo flossing but haven’t tried it yet. I tried light wrist curls (just the negative movement) for a while, but didn’t have the feeling that it improved the condition. I could always go back to physio therapy, but I don’t have the feeling that he would do more than what I am already doing.
Thanks a lot in advance!


#2

Hi,

Unfortunately it seems that you’ve mismanaged your condition, ignoring early signs, treating it as you would a muscle strain instead of an overuse injury and left it a bit late too see a physio.

You probably weren’t ready yet to start aggravating movements again and evidently it wasn’t slow enough

Should’ve stopped after one session not persisted for weeks.

Lessons for next time ey?

Repeated stress and overuse are the drivers so strategic rest and activity is still the best conservative intervention.

Like you’ve said while you’re not 100% yet but the trend is still getting better which is rather encouraging. Even with a couple of flare ups over time it seems you’re headed towards full recovery.

Had Golfer’s Elbow myself while working at a Butcher’s due to awkwardly carrying trays of meat. Stopped working there and it went away in time. I don’t sense that’s an option with lifting.

You already have the gist of what to do and some treatment examples from your past physio. All I can add is to play it smart/safe and be as conservative as possible. There’s no going too slow in your case. Try not to stop going to the gym completely because you’ll probably drive yourself insane.

Also some of the stuff listed below may be of help.

Consider differential diagnoses (similar symptoms/presentation):
Referred Pain from the Neck
Nerve Entrapment at the Elbow (Ulnar Nerve)
Joint Pathology e.g. Inflammatory Arthritis or Ligamentous Instability
Loose Bodies intra/extracapsularly
Bursitis

Modify form: probably pulling with the forearms muscles too much or curling with bent wrists loads up the forearm flexors excessively

Change Exercises/Reduce Volume: curls are probably not your friend especially your generic bicep curls. Likewise 10x10 curls is not a bright idea at least not for the foreseeable future

Use Straps: minimise work of affected muscles/tendons. eg figure 8 straps can enable you to pull with actually gripping anything with your fingers

Minimise stress/overuse outside the gym e.g. Occupation, Recreation etc.

Facilitate tissue healing e.g. Cease smoking, hot/cold therapy

A cortisone/corticosteroid injection may give some relief tho at this stage it’s no guarantee because while it may bring down inflammation the underlying degenerative processes in the tendons themselves are still present.

Not uncommon for chronic cases to last up to a year. It’s almost been one year so you’re possibly looking at surgical intervention if you’re unsuccessful with conservative management.


#3

Thanks a lot for the input!

I definitely mismanaged the condition in the beginning. No arguing about that. If I would have stopped and got some rest immediately, I doubt it would have come so far. However, I didn’t recklessly trained under pain. It was really only a light pain during the first 1 or 2 reps and you get quite often the recommendation to train around an issue and see if it is something exercise specific. Initially, I had no problems when I switched from Chins to Lat Pulldowns with a neutral grip. Problem solved I thought. When this started hurting after a while, I stopped completely but it obviously was too late at this point.

This summer it felt basically fine again. I started bench pressing the empty bar and put on 2.5kg from session to session. This was really the absolute minimum I could start with. It was all fine and pain-free, except for the back exercise, which soon caused problems. I should have probably stopped after the first signs, but I read many times that this condition is likely to stay forever and that people who once had it continuously struggle with the issue. I naively thought that I would just have to find the right back exercise for me. I was obviously wrong and it was still to early to go back to the gym. For me it is just really hard to judge this. I am doing my stretches but frankly it is more going through the routine. There is no pain and I am not having the feeling that there is any tension in the forearms whatsoever. Same for the transverse friction. I do it every other day, 10 min each side and afterwards I cool each side for 10 min but it is pain-free. I feel, however, that there is still this “nub” (now it just doesn’t hurt anymore to put pressure on it). In the acute phase of inflammation both stretches and friction hurt like hell. In my daily life, there is nothing I could change. I avoid carrying heavy, awkwardly-shaped things that get your elbows in unfortunate positions and may worsen things but other than that there is not much I could do. There is no detrimental repetitive movement that I could avoid. So I am basically already struggling with the basic question: When do you know it is completely ok without heading back to the gym and try?

Straps are a very good point. I would definitely get some if I decide to train again. From what I read in threads by people with golfer’s elbow about cortisone, it seems to be a waste of time and just a temporary pain relief.
I already thought about the surgical option, but when reading through tons of forums, I had the impression that this is really the ultima ratio that people take, who can’t brush their teeth anymore due to the elbow pain. I am basically pain-free, as long as I stay away from the gym…

I will look into the things you suggested!


#4

Unfortunately it’s hard to give you a timeline because usually that’s for the acute and early stages of injuries. Chronic is called so because it’s exceeded the normal healing time for whatever reason and the same rules don’t apply anymore.

It’s nice that you’re relatively pain/symptom free outside the gym. Don’t think we can say you’re all better yet tho when you are still limited in what activities you can do.

Sounds to me like you’re ready to take it to the next level so to speak. However, you are the expert in your own condition and best know how ready you feel: when to push and when to back off. As the adage goes go with your gut. If you don’t feel you’re ready yet maybe some gentle, endurancey, light kinda work can be done at home for a bit. For example squeezing a foam ball, light full ROM wrist curls or twisting a towel as though to squeeze out water. Moving without pain is good: builds confidence and physiologically inhibits pain (don’t ask for he mechanisms because I don’t know enough to explain it)

A bit strange to be having issues with your pressing movements. Might be because you’re pressing with a bent wrist or squeezing the bar too hard. Pressing movements should be the least affected by your condition if at all. Fix form and get back to doing these lifts. You’ll be slightly de trained so don’t go too ham on it.

On the pulling side of things maybe work backwards going from movements that were seemed to be less painful when you were experimenting the first time around and working back towards your favourites/most painful while applying some of the suggestions e.g. Straps. I can’t stress enough to take things slow and be conservative even if you do one set of rows the first day back doesn’t matter as long as somewhere down the track, weeks or months however long it takes, you’ll build back to where you were before. + No curls of any kind.

Continue rehab… or is it prehab now, as before.