T Nation

Training with Medial Epicondylitis (Golfer's Elbow)


#1

Hi CT,

From what I've gathered over the years, you seem to have successfully dealt with elbow issues. I suffered from a severe case of medial epicondylitis 5 years ago in which various treatments and about a year off from heavy training finally allowed me to lift again without pain.

Unfortunately, I am experiencing another severe flare-up that I can't seem to shake and I was wondering if you had any additional thoughts or tips on how to train through elbow issues. Here's my current strategy:

Therapies:
1. Weekly ART and Graston sessions
2. Daily Voodoo band flossing
3. Ice after workouts
4. Sleep with a Castor Oil wrap (for those that haven't tried, it's eerily effective)

Supplementation for Inflammation:
1. Flameout (4-6 daily)
2. Curcumin (4-8 dailiy)

Workout:
Modified layer approach
4 day splits: Bench Press, Squat, Overhead, Deadlift and back

  1. Reducing frequency to 2 days on 1 day off
  2. Higher rep ranges (6-10) with appropriate weight (60-80%)
  3. Choosing exercises that minimize or eliminate pain

I've found in particular that lat training is difficult. I'm focusing on face pulls for my back workout with only machine pull-overs and Meadow rows as I can execute them pain free.

Results:

Pain hasn't gotten worse but hasn't significantly improved. One misstep causes a flare-up.

Questions:

  1. In your opinion, can you successfully train through bouts of elbow tendinitis?
  2. Any modifications to my current approach

Any advice from the broader forum is appreciated as well.

Thanks!


#2

How long do you allow your elbow time to heal itself now?


#3

I haven’t completely stopped lifting and given it any rest, which was part of my question. The strategy has been to stop performing any lifts that immediately cause pain on the elbows, lower the frequency (I was using a high frequency strength program), and lighten up on the weights a bit.


#4

@jpg: Have you tried Kinesiology testing, specifically where they put you in different positions and test to make sure all the muscles around the injured area are firing? This is much more popular in Europe than in the states. Just curious as you seem to have done a lot of other things (like Voodoo flossing, etc…).


#5

Thanks for the tip on kinesiology testing. I hadn’t heard of it before so I’ll check it out.


#6

I had inner elbow pain for years. Bothered me most on chins and pull-ups, but curls and rows hurt too, as did back squats and unracking/re-racking bench presses. I tried everything I could think of, including complete rest for three months, voodoo flossing, eccentric exercises and various other things, and nothing really worked. Eventually I ordered a device called an Armaid and gave that a go (it allows you to massage your forearams very firmly). I started off using it every day for five to ten minutes and it didn’t seem to help. A few months ago, in a moment of extreme frustration, I sat down and used it for 20 minues on each arm, and carried on doing the same every day. The pain was gone in a few days. I have to stay on top of it- I can feel the muscles attaching to the medial epicdonyle tightening after an upper body workout- but I haven’t had problems since.

While I was having problems, I found that squatting with a safety squat bar and benching with a Swiss bar helped. I also used a pair of those ab slings to do hands-free chins and inverted rows (I think there’s an article by Ben Bruno on here somewhere with a video). This enabled me to get some back work in (my chins atually improved when I went back to doing them!)

Hope this helps.


#7

Thank you for the tips!

The back workouts are the most challenging and lat work in particular aggravates the elbows more than any exercise. The ab slings are a interesting tool. I’ve done Thib pulldowns before with them and I can see how they would help. I’ll also check out Ben Bruno’s article.

Just a quick progress update:

I’ve seen significant improvement in my elbow pain by following the strategies I first mentioned. I still have to be somewhat careful but most days are pain free and most exercises are pain free. I still need to watch out on back days and I’m not doing any direct arm work yet.

The only thing I’ve added that seems to make a big difference is using Fat Gripz. I purchased them a week or so ago and they seem to be helping in two significant ways:

  1. They help distribute the force across more of your forearm muscles rather than concentrated at the joints. I really like them for pressing exercises for this reason.

  2. They seem to help train your entire forearm (particularly the extensors), which I think gets at the root cause of the inner elbow pain. I feel like I’m training my forearms with each workout for the first time in 5 years as I’ve used Versa Gripps and straps to reduce forearm work in hopes of eliminating the inner elbow pain.


#8

No problem at all.

I’ve had a fair few aches and pains over the years but this one has been the most persistent and hardest to fix. I think it was overdoing heavy weighted pullups that did the damage.

The ab slings work well- a bit awkward and you can’t really hit the bottom range of motion (as your arms fall out) but you can get a very good squeeze at the top. The other thing I did was replace my usual deadlift assistance (good mornings) with very strict RDLs, keeping the bar pulled tightly into my legs all the way down and up, for sets of 8-10. This absolutely hammered my lats, and along with the ab slings, enabled me to maintain or even improve my lat strength and size. Thibs posted something recently about a variation with a band pulling the bar away from you (can’t remember what he called these)- I imagine this would involve the lats even more.

The Fat Gripz are a good idea. I tried this myself and while the elbows felt better, they killed my wrists, so I ditched them.

The massage was the missing piece of the puzzle for me, though. You may have this covered if you’re having weekly ART/Graston sessions, but I found that it didn’t start to have an appreciable effect until I got very aggressive with it, as described in my last post.

The Swiss bar for benching was enormously helpful as well. With a straight bar, I can either flare my elbows and destroy my shoulders, or tuck and destroy my elbows. The Swiss bar lets me keep my shoulders, elbows and wrists perfectly stacked. Give it a try if you can- I don’t compete in powerlifting and honestly can’t see myself benching with a straight bar again.

One other tip- Bret Contreras’ most recent article had a variation of the DB curl that, I have found, causes no discomfort at all- a first for me when it comes to curls. They keys are the offset grip and the starting position, with the arms slightly abducted.

Good luck with it and let us know how you get on!


#9

Oh and I forgot- training the extensors is definitely a good idea too. I set a bar in the rack at shoulder height, loop a 41" band around the sleeve, hook a weight to the end and roll it up and down using wrist extension to rotate the sleeve towards me (eccentric extension on the way down, obviously). Works far better than a wrist roller. I think this is important to restore balance to the forearm- so much of the stuff we do in the gym heavily involves the flexors but the extensors rarely get much work. I know that my flexors were like beef jerky when I first started soft tissue work on them.

This has also added some meat to my forearms, which is a nice bonus.

The other thing I do religiously is finger extensions with elastic bands to work the muscles that open the hand, for the same reasons. A rice bucket also works very well for this.


#10

Find a good therapist


#11

Thanks everyone, this information is fantastic. I’m always impressed by the knowledge base in the Tnation.


#12

Is there anywhere I can find the whole study? I have struggled with golf elbow in my arms for many years now. It has lasted from two years to a few months, but if I could do something with my shoulders to prevent it from happening again that would be amazing! :slight_smile:


#13

I have dealt with golfers elbow in one are an tennis elbow in the other from over doing the chins / pull-ups. I did ART for a few months, stretching, ice and heat and extensor work without much improvement.

This is what worked for me.

  1. Sling shot compression cuffs while training upper body. This keeps the area warm and all the “guts” of the forearm sliding correctly.

  2. Making sure that I don’t initialize the pull / chin with a wrist curl. This puts a ton of strain on the small connective tissue of the forearms.

  3. Gradually work up on anything that involves the arms.

  4. Self massage in the shower. Not what your thinking but this may be the thing that helped the most. Soap up the opposing hand and forearm that is hurting and grab it with the thumb on the injured area. Work the hand down the forearm as if you are trying to get the blood out of the injured area. Make sure to dig the thumb in and around the funny bone area. Get aggressive with this. When you think it hurts go harder. Also do this on both arms. If one side is injured the other might be soon to follow. 20 per arm should do it.

  5. Make sure you always have a proper grip on the bar. I have a tendency to allow a curl or a row slip into my fingers rather than staying seated in the hand.

This combo has put me back on track in about a months time.

I know #4 is creepy to read but I think that and the cuffs are the biggest help.

Best of luck.