Elbow (golfers?) injury recovery advice please.

[mrjonathanr]

I had horrible problems with golfers’ in both elbows which took several years to fix. All fine now. Occasionally it feels tight but always settles. My solution:

I had a layoff, born of frustration really. Resumed climbing at a very gentle level (ie not even as much as a good warm up) and built up to previous level in small regular increments.

Kept doing forearm dumbells ( whether for FCU/Pronator Teres according to what hurts) regularly, slow and heavy. Did them especially if the forearm felt tight- it’s a strengthening exercise for the tendon which responds slowly.

Did various weights (Turkish get ups, dumbbell press, external rotation etc) to get stronger shoulders. I think that was really important- the elbows work from the platform of stability provided by the shoulders, they should be solid.

I do these exercises once a week as a matter of basic conditioning now. My fingers are getting hammered this year with deadhangs and board climbing but there’s no recurrence.

That’s what works for me.

 

[Dingdong]

I had horrible problems with golfers’ in both elbows which took several years to fix. All fine now. Occasionally it feels tight but always settles. My solution:

I had a layoff, born of frustration really. Resumed climbing at a very gentle level (ie not even as much as a good warm up) and built up to previous level in small regular increments.

Kept doing forearm dumbells ( whether for FCU/Pronator Teres according to what hurts) regularly, slow and heavy. Did them especially if the forearm felt tight- it’s a strengthening exercise for the tendon which responds slowly.

Did various weights (Turkish get ups, dumbbell press, external rotation etc) to stronger shoulders. I think that was really important- the elbows work from the platform of stability provided by the shoulders, they should be solid.

I do theses exercises once a week as a matter of basic conditioning now. My fingers are getting hammered this year with deadhangs and board climbing but there’s no recurrence.

That’s what works for me.

Similar story for me, had golfers in both elbows, rehabbed them and then did a metric ton of conditioning for my shoulders, upper back and arms and they have not returned even though I’m trying harder compression stuff now, both wide and narrow.

I think strengthening all the surround areas is key, just being consistent week in, week out with it is so important to good body maintenance.

 

[stone]

I think I remember slabhappy posting that she does single rep turkish getups on the minute. You are also saying doing low reps and heavy.

I was doing a weight that felt an effort to do six reps. Should I be doing a weight that is an effort to do one rep? I'm guessing I should warm up with eg six reps of a low weight before doing such single reps?

 

[Fultonius]

I think I remember slabhappy posting that she does single rep turkish getups on the minute. You are also saying doing low reps and heavy.

I was doing a weight that felt an effort to do six reps. Should I be doing a weight that is an effort to do one rep? I'm guessing I should warm up with eg six reps of a low weight before doing such single reps?

Are you injured?

They're quite a complex manoeuvre, so perhaps better to stick with the 6 reps. The main thing about low reps is that they stress tendons and ligaments (promoting growth) without building up too much fatigue.

If you're injured, pain is the usual good reference. Fresh injury you want almost no pain, but after a few weeks you might need to promote a 3/10 pain to get the damaged tissues to respond, form 6-8 weeks onwards you might need to even ramp it up to 6/10!

 

[stone]

I was really viewing the turkish getups as a general injury prevention measure.

I've got a forefinger A1 joint injury of some sort from eleven days ago. It seems to be getting better.

 

[slab_happy]

I think I remember slabhappy posting that she does single rep turkish getups on the minute. You are also saying doing low reps and heavy.

I was doing a weight that felt an effort to do six reps. Should I be doing a weight that is an effort to do one rep? I'm guessing I should warm up with eg six reps of a low weight before doing such single reps?

I'd say the key thing to consider in your planning is that form really, REALLY matters with TGUs. It's about being able to control and stabilize the weight while the rest of your body goes through a wide range of motion in relation to the raised arm.

Which, for me, is one reason for doing singles with decent rests. On the minute works well for me (bearing in mind that if you're not rushing, a single TGU can take 20-30 seconds of that minute), but you can go longer -- it can work nicely to just take as long as you need between reps, and go again as soon as you feel you can do so cleanly.

I'm not doing singles in a "single rep max" sense, I'm doing singles with the goal of getting 10 really good quality reps, if that makes sense?

You want to concentrate on perfecting the form before you increase the weight; if you're struggling or in danger of having to drop the kettlebell at any point in the movement, it's too much.

If you want, you can get even more of a stability challenge (and bonus grip and wrist work!) out of a much lower weight kettlebell by doing the TGU with the kettlebell in the "bottoms-up" position.

I believe one of Dan John's strength standards is a TGU with a half-full plastic cup of water balanced on your hand. Preferably done on a waterproof surface.

 

[stone]

Thanks slab_happy, that is really helpful. I was thinking you were meaning a one-rep-max type weight (ie a weight at which I wouldn't be able to do two reps). I'm using a dumbell not a kettlebell since that is what I have.

I've been doing turkish get ups off and on for about 15years now but I've always worried my form was probably bad. You saying about the importance of form makes me think I ought to try and video myself with my laptop and then compare to the how-to videos online. I think if I were to use a cup of water, it wouldn't spill though.

Is your emphasis on form because poor form can harm the knees or what?

 

[monkoffunk]

Great, a lot of the focus of the physio is shoulder and upper back with a bit of brachioradialis and lock off strength.

I started doing top heavy dumbbell pronator teres style rotations again this month but found my wrist really hurt with them at quite a light weight. Doing it with a normal dumbell seemed better for the wrist.

 

[mrjonathanr]

I started doing top heavy dumbbell pronator teres style rotations again this month but found my wrist really hurt with them at quite a light weight. Doing it with a normal dumbell seemed better for the wrist.

Might not do much for PT if that's where the problem lies, though. You may need to build up wrist strength gradually before you're able to fully load the PT tendon with a heavy weight. I've experienced that. It all takes patience. Worth it, though.

 

[slab_happy]

Thanks slab_happy, that is really helpful. I was thinking you were meaning a one-rep-max type weight (ie a weight at which I wouldn't be able to do two reps). I'm using a dumbell not a kettlebell since that is what I have.

I've been doing turkish get ups off and on for about 15years now but I've always worried my form was probably bad. You saying about the importance of form makes me think I ought to try and video myself with my laptop and then compare to the how-to videos online. I think if I were to use a cup of water, it wouldn't spill though.

Is your emphasis on form because poor form can harm the knees or what?

First off, thanks for giving me some impromptu psyche to go and do some! They're always good for me and I really need to do more as part of my project to rebuild strength after last year's illness clusterfuck.

As I understand it, the emphasis on form is because you're trying to build control and stability (especially in the shoulder joint) through the whole exercise. Trying to make it smooth and polished is harder (though also safer) than doing a desperate flail to get the weight up there by any means necessary.

And there are details of form which can create extra challenge or nuance, e.g. doing the high hip bridge to sweep your leg through rather than rearranging your legs on the ground.

In my experience, if you try to make it smooth and polished, especially going slowly, it will ruthlessly expose all those little points where you wobble or have to lurch that little bit to get through a step on momentum (my knees always thump the last few inches to the ground on the descent). I have a selection of slow music specifically for doing TGUs!

I'm not aware of it being any more prone to harming your knees than any other exercise with a lunge/step component, but then it's not going to be less likely to either, so if your knees are wobbly, obviously better keep an eye on them.

But in my experience the major injury risk is losing control of the weight, trying to hang onto it for that bit too long as it starts to drop, and wrenching one of your joints. Train yourself to NOT try to save the floor/nearby furniture at the expense of your own joints!

Also a bunch of climbing walls seem to have kettlebells now, so worth having a play with them if you get the chance. Just because the weight's off-centre, you get an extra bit of stabilization challenge.

 

[PeteHukb]

Hi Monk. Fully paid-up member of the golfer's elbow club here. I've got myself back to heavy (150% BW) weighted pull-ups again, and I actually think they help a lot, when done right. However, much like someone with substance abuse issues, I continue to regard myself as being at constant risk of relapse. I'll give you my tuppence.

Everyone's experiences on what works for them will differ a little - I suspect this is because what climbers call "golfer's elbow" is typically an acute injury of one of a variety of load-bearing structures near the medial epicondyle - some people heal this up fine and think they have the answer to golfer's elbow. For those of us who didn't allow it to recover properly the first (or second or third) time, it becomes chronic. You get scar tissue, which then means nerve fibres that sense pain in response to loads that previously were pain-free. Recovery/lifelong management involves avoiding aggravation (both to avoid actual injury and avoid detrimental feedback cycles in response to pain), and slow progressive loading to both strengthen all the structures involved and to desensitise the hypersensitive neural pathways (I am not an expert in this area but I've found this construct helpful.)

Golfers is incredibly easy to aggravate, with training, climbing, or even over-enthusiastic rehab. You will learn what does it for you! For me it's deep lock-offs in pronation (a la crimp pull-ups). Ease off, back away from these, it will be better in a few weeks. Sometimes it remains "tight" and then gets abruptly better after a day's cautious climbing.

I never found dumbbell eccentrics helpful. Slow controlled progressive loading of all relevant structures, and avoidance of irritation/aggravation are key. Heavy isometrics may be just as good or better than eccentrics (there's evidence on this). On occasions I've done weird things like really steep juggy climbs trying to keep my arms as straight as possible, and that has really helped. When you start doing pull-ups, by all means build up weight progressively but consider avoiding deep locks altogether until the whole chain is much stronger. Terminate the movement just above 90 deg of elbow flexion. Be strict about form ie scapular retraction etc. No doubt stronger shoulders will help, so I echo others' advice on this.

Avoid doing rehab exercises just because they "seem to be hitting the spot" - this is probably just mild irritation, which will aggravate if repetitive enough!

Don't do too much rehab all at once! Need to separate out different activities to assess their individual impact.

Stretching the forearm by forced wrist extension + elbow extension may just compress and irritates the tendon. Can do Tom Randall stretch (YouTube vid somewhere) - wt on palms not fingers, avoiding elbow hyperextension. I found kneeling on my own forearm muscle (not the medial epicondyle) and clenching my fist a much better way of loosening up the muscle.

Some of this sounds bonkers as I write it down, but it continues to work well for me to at least keep training, climbing and (maybe?) progressing despite not being totally "cured".

Good luck!

 

[monkoffunk]

When I first injured the elbow I did some pronator teres stuff, built up slowly without wrist issues. Huffy said that was probably useful to begin with but felt the focus should then be on the overall strength deficiencies going forward and so I stopped after seeing him.

This Jan, after a bit of a post baby arrival lay off of everything I thought maybe I should do some preemptively, and the wrist pain was horrible. Maybe a sort of De Quervain type thing, certainly in that area. It’s something I also had problems with in the past. I don’t think this means I shouldn’t do the standard rotations, but I have to be really mindful of the wrist.

All of the input has been really useful here, thanks very much. I think going forward I will put some focus into both wrist strengthening and maybe some pronator teres work building up slowly. But primarily I’ll work on the additional strength stuff, shoulders etc and try and get that strong.

I will add in some body weight pull ups on a bar when fully warmed up as a start point to progressing back to weighted pull ups. Just low reps to start with just to see how it’s all feeling, and stop if any issues. Really focus on form, which I basically never have thought about much before as it seemed like such a natural movement. Deep locks definitely seem to be an issue for me, so great advice on terminating the movement a bit early. I’ll totally can finger tip pull ups for now, maybe revisit in the future, but realistically I can get more than adequate gains from standard hang protocols, so that will be the focus for fingers.

Then yep, gotta be sensible about climbing on a board and stuff and stopping whilst still strong.

Also never even thought about doing TGUs, I’ll have a read and see if I can find someone to show me how to do it right!

 

[slab_happy]

Also never even thought about doing TGUs, I’ll have a read and see if I can find someone to show me how to do it right!

They're good and weird and really do seem to hit something which other exercises don't!

 

[stone]

With TGU you also can revel in being part of an ancient tradition. Think of all those Turkish wrestlers centuries ago, slathered in olive oil, taking care of their shoulders. https://en.wikipedia.org/wiki/Oil_wrestling

 

[slab_happy]

Sadly, as far as I know, there's no solid evidence of Turkish get-ups having any actual association with Turkey.

They first appear as a 19th-century strongman exercise (think dudes in leopardskin leotards with handlebar moustaches), and realistically they probably got called "Turkish" because it was a way to make them sound ~exotic~ and impressive.

(Also I feel like olive oil and TGUs would be a bad combination ...)

 

[stone]

That's not sad, it's tragic.

Leopardskin moustached dudes are a bit of a consolation though.

 

[duncan]

This thread is great as I have nothing to add. When I first started reading climbing social media too many years ago there would be all kinds of nonsense about how to help people with elbow (tendon) pain. I'd also read of shocking advice and practice by medical professionals. Gratifyingly, this is all much less likely now in the UK.

Sadly, as far as I know, there's no solid evidence of Turkish get-ups having any actual association with Turkey.

They first appear as a 19th-century strongman exercise (think dudes in leopardskin leotards with handlebar moustaches), and realistically they probably got called "Turkish" because it was a way to make them sound ~exotic~ and impressive.

(Also I feel like olive oil and TGUs would be a bad combination ...)

I was thinking of a mildly satirical post about Turks coming over here with their get-ups and why couldn't we use proper British exercises (with a picture of your Victorian chap lifting an implausibly large dumbbell). Entertained to read it's an example of branding/mild Orientalism!