I’ve been working with a client who was dealing with an elbow tendonitis type issue. They have made amazing progress and I’m quite proud of them. So today, I’m sharing some of the behind the scenes of our work together. Whether you’ve had golfer’s elbow, tennis elbow, or some other tendonitis type issue, you know how frustrating they can be to figure out. I hope this article helps you improve how you approach tendon care.
Tendonitis Issues: A Real Sticky Wicket
I picked up the phrase ‘sticky wicket’ when I was studying abroad in college at Cambridge, England. One of its meanings is “a difficult or unpredictable situation”. This is a perfect phrase to use when discussing tendon inflammation issues. They can be tricky, finicky, and slow. Progress is often slower in tendons than in muscles, and inflammation in the area can make sending signals* to the tissue result in inconsistent responses. Sometimes things feel ok, other times they feel terrible.
*Signals are things that tell your body something, and to which your body will respond. Any action or non-action is a signal to your body.
The best way to deal with a tendon issue is to avoid developing one in the first place. But sometimes, things happen. In that case, the next best thing to do is press pause on whatever you were doing while you investigate what’s going on while it’s still a minor issue. That way you can head it off at the pass before it becomes a bigger issue.
Investigating might simply mean resting from the activity and then having more recovery time between bouts of the activity that flared up the tendon issue. Or, it might mean stopping the activity altogether and consulting with a clinician or coach who can help you get on an appropriate program. *Perpetual reminder: see a doctor for things that cause pain to ensure it’s not something more serious before taking on your own training program, whether solo or with a coach.*
How Do I Avoid A Tendonitis Issue?
Here’s a quick and not-exhaustive list of reasons someone might develop a tendonitis issue:
- Overuse issue – You do too much for what your tissues can tolerate and you surpass the zone of tissue homeostasis where tissues can recover their best from whatever stimulus they received. Do this too often or too severely and tissue damage becomes more likely.
- Misuse issue – You use a technique to accomplish a movement that doesn’t disperse forces as readily across your tissues, and some tissue ends up being used for actions it is not tolerant of.
- Other health issues – tendons, and all tissues, need favorable conditions that you achieve through good sleep, a healthful diet, low stress, hormonal balance, and other health factors.
My client was doing a program that was focused on using gymnastic rings as a training tool when his tendonitis developed. He had approached the program with intelligence, that is, he didn’t go head over heels into the intensity without building up his readiness first.
So how’d he end up with a tendon issue? Hard to say for sure what any one singular impetus is, but his assessment showed that some of his arm, hand, and wrist soft tissues and joints didn’t have as clean of range of motion, control, or strength, as I’d want for someone doing a lot of pulling and gripping. So we started with training to improve those things.
I Have Tendonitis,
What Do I Do Now?
Did you talk to a doctor yet? Remember, rule out more serious stuff when you are experiencing pain. Second disclaimer, stuff on the internet is not tailored for you specifically. Use your own judgement when deciding on a course of action. Ok, with that aside, here are the basic ideas we followed as I supported my client in his efforts.
“Calm stuff down. Build stuff up.” Often attributed to physiotherapist, Greg Lehman, the phrase is simple but carries a lot of action in it. Whether you’re calming tissues down or building them up, what you’re actually doing is managing a lot of biochemical and nervous system activity by way of sending particular signals to the body.
The point of calming things down is, in part, to clear noxious stimuli in the area, allow inflammation to do its thing, and to down-regulate the afferent nerve fibers that have sent info to the brain that has resulted in the creation of a painful sensation emerging.
The point of building things up is to make the tissues that are currently dealing with the issue and the tissues elsewhere that may factor into this particular tissue issue become stronger and more tolerant to the type of loading you want to put on them via whatever activity you want to do.
In order to CSD/BSU, my client and I included elements of each of these items:
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- Lots of pain-free movement plus low-intensity isometric contractions that targeted arm, wrist, and finger tissues that showed up in the assessment as sub-optimal for what we’d like to see for my client’s needs. This is the classic, “low intensity but lots of it” that so many people overlook because it’s not ‘hard’. Resilient tissues don’t develop because you beat them into submission with ‘hard’, ‘sexy’, or ‘exciting’ stuff.
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- Incremental build up of the work volume and intensity we exposed the arm, wrist, and finger tissues to. You can always add more, you can’t take some out if you put in too much. This notion comes from the cooking world, but it applies to physical training, too. If you overdo it, there’s no undoing it other than taking extra time to deal with the setback of symptoms that come from overdoing it. Conversely, if you do just the right amount, or maybe even “under do” it (gasp), you can always do a bit more tomorrow. I’d rather see someone’s trajectory move steadily up and to the right over a period of time, than see it rise more sharply up and right but with drop offs due to overdoing it that hamper their progress.
- Address weakness or sub-optimal movement that we’re seeing in other tissues that may have some impact on what’s happening at the elbow. This included building finger/hand and wrist strength, and improving shoulder movement as well as ribcage and pelvic position. This video is of a finger/hand strength drill is one I like to share with folks as a starting point. Try 3-5 rounds on each hand and take note of what your body tells you as you do it.
Which brings me to the last item…
- Listen to the body’s responses to know how to adjust the signals you’re sending. One thing I make clear to my clients is that body responses are informative. If you feel better, worse, different, or same, that’s all helpful. By tuning in to how your body seems to be responding, you can make a smarter and more informed decision about what you’ll do next. You are a living experiment and you’ve got a number of ‘dials’ you can turn to adjust the signals coming into your body so that you eventually land on the ones that give you the responses you desire.
Take Charge Of Your Body Care
I’m glad you read this article, but don’t stop there. Read more articles. Work with a coach. See each area of opportunity (we don’t call them “problems” here) you face as a chance to become even more of an expert in care-taking for your body.
I offer a free Arm Care Mobility Course that takes you through four lessons to help you have healthier hands, wrists, elbows, and shoulders. The content is geared to be extremely approachable, ie, my grandmother could take the course and find it relatable and understandable.
Or, if you’d prefer to explore working together one-on-one, my request form is here.