Thursday, March 04, 2021

Golfer's Elbow exercises

I may have mentioned before that since sometime in December, I get some pain in the inside of my left elbow when I apply force with my left palm towards my right, like when I wash my hands. I also feel this pain when I lift anything with my left palm supinated. This condition seems to match Mayo Clinic's description of Golfer's Elbow. Fortunately the pain is about 3 when ranked on a scale of 1 to 10, with 10 being worst pain ever, when I wash my hands, and about 5-7 when lifting in supinated grip, depending on the load. I lifted some boxes that my neighbor had ordered but were mistakenly delivered to my home instead and those were heavy enough to cause more pain than usual. So because the pain has been relatively minor, I haven't consulted a doctor and thus been officially diagonosed with Golfer's Elbow.

To start trying to address this issue, I first tried some exercises from the GMB Elbow Pain article. Some comments:

Open Chain Rotation - Because of the shoulder issue, I can't really do this with the straight arm. With the bent arm, rotating from pronated hand to neutral hand was fine. However, anywhere between neutral to supinated hand was painful. Most of the time, GMB is on point, but there were some missing details that I found later.
Band Elbow Flexion - Seems fine. Is it working the same muscles as the Isochain Reverse Curl? Not sure.
Grip on Towel - Tried it once and felt pain. Haven't tried it again yet.
Ring Pullup - Feels fine with feet on floor to reduce load and strict pronation of hands - no neutral grip. Full bodyweight load was a little questionable.
Elbow Extension - I didn't try because straightening the arm has not been an issue for the elbow.

Later, I found this video by E3 Rehab for Golfer's Elbow, which they state is based on latest research. The GMB article was published in 2017. The below video was uploaded in 2020.


Comments on the exercises, based on when I tried each exercise for the first time:

Wrist Flexion - 6-15 reps dynamic, 10-45 seconds isometric - I started with a bag with one soup can for load. I ended the week with 3 cans. What feels good for me is slowly opening my palm during the eccentric movement until the the load is resting on the phalanges of my fingers, then during the concentric, forming a fist before raising my hand.

Elbow Rotation - 2-3 seconds up and down, 6-15 reps dynamic - This basically half of the Open Chain Rotation movement shown in the GMB article. For Golfer's Elbow, the E3 Rehab doctors did not see any value in rotating the hand all the way to pronated position. At first I choked up a lot on the hammer and only allowed it to pull my hand towards pronated position, to the threshold of pain. After reading the Overcoming Tendonitis article (below), I started letting it pull my hand through the pain zone all the way past pronated position, as far as my hand could rotate.

Side-Lying Thoracic Windmill - Shoulder rotation placing high valgus stress on elbow structure is one possible cause of golfer's elbow.  Recent research found that elite golfers have sport adaptations which give them greater than average range of motion in internal and external shoulder rotation.  Research also found that greater degree of thoracic motion leads to greater degree of external shoulder rotation. Thus, this exercise works on thoracic motion and shoulder rotation together.  This exercise feels fine if I start with a slightly smaller circle of rotation for the first couple of reps, then gradually increase the range of motion, paying attention to when I rotate the hand on the working arm.  I just have to remember to include it in my warmup routine!

Prone Shoulder Extension - 6-15 reps - Researchers found that Golfer's Elbow sufferers showed significant strength deficits in different shoulder motions. This exercise addresses one of those motions. I tried this empty-hand and it was too easy.


Arm Raise Variations - Tried with a soup can in each hand. I managed one rep with no pain, but it's difficult to do this without any shoulder pain, for the same reason I can't do a standard front raise or side raise. Taking into account what the Overcoming Tendonitis article says about painful vs. aggravating exercise, I can't really tell if this movement is aggravating to my shoulder or just painful. Since Isochain Shoulder Press has been delivering results, I see no reason to gamble here.

Overcoming Tendonitis article by Steven Low is yet another useful resource that I found. One point that surprised me is that pushing through pain in a movement is acceptable as long as the movement does not aggravate the issue. The article goes on to describe the differece between painful exercise and aggravating exercise. The article agrees with the E3 Rehab video about the effectiveness of eccentric movement, and the choice of Wrist Flexion and Elbow Rotation for rehab exercises. Where it diverges is the recommended number of reps (a lot more reps!) and the recommended range of motion for Elbow Rotation. Also, it recommends a 3rd exercise for directly rehabbing the issue which is the Heavy Finger Roll. I was thus inspired to try adding a few sets of isometric "finger roll" on the Isochain after my regular Isochain workout.  I changed the exercise by positioning the bar behind my back, which makes it easier to keep the chest up and the arms straight. Based on the Isochain readings at various levels of effort, I settled on a target load of 50 lbs and used the Timer mode in the default setting, thus a 6-sec. hold at 50lbs.

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