Hi guys, mr. Physio here in Australia. Today I’ll talk about the ‘Golfer’s elbow’ again. I’ve covered this topic before ,but there are more to discuss and more exercises to show you. People often ask me: “I’ve suffered for many years. Is there any hope?” According to this study: Yes. There is! They found more healthy tissues in degenerated tendons than tendons with no symptoms. They found more healthy tissues in sore tendons than healthy tendons. This is the chart where they compared pathological tendons with symptomatic tendons. You can see there are more good tissues in pathological tendons than normal tendons They say pathological tendons have a higher ability to adapt to loading. We need to give them more ‘loading’, as these ‘good tissues’ are waiting for us to load. You don’t need to be scared! You don’t need to be frightened by the MRI showing you some degenerative changes or partial tear. What I always tell my patients is this: No matter what you do, you’re degenerated tendon cannot be repaired. But you’ve got plenty of good tissues you can work with. Don’t lose hope! I don’t recommend stretching, as strain starts from the stretching force applied to the tendon. You can’t control the stretching force at the moment, which is why it get sore. If you keep stretching without your tendon being able to control that stretching force, it can make it worse. Instead, we’re going to loosen up your muscles first, and then do some eccentric exercises. We discussed this in the last video. When you massage, do not massage around the bony area, as the tendons are hooked around that area. Do not compress the tendon, as this is the same as rubbing this rubber band around the hard structure. We will loosen up this middle part (muscle belly) first. First of all, try to find a painful or tight area. Normally, this will be right next to the bone. Hold on to the muscle, and do some activities that has been painful for you to do, like gripping a hard object. It shouldn’t be painful anymore if you hold on to the right muscle, and press firmly. It may not always be the case, but most of the time, it reduces the pain significantly. This means that your muscle tension definitely contributes to that tendon problem. When massaging, don’t touch around the bony area. Massage 5-10cm away from the elbow, onto the middle of your forearm. Massage across like this, for about 30 seconds. Then, press onto the muscle and do extension and flexion of the wrist for about 30 seconds. Try to massage various spots for the 30 seconds. Try to massage the whole muscle, but do more on the tighter spots. You can also do it with some tools. I used my highlighter 🙂 You can use any tool to apply the pressure. Start with gentle pressure, but as you get used to it, try to push a little harder each time. Try to do 30 seconds of Massage and another 30 seconds of Massage and wrist movement. The exercises I showed you in the previous golfer’s elbow video, is this one: Pull towards you with your right hand and push away push it away with your left hand. Keep your right hand pushing towards you. When you do this, your right forearm muscles contract, because you try to pull towards you. At the same time you are also lengthening your right forearm muscle with your left hand. This lengthens your tendon with ‘loading’. Once you can do that with your elbow bent, you can also do it with your elbows straight. Same procedure, push with one arm and resist with the other. Then, straighten up your elbow. Alot of people ask: “Isn’t this the same as stretching?” But it’s not! There’s a huge difference because this exercise uses muscle contractions, and tendons control the loading. However, if you do this, and simply stretch for 30 seconds: There’s no muscle contractions, tendons are not being used, and it is not effective. It’s proven by many studies like this: Tendon stiffness is reduced significantly with eccentric contraction, whereas there is no change after stretching. This exercise has applied the tendon rehab principle. Pain level should be below 4/10! If you can do 3 sets of 15 twice a day, this means you can progress on to next level. This is a really good exercise, fairly easy, and you can do it anywhere and anytime. But, the problem with this exercise, is you don’t know how much weight you’re putting on. This makes it hard to progress and hard to regress. That’s why can also use Dumbbells as well! Since I am holding onto the weight, my muscle is contracted at the moment. If I lower the weight my whole muscle length will be elongated. So going up, my muscles contracted and from here, the whole muscle length will be elongated. That’s the tendon doing most of the job. The last exercise is this one: Start like this, and hold the weight out to the side. Lower down, and come back up. It’s exactly the opposite movement to the exercise I showed you in the “tennis elbow” video. Go down for 3 to 5 seconds At the beginning of tendon rehabilitation, the slower the movement, and lighter the weight, the better. Once you can do these two actions, going down and rotating down, you can apply the 2 movements into 1 action. It’s similar to the bicep curl, and I will tell you why later. Start from this position, going down and rotating out. As you do this, try to straighten your arm. Try to go up with the other hand, as we don’t want the shortening phase of the exercise at the beginning, Going up, and slowly lower down for 5 seconds. At the end of the position, your hand should be like this, almost rotating out to the side, ‘dropping’ the weight. This will stretch it out, under ‘loading’. You can also do it to the front rather than down, as It’s the same thing. Go forward and rotating out to the side like this. Keep your palm away from you. That way 🙂 Going down And coming up. And going down. The reason why it is similar to biceps curl, is that the forearm muscles are actually two joined muscles. This means they run through two joints. The elbow and the wrist joints. They start above the elbow and run through the elbow and wrist joints, and attach on your fingers. So normally when they contract, they bend your wrist. But, if your wrist is fixed, and you do a bicep or tricep curls, your forearm muscles can be used in that action. For example, let’s say I’m doing a rowing action, with a barbell that is 10kgs. When I grip the barbell hard, my forearm muscle is contracted. But since it is 2 joint muscles, it’s attached above the elbow joint. So, when I bend my elbow, this muscle is shortened. When I release the barbell, this muscle will be lengthened. So, I am already contracting my muscle, and when I do this, my muscle is being shortened. Then, when I release the barbell slowly, these forearm muscles will be stretched out. Again, the forearm muscles normally do this action, but my wrist is now fixed due to the barbell weight. Now, when I do this action, this muscle will be shortened as it is attached above the elbow. When the barbell is lowered, that muscle will be stretched out, which is ‘eccentric control’. The muscle is being contracted, while being elongated. This is why there are some people getting better with weight training, that involves grip strength and arm extension and flexion. You can do the the barbell row, bicep curls, tricep curls, anything that involves grip strength. Dumbell HARD So the dumbbell should be a little bit heavier than what you use for light training exercises. My recommendation is this: Do these eccentric exercises using a light weight first. 1kg, 2 kg or 3kgs, and do 3 sets of 15 twice a day. If you can do them without any problem, you can then move on to weight training! There is evidence that slow, heavy weight resistance training is as effective as eccentric exercises. As long as you have eccentric components in your exercises, this can be effective. Plus, you need to work on sport specific activities depending on your goal. If you’re a golfer, you need to work on your speed. If you’re a weightlifter, you need to work on your heavy loading. I hope this video has helped you, and I will see you next time. Don’t forget to like and subscribe!