Elbow Pain

okay after a recent upper day my elbow has been kinda feeling wierd.
i’ve uploaded a picture of an elbow with the affected area circled in red, and i have no idea why it hurts like this. it hurts the most when my arm is in that hand position(except that my palm is facing down and pressure is exerted downwards on the wrist). it also hurts quite a big in the first half of a preacher curl movement(even now when its not loaded).

i did these exercises on that day
military press(felt fine)
dumbbell lateral raises(felt fine)
bent-over rows
low cable rows
dips(felt quite okay too, maybe a little hyperextension on the top. could be that)
reverse cable curls
preacher machine curl

right now i’m applying some deep heat(heat lotion) and wrapping it up with some compression thingys to keep it warm. hope someone could help me with this

You may have some wrist flexor tendonitis (tendon inflammation) at the attachment site on the humerus (medial epicondyle). For more info look up golfers’ elbow. Let me know if this doesn’t fit with what you are experiencing.

How long ago was the injury?

If it was within the last few days it is best to ice and stay away from heat. Ice should be applied for ~10mins every 1-2 hours. The aim during the early phases injury is to reduce inflammation. If practical you should also rest, elevate and compress.

After the inflammation subsides (~2-3 days) you can begin with contrast bathing or contrast ice and heat packs. With contrast bathing, alternate 10min hot, 10min cold every few hours. No need to go overboard. The problem should heal on its own, you just want to help it as much as possible through contrast bathing and preventing further irritation. If the pain persists you might benefit from going to see a sports massage therapist or similar.

Jesse

okay thanks jesse i’ll try out your suggestions. it’s a great relief to hear it isn’t something major :D!

No problem. Give it time, but if it doesn’t clear up go see someone.

Hi
contrast baths for tendons IS about getting inflammation down - it’s not usually about healing stuff.
Indeed, from what you describe - after workout pain - you mayn’t have inflammation really.

There are a couple points - once you feel pain like this it’s usually, sorry to say, because damage has been done so - question is - if it’s your form or your practice that’s causing the issue, how will you address that form/practice thing to ensure (a) you don’t make the situation worse (b) you get better?

so here’s some recent research on how using eccentrics may help

and also a wee training program to help
http://extremehumanperformance.com/blog/tennis-elbow-tendonosis-vs-tendonitis-exercise-fix/

and some food for thought on practice to ensure excellent form

mc

mc gives good advice

[quote]BackInAction wrote:
mc gives good advice[/quote]

x2

mc’s response brings up quite an important point, that isn’t often discussed. The conventional wisdom is that in the acute phase of injury it’s best to RICE, without external heat. After 48-72 hours we begin adding hot/cool contrast. Mc, BackInAction, and LevelHeaded, what are your thoughts on this? Is there any actual research on the effectiveness of contrast bathing at particular stages of injury repair?

mc, I’ve been having a look through your blog, and you mention in one article (begin to dig: Why DHA/EPA of Omega 3's (like fish oil) are Anti-Inflammatory - Q&A with G.Fear, RD) that you were planning on writing something about what we actually do know about the effects of ice. Did you end up writing this and if so can you link me to it?

psynz,

There is a lot of debate on the effects of ice - what application of cryotherapy actually does, what true effects take place, etc. Tthere is not a lot of research (if any) to truly state that “Ice decreases inflammation” post-injury. I have read studies relating to edema reducing, but not true inflammation.

Then there is also the discussion of a possible decrease in performance due to cryotherapy application. Here is an article abstract which discusses both of the previous arguments (Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial - PubMed) and states “Local ice therapy immediately following sprint-interval training was associated with greater decreases in both pro- and anti-inflammatory cytokines and anabolic hormones supporting some clinical evidence for possible negative effects on athletic performance”.

And here is another study discussing the outcomes of cryotherapy usage (Does Cryotherapy Improve Outcomes With Soft Tissue Injury? - PubMed) which says it decreased pain levels, but "The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated.

Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy."

Now before you get the impression that I am anti-ice, I’m not. Do I use it myself and have athletes I work with use it, yes in certain situations. Do I feel that it is overused a lot in the clinical setting and there isn’t much evidence to support its usage, yes I do.

IMO, most people use ice because that is what they were taught and it is what has always been used on injuries. You also have to realize what you are using the ice for specifically and know what benefits you are looking to get.

Ice will decrease pain and spasming, which can help a lot with injury recovery. With the decrease in pain and spasm, you promote movements which will facilitate injury. But there are also other methods that work to help decrease pain and spasm, so you have to find what works best for you.

Through research articles though, I am a big fan of cryotherapy to reduce edema, in conjunction with a milk massage to flush out the edema.

One interesting read, if you want to get a good look into the opposition side to ice is “Don’t Ice That Ankle”. I think it brings up a lot of great points and I use the techniques in that book a lot myself.

I am not and am proud to not be a “black and white” type person - I rarely fall to one extreme opinion or another and usually fall somewhere in the middle, always willing to hear other opinions and willing to adapt my own. When people get to those “extreme” opinions and say it is either “THIS” or “THAT”, you end up getting skewed points of views that are just trying to validate their own opinion rather than find the truth.

To end on an interesting physiological note (before this turns into a novel), lets look at the physiological effects of ice. Ice causes vasoconstriction of blood vessels (makes blood vessel diameter smaller). The ice will work from the outside of the body and work inwards, so superficial tissues will be effected first before deeper tissues.

The two main blood vessels in the body are arteries (bring blood toward extremities) and veins (bring blood away from extremities). Veins are more superficial and arteries are deeper. So by applying ice, vasoconstriction will occur first at the veins and then at the arteries.

So by looking at things in a simplistic physiological perspective, by applying ice you may be slowing down the blood leaving the area before you slow down the blood coming to the area, which would be the opposite of what you would want to occur if you want to decrease swelling and inflammation.

Just food for thought. But again, I do use ice myself in specific situations for a variety of reasons, but I have written and rambled too much as it is. I am interested to read other people’s opinions as well.

I was having elbow pain that i ignored for a while but a bit different from what you described. It lasted for a month then started to get worse so i finally did something about it. I couldnt really pinpoint where the pain was but i think it was related to a biceps tendon.

Anyway i have a roller that is something like this http://www.sportstek.net/massage-roller.htm and just massaged the hell out of all surrounding muscles of the elbow, including forearm, biceps, and triceps. I was amazed out how quickly it got better after having to work through it for weeks.

LevelHeaded, Thanks very much for your reply. I’d really like to come back to this and reply properly in a few days when I’m at my computer again. In the mean time you’ve given me something to think about :slight_smile:

thanks so much for the responses guys. coincidentally, i had a week deloading off and seems my elbow got better. i tried the contrasts baths and i slept with a snug elbow sleeve every night. seems to do the job!

Lucky, I’ve been off wieghts since February - Doctors diagnosed me with Calcific tendonitis of the triceps tendon at the elbow (after ultrasound scan). Been taking glucosamine, keeping elbows covered at night, and started doing eccentrics now.

No big improvement as yet & I cant find any specific info on calcific tendonitis (I’m starting to think it’s the baddest/most fucked up type of tendonitis). Imma start taking some magnesium see if that helps at all. Sux balls for me right now.

Im tempted to just train regardless & run this elbow of mine into the ground >:)

Just to add a wee note to Levelheaded on ice, and in reply to psynz, yes i’ve done the research for the ice article, but haven’t written it up. I started to get into the work here based on the applications of ice in sport that made me a little ill as an enabler of numbness so as to continue to perform - and the costs to performance and potential reinjury that were rather skated over

also fascinated by chinese approaches which see icing as what one does with dead rather than living tissue.

Really like what levelheaded says about understanding ice, but also in the research we see that it’s limited physiologically to an anaesthetic, and there’s actually big question marks about its role in reducing edema - that compression seems to do that better - this point is debated.

What the latest survey seems to suggest - i need the quote because it’s great - is that while the actual effects of ice are ambivalent, its doubtful that practitioners will stop using it cuz it’s so engrained, and the costs of applying it in a “wrong” context are pretty low. Is it optimal? likely not for a lot of the cases, and so the ankle book is really provocative for getting that discussion going.

That said? i tend to try to come at things from a neurological perspective and threat modulation to the nervous system. Even if the only thing the ice is doing is temporarily numbing pain, and that can help the nervous system calm down to deal with the issue, that’s great.

A problem from my perspective is if while one is numbed and thinks they feel better they start doing stuff with that limb that it’s not ready to do. like moving it and putting a lot of load on it. It would be like someone on an operating table with an organ open saying heh i don’t feel the pain now - guess i’ll get going. Not an optimal idea.

What i’d like to check with folks - and maybe level headed you can help here too - is if when folks get ice, their nervous system does give more of an “all clear” from the ice or if it’s not helping. We can do this with things like ROM. EG, someone has a pulled ankle.

Before applying ice, check shoulder range of motion in adduction and flexion. Apply the ice for five or so minutes. Recheck ROM - if there’s no difference the ice may no longer be helping; time to move on and give some mobility a go, if this is later in the healing process. Or if it does nothing at the start of a treatment phase, may be time to go for compression.

That kind of just test it approach means that we can get some clearer faster feedback on whether what we’re doing is perceived as a plus or a minus to the governing system of the body.

Just an idea.

ANd if you’re interested in why the bod can tell us this, the phenomena was first labelled in the 50’s as tthe arthrokinetic reflex - here’s a bit more on it:

best
mc

mc,

Been without internet for several days, so I apologize for my delayed response to this great discussion. I whole-heartedly agree with your points you brought up and especially love the quote regarding practitioners not stopping using ice because it is engrained in the process of healing an injury.

I am relatively new to the sports medicine professional field (only finishing undergrad in 2006), and they still hammer home “R.I.C.E.” in the classwork. You definitely are not going to do harm by using ice, but is it the most optimal treatment?

I have found that a lot of the athletes I work with just don’t want to deal with the pain, so they go to ice to numb it immediately. Sometimes, it is a short term pain so the ice is the quick fix and the pain resolves (DOMS, acute contusions, minor strains/sprains), but I see the problem being when there is a significant issue and ice is being used in the sense of a bandaid being used as a tourniquet.

I do however feel that the numbing/anesthetic effect of ice has some great benefits, if used properly. If a lack of motion is strictly due to a muscle tissue mobility issue, then the ice will do no good as it will stiffen up and decrease the elastic properties of the muscle even more.

If it is pain limiting the motion, the ice can be of benefit in allowing for the anesthetic effect to decrease the inhibition of movement. This can be beneficial as long as the ROM is done within a safe and proper range and not forced. For example, you have an athlete returning from an ACL surgery.

In the initial stages where we want to encourage knee flexion ROM with heel slides, I would have the athlete perform heel slides to encourage knee flexion ROM, then perform some ice and compression therapy (I love the gameready unit for that purpose) and then have them perform heel slides again.

Generally after the ice/compression, the heel slides were with a greater ROM due to the decrease in pain and thus decrease in spasm/inhibition. At the same time, I would not ever ice a body part and expect to re-educate it with loaded motor patterns due to the decreased neurological response and activity from the cryotherapy.

Just some of my opinions and would love to continue getting other’s opinions as well.

Thank you LevelHeaded and mc! You’ve changed the way I think about the use of ice.