I don’t know. This can presumably muddy the picture and might make a proper diagnosis more difficult. Seeing as I don’t have any clinical experience, I can’t really advise you specifically, but what I could do is share my knowledge and how it has applied to my case of medial epicondylitis (golfer’s elbow).
What you do with that knowledge is up to you.
AFAIK, golfer’s elbow (i.e., medial epicondylitis) means that the common flexor tendon has become overused. There are several muscles that attach to the common flexor tendon and therefore it can be difficult to distinguish which muscles need the most attention. Pain can be a decent guide here.
Steven Low suggests the following exercises, and when in doubt suggests that all exercises be performed,
- Wrist curls + eccentric — Flexor carpi radialis and ulnaris (FCR/FCU)
- DB or hammer Pronation + supination — Pronator teres
- Finger rolls/finger curls — Flexor digitorum superficialis (FDS)
I found that engaging in all of the above exercises helped initially before plateauing.
Those were programmed in accordance with the following guidelines:
- 30-50 reps for 3 sets . Start at 30 and work your way up to 50 slowly. If higher reps make it worse after a few sessions then drop back down. Working through pain is fine, according to the scientific literature as long as function is improving.
- Not to failure on the reps. This is super duper important as going to failure is when most people re-injure themselves!!
- 2-3s uniformly slow controlled eccentric and 1 seconds concentric . For example, 3010 or 2010 tempo works. Basically, controlled is the name of the game. (I initially recommend 3-5s eccentrics, but that tends to take too long for most people so 2-3 is similar and cuts half the time).
- 3x a week frequency . Can go up to 4x a week if it helps. If it doesn’t help drop back down.
However, while the above helped with pain management and made it so that it stopped hurting in daily life and for instance lifting a frying pan it did not help me return to sport (climbing) and lifting.
I can now climb pain free, I can’t lift pain-free yet.
What I’ve been doing is that before an upper-body session and climbing I’ve done a warm-up that looks outlined below.
Warm-up (isometric hangs)
Key form notes:
- focus on pulling with your lats and not your arms. Mentally engage with your muscles and contract them during the hangs.
- “curl” your wrist a bit. You genuinely want to engage your forearm flexors.
- if necessary: use a thick bar or fat gripz
Warm-up hangs,
- 2x5 second hangs pronated grip (pull-up) with 90 degree elbow angle
- 2x5 second hangs pronated grip with 120-140 degree elbow angle
- 2x5 second hangs supinated grip (chin-up) with 90 degree elbow angle
- 2x5 second hangs supinated grip with 120-140 degree elbow angle
- 3x5 second hangs neutral grip with 90 degree elbow angle
- 3x5 second hangs neutral grip with 120-140 degree elbow angle
Rest 10-20 seconds between hangs. If your problem was medial epicondylitis and you fix it you can still do this as a prehab thing, but you’d get away with fewer hangs and a much shorter rest period than you would in the rehab stages.
It is important that you ease into these, you don’t jump into them. Use a box if necessary to reach the bar. Do not pull yourself into position. You want to use as little velocity as possible when moving into these positions and moving out of these positions. That means not dropping down on the floor but stepping back on the box.
I still use this warm-up despite having progressed beyond the initial stages of my rehabilitation.
Phase 1 Unloading (3-4 weeks)
In this phase we want to use a relatively high intensity (75%) and low velocity as I remarked above in the warm-up. After the warm-up you then continue with hangs, and do
- 2x30-45 second, 120-140 degree neutral grip hang. Rest 2-3 minutes.
- Aim to fail at around 30 seconds. Ideally you want your grip to give out and not your lats (as a climber I struggle with this). Add weight if necessary, or use fat gripz (that worked better for me). If you can (I can’t) you can do a one-arm hang instead and aim to fail at 15-20 seconds.
- 2x30-45 second, 120-140 degree pronated grip hang. Rest 2-3 minutes.
Form cues from earlier still apply (curl your wrist over a tad etc.)
Phase 1 is to be done 4 days per week, and on those days 2x times.
I advice doing this on days you will be doing pulling exercises. Leave 4-6 hours between sessions. Ideally 6+ hours.
Phase 2 Strength (3-4 weeks)
ROM Regression.
Moderate velocity, 85%+ intensity.
Either do an overcoming isometric, where you pull as hard as possible on a pull-up bar with one arm (weigh yourself down so you won’t move) for 5x5 seconds. 30s rest inbetween sets.
Or, do reduced ROM pull-ups. From a bottom almost dead-hang to 90-degree elbow angle. Moving fairly slowly (remember, moderate velocity) and really focus on pulling with the lats and just letting the arms be levers.
I actually do a bit of both either intra-session or alternate sessions. Reduce frequency from the previous phase and do this 3x/wk, 2x on each such day.
There are additional phases but I haven’t completed them and I won’t share it until I have done so.