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Getting through the team series: Elbow pain + tendonitis rehab protocol

By September 29, 2018 No Comments

With the team series in full flow now and everyone’s work volume going through the roof the coaches are starting to see a bit of an increase in elbow and wrist pain. The key preventative here is not exceeding the acute to chronic work ratio. In other words if you’re raising the amount of work you’re doing more than 10% over each four week block. For more info on this look at the work of Tim Gabbett.

At CFL the most common manifestation in this is golfers elbow (inflamation of the tendons and other connective tissue around the elbow).

Tendons are a dense type of connective tissue that connect muscle to bone. They are found at each end of the muscle where they attach to the muscle at what is called the Musculotendinous Junction.

Here the muscle fibers start to become intertwined with the tissue of the tendon which ultimately attaches to the bone. The opposite end of the tendon attaches to the bone at what is called the Osteotendinous junction (“osteo” means bone) and this is what allows muscular contraction to exert force on that bone to generate movement. Tendon can become injured in a variety of ways with tendinitis being perhaps the most well known.

This is just inflammation of the tendon (“itis” means inflammation). Tendinitis can occur acutely but is probably most commonly caused by chronic overuse of the tendon that causes it to become chronically inflamed. In recent years this type of chronic inflammation is more commonly called a tendinosis.

The research on fixing tendinitis is very much pointing towards eccentric work:

– Maffulli N, Walley G, Sayana MK, Longo UG, Denaro V. Eccentric calf muscle training in athletic patients with Achilles tendinopathy, Disabil Rehabil. Advance access published 2008
– Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy, J Sci Med Sport , 2007, vol. 10 (pg. 52-8)
– Rees JD, Lichtwark GA, Wolman RL, Wilson AM. The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans, Rheumatology , 2008, vol. 47 (pg. 1493-7)

In fact in a study on soccer players with adductor tendinitis loading was around 13 times better than rest and ultrasound in facilitating return to play.

So to implement a successful (and pain free) RTP we need to find a way to load you without pain. The adaption we are looking for goes like this:

initiation of movement under load -> chemical signalling -> increased protein synthesis.

This works with the cells in the tendon responding to tension, shear, and contraction. The stimulus from this forces creation of at these new tissue:

• Intervertebral disc (Setton, 05)
• Articular cartilage (Knobloch, 08)
• Tendon (Arnockzky, 02)
• Muscle (Durieux, 07)
• Bone (Turner, 1996)

Practically the Rx looks like:

1) Reduce pain (NSAIDs) and protection of injury site
2) Reducing pain through activity
a) Iso-metrics at ROM with no pain
then
b) Iso-metrics at mid range
alongside
c) reduced compressive loading

3) Improve Strength – Heavy Slow resistance in a non-compressive position

4) Build “funtional” strength – as above in more “normal” positions. Here you would address movement patterning issues.

5) Increase Power – Shorter duration lifts.

6) Improve Stretch Shortening Cycle – jump progressions building up to plyometrics or psuedo-plyos

7) Sports or sports specific drills

Sooooo this is A LOT of info but please feel free to ask me to clarify anything that isn’t totally clear

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