Tennis Elbow, Eccentric Exercise And Rubber Bars: The Right Road To Rehab?

Podcast: Tennis Elbow "Rubber Bar" Rehab: Fact Or Fad?

Here's a slightly shorter podcast version of the video above.

Here's an improved, better-sounding version of the podcast that you can download and keep by clicking the "download" link under the player below:

A "New" Exercise For Tennis Elbow That Works (?)

A lot of the press and excitement revolves around a very small, but apparently successful study (in the short term, anyway) of Tennis Elbow sufferers who performed a specific eccentric exercise called the “Tyler Twist” involving a rubber bar, the “FlexBar.”

Is it a new Tennis Elbow exercise? Yes and no.

There’s nothing new about eccentric exercise for treating tendon injuries. (It’s the bar) Here’s a reference from 1986:

“In order for the healing tendon to be adequately rehabilitated, the treatment program must include specific eccentric strength rebuilding exercises.”

Stanish, Et Al, Clin Orthop Relat Res. 1986 Jul;(208):65-8.
Eccentric Exercise in Chronic Tendinitis

But the benefits are far from conclusive:

“Eccentric exercises (EE) have proved successful in the management of chronic Tendinopathy, particularly of the Achilles and patellar tendons, where they have been shown to be effective in controlled trials. However, numerous questions regarding EE remain. The standard protocols are time-consuming and require very motivated patients. EE are effective in some Tendinopathies but not others.”

Br J Sports Med 2009;43:242-246 doi:10.1136/bjsm.2008.052910
Eccentric exercises; why do they work...

So, although Eccentric Exercise does seem to make a difference in some cases...

That doesn’t necessarily mean you should make it the most important tool in your rehab toolbox!

And to complete the earlier thought, it’s the “FlexBar” rubber bar device that’s new.

Which begs the question, do you need it?

Well, I’m basically neutral on the subject.

I do like the “smoothness” of the resistance the rubber bar provides, but have some caveats:

1. I’m especially concerned about the amount of contorting you have to repeatedly do to your shoulder to perform the eccentric maneuver with the bar, which could put a lot of unnecessary strain on your Rotator Cuff…
   
   
2. I also think it’s better NOT to start a rehab program with the main exercise you do with the rubber bar, and rather to approach the injured "Tennis Elbow muscle" a little more indirectly.

   (See this article/video, which details the best exercise to start your rehab with.)

3. And in a larger sense, I’ve simply seen too many elbow pain sufferers rush from one treatment, remedy or cure to the next, chasing short-term pain relief…

Going through repeated cycles of hope and promise followed by failures, flare ups and the subsequent disappointment and loss of motivation…

Without ever understanding what the real problem is or what the goals should be to fully heal and recover from the injury. (Not that that necessarily describes you!)

But if you are sick and tired of the vicious cycle of pain, the endless chasing of symptoms and the ever-receding mirages of miracle-cure promises, you’re in the right place.

In that spirit, let’s dig deeper and quickly review what the main goals of exercise are:

1. To strengthen the muscle,
2. To strengthen the tendon,
3. And remodel the tendon

You may want to read the article {video, too} on the three goals of rehab exercise first to get a better view of the larger rehab picture.

The key question is:

Why Do Just The Eccentric Part Of The Exercise?

Instead of first raising the weight and then lowering it in a normal exercise – (getting both the concentric and the eccentric) WHY would you only do eccentric part?

Why go through that complicated maneuver with the rubber bar (or through other, fairly simple methods without it) just to perform ONLY the eccentric contraction? – What’s the point?

Well, the answer to this mostly has to do with the tendon, which is almost always the larger challenge with Tennis Elbow.

Tendons heal and get stronger much more slowly than your muscles.

Tendons are the challenge because although you can achieve faster strength gains in your muscles for a while, you eventually come up against the limits of how much force your tendons can handle and the slower rate at which they adapt.

In other words, you have to wait for your tendons to get stronger (more durable) before you can achieve the next level of muscular strength (power.)

This can be very difficult with Tennis Elbow and similar tendon injuries because the tendons involved have often begun to break down due to an insidiously sneaky degeneration process.

The degeneration weakens the structural integrity of your tendon making it less durable.

Picture what happens to rubber bands over time: They deteriorate, get brittle, crumble and eventually break.

Which makes the reversal of this degeneration the most important goal in healing and rehab.

Is eccentric exercise the most efficient exercise for helping you regenerate and regain the strength (tensile strength) of your tendon?

The research suggests that it may be (with some types of Tendinosis) – And, more importantly, it has been shown to be safer for your tendon.

Apparently, to ONLY “lower” the weight – which is to perform the eccentric contraction without performing the concentric – is both:

• More stimulating to tendon repair or regeneration
• And safer; posing less of a risk of further tendon injury

Knowing this, it makes sense when beginning a tendon rehab program to only perform the eccentric part of the exercise.

And then later, once some progress has been made, it seems sensible to introduce the concentric part of the motion, since to continue doing only the eccentric part would be pretty unnatural!

Why You Need To Do The Eccentric Part Slowly And Steadily

Whether you’re doing pure eccentric exercises or a full concentric followed by eccentric, you want to lower the weight (sometimes referred to as the “negative”) in a slow, controlled, steady way in order to get the most out of it.

The eccentric part requires the most coordination, as it’s more challenging to orchestrate the smooth, steady lengthening of a muscle (lowering a dumbbell weight in a Biceps curl, for instance) than to contract and shorten it (raising a dumbbell weight.)

This has a lot to do with momentum. It’s easier to generate momentum and “coast” on that momentum when doing the concentric part than it is to “fight” the momentum in the eccentric part.

This is counter-intuitive and easily forgotten.

Once the “hard” part of raising, pushing or pulling the weight is done, people seem to just let the weight fall back down quickly with gravity with very little control.

So it’s very important when you’re doing your exercises that you really concentrate on that “negative” eccentric part! – Otherwise, you won't get much benefit from it.

However, before rushing into an exercise program there's another critical consideration…

Is There A Higher Priority In Your Tennis Elbow Recovery? – Should Something ELSE Come First?

From my understanding based on many years of treating tendon injuries, especially Tennis Elbow, exercise is secondary.

There IS a higher priority in the rehab process.

See this article for more on the subject of timing and priorities

There has to be an ongoing repair and regeneration process happening for weeks and sometimes months (in severe cases) and exercise alone may not be enough to encourage it.

It may not be enough “jump start” your failed healing process if your injury has reached the point of moderate to severe Tendinosis, which is what Tennis Elbow usually is.

To attempt to make exercise the priority is like putting the cart before the horse, in my opinion.

The best way I know of – non-invasively – is the very focused, specific manipulation of the tendon through hands-on therapies.

Advanced "massage" techniques that you CAN learn to do for yourself at home!

This is the heart of what I teach members here at Tennis Elbow Classroom.

To Sum It All Up:

• Yes. Eccentric exercise seems to help achieve the main goals in the rehab of the muscles and tendons involved in the injury,
  
  
• It may be a safer way to begin your rehab program, so, instead of doing “normal” repetitions, it may be a good idea to isolate and focus the eccentric part,
  
  
• The rubber FlexBar may be a helpful addition (Watch out for shoulder tension or “pinching”)
  
  
• Starting “indirectly” with a muscle “teamwork” exercise rather than immediately challenging the main “Tennis Elbow muscle” is also a very good idea!
  
  
• And remember that exercise is secondary to healing and repair.

Keep in mind that your inflammation and repair stages (1st + 2nd) have to happen first (or be well on their way) before you can proceed at full speed with remodeling (3rd), which is when strengthening contributes the most.

And my opinion is that if you’ve “done your homework,” by allowing for and encouraging the first two stages of healing, you may not even have to concern yourself with whether you should follow the eccentric-only protocol or not.

The “foundation” will be laid down (new or stronger collagen protein in your tendon) and you can stress it with resistance exercises with some confidence – concentrically, eccentrically or both!

So, I invite you to learn the best self-treatment therapy techniques from a real Neuromuscular Therapist who treats these injuries every day. I'm standing by ready to be your virtual tutor!

Learn To Treat And Heal Your Own Tennis Elbow Or Golfer's Elbow At Home With This Video Program

You'll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!...

I'll be your personal tutor guiding you through step-by-step video lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)

Just watch the videos, follow along and start putting an end to your elbow pain today, whether you have Golfer's or Tennis Elbow from playing your guitar - or other stringed instrument or ANY instrument, for that matter!)

Tennis Elbow sufferers: Learn More About The Tennis Elbow Program Here

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