Why is it that when it comes to treating a tendon injury like Golfer’s Elbow (or Tennis Elbow, for that matter) one of the first things we tend to hear and think is “Better do some rehab exercises for it”
The question is: Are rehab or strength-training exercises really a top priority when it comes to the Golfer’s Elbow healing process? (And should you start them right away?)
Many authorities claim they’re critical to recovery, but I’m going to go against the grain (as usual!) and suggest some reasons why rehab exercises may initially be a lower priority.
Not that I’m completely rejecting their value! I’m just disputing their place in the order of things. I simply believe they belong in “Third Place” – Never First.
So, here is my perspective in three, quick bullet points, with details to follow, on why these exercises are not the first priority:
- Tightness Not Weakness – Tightness in the muscles is more an issue than weakness (most of the time) with Golfer’s Elbow, and exercises don’t help that…
- It’s Often Too Soon – Rehab exercises for Golfer’s Elbow and other tendon conditions can very easily aggravate the injury if started too soon, which they often are…
- Tendon Remodeling – Exercise (especially Eccentric Exercise) has been shown to help the remodeling stage of tendon healing, but that’s the third and final stage of healing – Not the first.
So now in more detail, here’s my rational for the above:
The muscles involved in Golfer’s Elbow, the Wrist and Finger Flexor Muscles are some of the most adaptable in the human body.
They generate (together with the muscles of the thumb) most of the strength needed for ones grip…
And although some of these muscles may be weak in some Golfer’s Elbow sufferers, what I find time and time again, treating people with this vexing condition, is a great deal of “tightness” and restrictions in this muscle group.
We’re talking about two kinds of “tightness” here:
- Simple muscle tension / ‘Hypertonicity’ – An excessive amount of muscular activity,
- And ‘Adhesions,’ which are when layers of tissue literally stick together.
‘Adhesions’ happen gradually over time (in everyone as we age) and more rapidly and severely in areas that are under higher-than-normal or constant stress.
Adhesions also happen more rapidly when there’s a sudden, Acute injury (like a significant tear) in which case we get Scar Tissue, and with it, a lot of Adhesions.
The result is the same either way: An often dramatic restriction in mobility and flexibility.
And I’m convinced that “releasing” all this tension and adhesion restriction is the number ONE priority for most Golfer’s Elbow sufferers.
Will Stretching And Exercise Help Release It?
No. You can’t simply “stretch it out” (Not past the very earliest stages, anyway.) Stretching may reduce some of the muscle tension, but it’s just not going to release those sticky Ahesions.
(This stuff is kind of like Velcro; it can be released, but the more of it there is – and the harder it’s been pressed together – the harder it is to separate!)
And, unfortunately, you can’t “exercise them away” either – Exercising too much or in the wrong way can actually compound the problem!
Advanced Massage Therapy Techniques can release these Adhesions, though!
The right kind of very specific Massage Therapy (or ‘Manual Therapy’ to get technical) can release those adhesions.
Even deep, dense Scar Tissue that’s been there for years, which nothing else will touch.
It’s a very “mechanical” thing, in a way, involving the right combination of pressure and tension.
Now, any kind of massage – even the most basic – is a start, naturally!
However, some methods are vastly more efficient at releasing these stubborn Adhesions than others.
(I’ve been doing this for over 25 years – first regular Massage Therapy, followed by Myofascial Therapy and now various forms of Neuromuscular Therapies – so I speak from some experience.)
And the important thing is that you can learn how to do this for yourself (if you don’t want to hire someone like me to work on you)
Or even if you do have a practitioner who’s treating your Golfer’s Elbow, you can still use these techniques on yourself every day (whereas how often can you afford or take the time to see your therapist?)
If you’d like to learn more about the Golfer’s Elbow Self-Help Program where I teach people like you how to release your muscle and tendon adhesions and recover naturally, please click here for the program overview.
Now on to point number two:
This might come down to common sense.
Most of us are familiar with the idea that after we have a typical Acute Injury, (as in one that involves obvious, sudden trauma) like an ankle sprain, there’s a certain, expected time frame for healing.
Sure, it depends on how severe our injury is (and our age and general health, and such factors) but we can count on a certain semi-predictable progression of healing.
And we know that the first priority after an injury like that is to take a certain amount of time to “rest” it.
Rest, of course, means different things in different circumstances; rest after a sprained ankle may mean “Staying off it for a day or two, then walking short distances with it wrapped up” and so on – Whereas resting after a fracture means NO use of that area at all for some weeks.
But the rest will be consistent with the nature and degree of the injury.
And this is where things get really confusing and people are often led astray and get into trouble (often with the “help” of bad advice) with Golfer’s Elbow and other tendon conditions.
We don’t always KNOW how severe these injuries are, (objectively speaking – Without an MRI) since the symptoms don’t necessarily match the severity at all…
- Severe injuries don’t always hurt that much and,
- Mild injuries sometimes hurt like hell!…
And, if there’s one idea about Golfer’s and Tennis Elbow that you can just toss out the window and safely forget – Is the myth that there’s some kind of “typical healing time” or “rate of recovery” for it.
See my post and video on “How long does it take to heal?”
Which doesn’t mean there’s nothing you can do to encourage and speed up your recovery!
It means that there is no guarantee that any healing will happen – especially while time is passing and you’re simply “Resting, hoping and waiting”
Tendons have this notorious tendency to NOT heal – And no amount of time (by itself) necessarily helps.
So, the point here, (sorry it took so long to get to) is the uncertainty of knowing just where you are in your tendon healing recovery process.
And just because a Doctor, Physical Therapist or WebMD says that Golfer’s Elbow takes “3 to 6 months to heal” and that the initial healing process takes “6 to 8 weeks” (or whatever)…
And that it’s a good idea / perfectly safe to begin rehab exercises for it after “X” number of weeks or some other arbitrary time period, doesn’t mean jack!
After all, isn’t it simply common sense that exercises can very easily aggravate an injury if started too soon?
That’s one of the top complaints I hear from the people I treat directly in my office and the people I talk to by email, in the member’s forum and in Skype consults.
(The rehab exercises aggravated their symptoms significantly and even though they stuck with them, in many cases, they didn’t make any real progress.)
Okay, you’ve stuck with this post this long, so now I’m going to hit you with the third point, which is a lot more technical than the first two..
There has been a fair amount of medical research on the effects of rehab exercise on tendon healing over the past 20 years or so.
(Especially with Achilles Tendon injuries – and with Eccentric Exercise, in particular.)
And it has been shown to help what’s known as the ‘Remodeling’ Stage of healing.
The thing is that the Remodeling Stage is the third and final stage of healing – Not the first.
Now, common sense suggests that RE-modeling presupposes that something was built there in the first place.
And just like you first need to HAVE a house before you can remodel it, my understanding is that there needs to BE an ongoing process of Collagen building (generation / regeneration) in the tendon before that Collagen can be remodeled.
(Collagen is the protein tendons are mostly composed of.)
Now, I’m not saying this is simply cut and dry. These stages of healing are not purely consecutive, as in 1 then 2 then 3…
They overlap quite a bit, like this: First 1 – then 1 and 2 – then 1,2, and 3 – then 2 and 3 – and finally just 3.
So, it’s not that you HAVE to wait for stage 3, Remodeling to begin your exercise. You can start it well before that. (Just not right away.)
My point is that it (and the exercise to encourage it) is not the priority, and that I believe you’ll make better progress if you focus on prioritizing and making sure the first two stages, (inflammation and repair) don’t stall and fail and leave your tendon sliding deeper into the sludge of stagnation.
I’m convinced the best way to do that is to release all those Adhesions we were talking about earlier…
And to stimulate the tendons with a lot of direct pressure and friction to keep the circulation and healing process going there.
A lot of stretching along the way (the way I teach – but not the way most recommend) to keep the tension from building up and as a gentle transition into exercise and remodeling…
And then, finally, to gradually add exercise – which eventually does become the top priority as you progress and your recovery moves into the final stage.
All of which I teach members here in the Self-Help Program, (including rehab exercises!) and here’s where you can go to learn more:
New Golfer’s Elbow Self-Help Program – Break your vicious cycle of elbow pain at home with the help of this self-help treatment, stretching and exercise program: What’s in the Golfer’s Elbow Program?