31.05.08
The Cure for Golfers Elbow (Medial Epicondylitis)
Oops, I missed my regular Friday Fun post, sorry. In my defence I was busy with work and down the gym for the 2nd time this week. Yep, my Golfers Elbow is holding up nicely in the face of many exercises! So I thought a round up of my treatment for Golfers Elbow was in order, including the exercises I’ve been doing etc. Sorry this is a monster post, but it’s the culmination of 6 months of my life.
A quick recap first: I have been suffering with Golfers Elbow (or Medial Epicondylitis if you prefer) ever since I banged my elbow at my brothers stag do back in September 2007. It got progressively worse over the latter quarter of 2007, culminating in me stopping attendance at my local Crossfit Gym at the end of Jan 2008. The reason was that I wanted to concentrate solely the cure for Golfers Elbow and getting better as fast as possible, as it was just getting worse. Now 4 months on, I’m well enough to go back, woot!
So, how did I do it?
The first point to note is that I tried many different Golfers Elbow treatments (pretty much all of them in fact), so I can’t say if any one was the definitive “cure” or not. All I can do is take you through the list and explain the effects, the following is in roughly chronological order.
1) Complete Rest
The first thing I did was totally stop doing anything that hurt. None of this “work through it” lark which I had been doing for 3 months. To my annoyance, that meant no more Crossfit. I did try for a bit, but soon got bored with just doing sit ups, box jumps and squats (I couldn’t even do weighted squats, just holding the bar on my shoulders hurt!).
2) Physiotherapy – Ultrasound
In the end I’ve been to 3 different physios and had 3 different sets of treatment. The first made the interesting comment that most cases of Golfers Elbow she saw, didn’t actually occur in golfers! (She also noted the same thing about Tennis Elbow.) The first trick up her sleave was an ultrasound machine, designed to promote healing somehow. I think the thing could have been turned off for all I know, didn’t really notice much apart from possibly my elbow getting hot, but that could have been from the constant manipulation of the ultrasound probe on my elbow. I had 5 x 10 min treatments of this over 5 weeks.
3) Physiotherapy – Interferon
I’m not sure this is the scientific name for it, it’s what the physio called it. This one requires pads stuck to your arm and the frequency sweep artificially activates your muscles, this one you definitely notice! Lot’s of tingling and making my whole arm twitch and move, it was quite uncomfortable at points. Very odd and very strange, there was definite movement of the elbow components, once can only hope that was a good thing. I had 5 x 10 min treatments of this over 5 weeks, at the same sessions as the Ultrasound.
4) Physiotherapy – 10 min Massage
At the same time as the Ultrasound and Interferon treatment, I had a short 10 minute elbow and arm massage. Now like the next man, I normally like getting a massage, not this one! I was poked and prodded and many many painful ways. It certainly hurt and manipulated things. 5 x 10 mins over 5 weeks again.
The argument for all these physio treatments, was to get blood into the epicondyle tendons. Apparently the blood supply to tendons is generally poor and so helping to get new blood in, aids the healing process… To be honest, that sounds like bolox to me, I’m not convinced that blood effectively sits stagnating in any blood vessel, and requires manipulation to replace it, would love for someone to tell me otherwise?
5) First Stretching Exercise
Here was the first exercise I tried, designed to stretch the epicondyle tendons: place your hands flat on a table, twisted 180 degrees to the outside so that your fingers are pointing at your body. (So twist your right hand clockwise, and your left hand anti-clockwise.) Make sure your whole hand is flat on the table, from fingers to the heel of your palm. Now by leaning back away from the table, you will feel your whole forearm muscles and tendons stretch. Stretch them as much as you can comfortably do and hold for 30 seconds. I did this 5 times a day for several months (both arms for consistency and a control test).
EDIT: Several people have got confused over this description, so here’s a picture:
6) CT Cream off the internet
Around this time I was casting about the net looking for alleged Golfers Elbow cures, and stumbled on something called CT Cream, which is a herbal cream full of the right vitamins etc that promote healing. I found lots of nice testimonials from people who claimed it had cured them. At about £15 I figured it was worth a shot and bought some off eBay. I dutifully applied this stuff twice a day for about 6 weeks… and noticed nothing. There was not miraculous cure, nor even much improvement over the time period.
It occurred to me afterwards (duh!) that there is of course no regulation to buying “medicine” off eBay, and it could have been repackaged Nivea skin cream for all I knew. Either way, I don’t recommend it and I’ve subsequently spoken to other epicondylitis suffers who tried it, with similar non-existent results.
7) Band-It forearm Band
This was recommended to me by several people on a Crossfit forum in the States, it looks like this:
and the cheapest place I found it in the UK was Sweat Band Tennis for £20 including p&p. At first I wore it during the day all day, and didn’t notice a huge amount of difference. Getting the tension right is tricky: just tight enough so that it doesn’t fall off, but not so tight that it pinches. The issue of course is that the cross section of your forearm changes, depending on what you’re doing with it.
I wore it list this for several weeks, then back on the forum, the guy who’d recommended it said it only started to make a difference for him when he started wearing it 24/7. So I started wearing it at night too. That took a LOT of getting used to, but I did wear it day and night for about 2 months in total. One of the physios I saw pointed out that wrapping something around an appendage and going to sleep was not a good idea! To be fair, I nearly lost a finger like that one Christmas, but that’s another story!
How the BandIt band is meant to work is still out for debate, I’ve heard 2 explanations: A) It relives the pressure on your tendons, allowing it to heal. B) It constantly stretches your tendons (seeming the polar opposite to (A)) which means that normal use is easier. All I can say is, it was around the time that I started wearing it day and night, that I first started to notice an improvement in my elbow. Not much, but some. Each week didn’t seem to hurt quite as much as the last.
It was late March I think and I had started to turn the corner.
8 ) Acupuncture
Around the same time, my first physio recommended that I try acupuncture. Clearly things were not improving very fast and acupuncture does seem to work for many people. I’ve always shied away from it in the past, chi and energy lines and stuff, just doesn’t fit too well with my western scientific mind. However I was prepared to give anything a try (see CT Cream above for example) so had 2 acupuncture sessions in the end.
If you read my posts at the time, you’ll know that acupuncture hurts! Well it did for me. Maybe it was because it was in the arm, wrist and elbow and I had to look at it, I don’t know. I do know that I soon learnt that when the (now 2nd) physio said “Does it hurt?” I had better reply “Yes, that’s a sharp pain.” or she’d come and grind those needles in further until she was sure they did! When the 2nd session left me with debilitating pain for the rest of the day, I called it quits on the acupuncture front, and was glad of it. My verdict: Acupuncture is an exercise in pain only and a waste of time for treating golfers elbow.
9) Physiotherapy – Remedial Massage
Now on to my 3rd physio, I started going for weekly remedial massage. These were 30 min sessions of massage (3x what I was doing with the first physio) and didn’t hurt quite as much. Whereas the first physio enjoyed really shoving her fingers into areas of pain, this remedial massage was of a slightly more therapeutic nature. Did they help? I have no idea, but I did enjoy them. Certainly the most enjoyable of all the physios I visited. I went 4 times over a 3 week period and (in combination with the exercises below) each week felt better than that last.
10) Golfers Elbow Exercises
Along with keeping up with the stretching, the 3rd physio gave me a list of exercises to do twice a day. The regime was this:
- Heat the elbow with a wheat bag for 10 minutes
- With an empty dumbbell bar (weights 1.5kg) do 10 palm up wrist curls, with back of forearm resting on your leg and hand jutting out past your knee.
- Reverse the hand so palm is down, and do 10 reverse wrist curls i.e. back of hand is raised, again forearm rests on leg.
- Keep the arm resting on your lef, grasp the dumbbell bar at one end, and tilt the bar back and forth from the horizontal on the left, through 180 degrees, to the horizontal on the right, and return. Do that 10 times.
- Setting the dumbbell bar aside, form a circle with the tips of your fingers (make your hand like a claw) and wrap an elastic band around the outside of your finger tips. Now try to stretch the elastic band by spreading your fingers out wide, maintaining the circular shape. Do this 10 times.
- End by cooling the elbow with an ice cube.
These exercises were tough to start with, but I soon moved up from 2 rounds of 10 of each exercise, to 3 rounds of 10, then 3 rounds of 15, all twice a day still. I also did all this with my good left arm too, partly as a control test and partly so that I was exercising my body evenly. I actually soon ditched the final icing of the elbow, which was far too uncomfortable, with a 2nd heating with the wheat bag.
These exercises were done twice a day all through April and May. I also added another once I had worked up to 3 x 15 of each:
- Tie some string round the middle of the dumbbell bar and wind up about a meter of it, like a yo-yo. At the other end, tie a weight. I used a 1.25 kg weight and that was more than enough!
- Grab the dumbbell bar at each end with both hands, and just by moving your wrists, unwind the weight (you may need to stand for this) until all the string is paid out and the weight is at the bottom.
- Now keep winding with your wrists in the same direction so that the string winds on the other way and the weight rises up from the floor to your hands. This is surprisingly hard!
- Finally reverse the process completely.
- Do this for every round of the above set of exercises, so 3x in total, twice a day.
11) The Zone Diet
Throughout all this I’ve been on the Zone Diet, which if you believe the hype is a naturally anti-inflamatory diet. I can’t tell you that it made a difference but I can provide 1 bit of evidence: at Easter, I basically threw the diet out of the window for 2 weeks (hey, it was Easter!) due mostly to the consumption of large quantities of chocolate. And yes, it DID make a difference, I definitely noticed that my elbow felt worse during those 2 weeks, until I went back on the diet. Coincidence? Maybe, but I’m a Zone Diet convert, so I’m not so sure.
12) Fish Oil Supplements
I also take a high dose of fish oil regularly. That’s 2.5g of high grade, super refined, EPA/DHA per day. Note not 2.5g of gross Fish Oil, but 2.5g of the good stuff in it, the EPA and DHA. For most high street off the shelf fish oil, that would be about 10 capsules a day, because it’s such poor quality. In fact, I can’t find anywhere in England that sells stuff I’m happy to take, so I import mine from America. And the funny thing is, it’s actually cheaper that off the shelf stuff here!
Anyway I can’t say that it made a difference or not. I did try upping the dose to 5g per day for 2 weeks but didn’t notice any change. I include it here for the sake of completeness. I personally believe that fish oil is an important part of our diet, fundamental to our evolution into homo sapians and vital to long term health, but that’s the subject of another post some time.
Finally Getting Better
Throughout April and May, I was definitely getting better. Each week I noticed my elbow hurting less and less just in normal use, and when doing the movements that would always bring me pain (making a fist was a good typical one) it took more effort to induce pain in the elbow than before. But what was the Cure for Golfers Elbow?
If you speak to people who’ve had medial epicondylitis, or read up about it on the web, you’ll find 2 interesting facts:
- Everyone eventually gets better, whether that be 6 months or 18 months later.
- There is no consensus on a golfers elbow cure.
So here’s my take on it: If you have golfers elbow, providing you don’t continue to aggravate it, you will get better… eventually. There are several things you can do to help the healing process. It’s likely, that when you do decided you’re fixed and the treatment has worked, whatever you were doing last, will be what you reckon cured you. For me, I saw no benefit to the main stream physio, CT Cream or acupuncture. But I did see improvements begin around the time I was wearing the BandIt band 24 hours a day, and saw weekly gains whilst getting remedial massage and doing twice daily sets of exercises at home.
One potentially interesting point, is that I’ve got better pretty quickly. Most people say 6 – 18 months, and I’ve heard as much as 24 months to heal. Whilst it’s been 8 for me, I only started doing anything about it in Jan, so only 5 months since the start of treatment really. In the scheme of things that’s a fast cure for Golfers Eblow.
Where am I now?
Now at the end of May, 8 months after I initially hurt my elbow and 5 months since ceasing all elbow related exercise, I feel able to go back down the gym and restart Crossfit again. I’ve possible left it later than the earliest possible moment I could go back, but then I’m not yet 100% better either. I’d say currently I am 95% cured. I say this because I still feel slight twinges occasionally.
For example 5 x 30Kg Shoulder Presses on Tuesday I could definitely feel in my elbow and so didn’t go heavier. But I can row and knock out pull ups, wall balls, kettle bell swings, dumbbell push presses, all without any pain, albeit currently with much lower weights than I have been used to. That’s ok though, I’ve been patient enough for the last 4 months and will continue to be. I’ll take it easy and build back up slowly. I expect to be 100% back to normal and going for new Personal Bests in about 2-3 months time. Hopefully just in time for the Crossfit Certification at Manchester in September.
I also hope to improve my Clean & Jerk and Snatch enough to compete in the Northern Masters Olympic Weightlifting competition in Feb 2008 and fingers crossed, qualify for the British Masters a few months later. But I’m getting ahead of myself a bit. To be honest, I’m just glad to be back down the gym. 
