The #1 Exercise For Golfer's Elbow

About a decade ago I had a neck injury which caused me to stop lifting weights for a few years. When I was finally feeling better my enthusiasm for exercise led me to do too much too soon and I ended up with a very unpleasant case of Golfers Elbow in both forearms.

I tried stretching but that only felt better for a minute or two.  Massage and/or acupuncture both helped it feel better longer, but as soon as I began doing pull-ups or lifting something heavy, it hurt all over again.

Then a client of mine, who was also a physical therapist, introduced me to the Reverse Tyler Twist with the Flexbar, and that changed everything.  The pain went away and never came back!

Before I show you the awesome exercise that helped me heal, I'd like for you to understand what causes tendinitis and how to avoid it in the future.

It also helps to know that I've spoken with numerous tennis players who had golfer's elbow, and golfers with tennis elbow. So in this post I'll cover how to identify one from the other and exercises for each.

What is Elbow Tendonitis?

The first thing we should clear up is that what we are calling tendonitis is actually tendonosis.

Tendonitis vs. Tendonosis

“Tendonitis is the inflammation of the tendon and results from micro-tears that happen when the musculotendinous unit is acutely overloaded with a tensile force that is too heavy and/or too sudden. Tendonitis is still a very common diagnosis, though research increasingly documents that what is thought to be tendonitis is usually tendinosis(1,2,3,4,5).”
“Tendinosis is a degeneration of the tendon’s collagen in response to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done repeatedly.”

Repetitive Strain Injury

Repetitive Strain injuries are due to chronically injuring the tissues and not giving them sufficient time to heal.

This could be due to a sport, hobby or work demands...an activity that's regularly exposing your tendon to more force than it can withstand.

When I say force, I am specifically referring to shock forces, or shock loads. These are dynamic loads and increase with movement either during acceleration or deceleration. Let me paint you a picture...

A average tennis racquet weighs between 9 and 11 oz. But when you accelerate it through your backhand or decelerate your forehand, the load going through your wrist extensors multiplies.

But the real damage is done when your hit the ball and the shock load can be as high as 100 lbs.

By the way, hollow core racquets are most likely to cause injury because they transfer the most shock whereas triple core are the least likely to hurt you.

The same concept applies to swinging a golf club and Golfer's Elbow.

Golfer’s Elbow or Tennis Elbow?

It is now time to identify whether you have lateral epicondylosis (Tennis Elbow) or medial epicondylosis (Golfer's Elbow)...or both...or perhaps neither.

Golfer's Elbow Tests

 Test 1: Use your thumb to press the medial epicondyle.

Test 1: Use your thumb to press the medial epicondyle.

 Test 2: Straighten your injured arm with palm facing up. Use the opposite hand to bend your hand down at the wrist but resist it with the injured arm.

Test 2: Straighten your injured arm with palm facing up. Use the opposite hand to bend your hand down at the wrist but resist it with the injured arm.

 Test 3: Using your injured arm, pick up a moderately heavy object with your palm facing up and elbow straight.

Test 3: Using your injured arm, pick up a moderately heavy object with your palm facing up and elbow straight.

If any of these tests hurt on the medial epicondyle (the bony spot on your arm that I’m touching in the first photo) you probably have golfer’s elbow.

Tennis Elbow Tests

 Test 1: Use your finger to press the lateral epicondyle.

Test 1: Use your finger to press the lateral epicondyle.

 Test 2: Straighten your injured arm with palm facing down. Use the opposite hand to bend your hand down at the wrist but resist it with the injured arm.

Test 2: Straighten your injured arm with palm facing down. Use the opposite hand to bend your hand down at the wrist but resist it with the injured arm.

 Test 3: Using your injured arm, pick up a moderately heavy object with your palm facing down and elbow straight.

Test 3: Using your injured arm, pick up a moderately heavy object with your palm facing down and elbow straight.

If any of these tests hurt on the lateral epicondyle (the bony spot on your arm that I’m touching in the first photo) you probably have tennis elbow.

The 2 Inexpensive Tools You'll Need

Now that you know which type of elbow tendonitis you have, the very first thing to do is get a Flexbar. They're inexpensive and you'll need one to perform the corrective exercise. Don't maybe get it...definitely get it...in fact, order it as soon as you finish reading this page.

It's not something I ever see sold in stores, so the easiest place to get it, is Amazon. They range anywhere from $13 to $20 US.

The next question is, which resistance level should you buy? Guys, don't get too cocky here. You have this injury because the tissue was weak.

I'll walk you through an approximate explanation of how to gauge strength for these.

Flexbars.jpg

Yellow Flexbar - Extra light, offering 6 lbs (2.5 kg) of resistance. For most, this will be too easy. But if you rarely perform manual labor or any type of training/sport that requires grip work such as swinging racquets and clubs or lifting weights, this is where you should start.

Red Flexbar - Light, offering 10 lbs (4.5 kg) of resistance. This is the best place for most people to start. If you perform light manual labor or any type of training/sport that requires grip work such as swinging racquets and clubs or lifting weights and perhaps you increased your intensity too quickly and got hurt, begin here.

Green Flexbar - Medium, offering 15 lbs 7 kg) of resistance. This a good "injury prevention" resistance level for most people to use after they've healed and gained strength. With that said, if you already do grip training and have strong forearms, this may be an appropriate place for you to start.

Blue Flexbar - Heavy, offering 25 lbs (11 kg) of resistance. If you're strong enough to start with this resistance level than I have no idea how you got elbow tendonitis. You can get this one to use once you've outgrown the green and you want to be a beast, but don't try starting here...that's just silly in my opinion.

Personally, I hurt my elbows in my late 20's. I stopped lifting after a neck injury and mostly did yoga for a few years. But when I healed and got back into lifting, I went too heavy too quickly, causing both Tennis and Golfer's Elbow in both arms.

I started with the red Flexbar and now use the green occasionally for maintenance.

My wife, Maribel, had a similar injury and also began with the red and uses the green to prevent Tennis Elbow from playing Pickleball. I really love that woman. :-)

Anyway...

The next tool I recommend getting is The Stick. You can recover without it, but in my opinion, not as quickly or as well. You'll see why in a minute.

The Stick.jpg

4 Step Process to Fix Elbow Tendonosis

STEP 1 - Identify Offending Activity

This should be pretty obvious because it will hurt when you do the offending activity. And it might not be just one activity. Anything that makes your elbow tendonitis pain worse, falls under this category.

STEP 2 - Reduce or Stop Offending Activity

Ideally you’d be able to completely stop doing any activity that worsens your injury until it is healed.  But sometimes that’s not realistic, so try to at least reduce how much you do them, and maybe even alter the way you do them.

And sometimes, there is no escaping these activities because they're a part of your business or it's golf season, and let's not kid ourselve. In this situation you need to double your efforts at steps 3 and 4.

arm brace.png

This is when I recommend wearing an arm brace for support.

Essentially, the brace works by compressing the tendon above the pain sites, adding a form of external structural support. This can help minimize further injury while you get through a specific work project by taking tension off of the trigger points and tendon.

One further clarification before we move on...if your elbow hurts when training at the gym, it doesn't mean stop training altogether. It means modify or change out the exercises that aggravate your injury, but keep everything else.

For example, many people get Golfer's Elbow from pull-ups. If you don't want to completely lose the strength gains you've worked so long and hard for, try lat pull-downs with a similar grip. But slow your tempo way down to 3 seconds on the concentric phase (the positive), 2 second hold in the isometric phase (at the bottom) and 4 seconds on the eccentric phase (the negative).

The slower tempo and lighter weight should help avoid a shock load from going through your tendon while keeping you challenged.

STEP 3 - Release Trigger Points

Trigger points are tight little bundles of muscle fibers that feel tender when you press them. They can occur when a muscle is contracted for long periods of time and they get stuck in a shortened position, such as when you spend a lot of time typing and using a mouse on a computer.

Interestingly, they also occur when a muscle is weak and overstretched. Sections of the muscle will contract defensively so as not to stretch to the point of tearing.

Trigger points in your forearm are best released by regularly using a self-massage tool like The Stick (the small, less expensive one works just fine). You can also see a massage therapist or acupuncturist.

 Golfer's Elbow

Golfer's Elbow

 Tennis Elbow

Tennis Elbow

An additional muscle with trigger points that can affect tennis elbow is the tricep. This is a great muscle to have a massage therapist dig in on but you can do a good job yourself with The Stick or a foam roller.

If you've ever seen my original elbow tendonitis video on Youtube I said that over-stretching of the tendon was part of the problem and therefore shouldn't be part of the solution.

Well, 4 years later I'd like to modify that statement a bit. I still believe it to be part of the cause but I believe it can have it's place in recovery if done properly. And I believe the proper time is after massaging the trigger points to help "unstick" the muscle fibers even further.

When you gently release tension from the tight muscle it lengthens and becomes more elastic. This, in turn reduces the possible shock loads on the injured tendon. Remember earlier when we discussed shock loads?  Well, the more elasticity the muscle has, the more it can absorb dynamic forces so the tendon doesn't have to. It can also increase circulation and muscle function for the next step.

Sometimes it’s incredible how much better you can feel just by stretching the right muscles and releasing muscular tension, but don't stop there! Step 5 is where the magic happens.

 Golfer's Elbow Stretch

Golfer's Elbow Stretch

 Tennis Elbow Stretch

Tennis Elbow Stretch

STEP 4 - Strengthen Weak Tissues

The reason why you got this injury in the first place is two-fold:

  1. Your tendon wasn't strong enough to hold up against the stresses you exposed it to.
  2. Your muscles weren't strong enough to absorb the shock loads as they lengthened during eccentric contractions.

Therefore, this is the most important step by far.

Perform 3 sets of 10-15 slow reps daily. When you can easily perform all 3 sets for 15 reps, it's time to begin using a more challenging Flexbar.

The injury site should feel sore, and maybe even hurt a bit while doing the exercise. That's because you are intentionally stressing the tendon in order to stimulate growth and realignment of the collagen.

Golfer's Elbow Exercise

 Golfer's Elbow 1 - Hold bar with injured arm.

Golfer's Elbow 1 - Hold bar with injured arm.

 Golfer's Elbow 2 - Lift uninjured elbow high while grabbing bar, palm facing away.

Golfer's Elbow 2 - Lift uninjured elbow high while grabbing bar, palm facing away.

 Golfer's Elbow 3 - Squeeze tight.

Golfer's Elbow 3 - Squeeze tight.

 Golfer's Elbow 4 - Straighten both arms while flexing the wrist of the inured arm.

Golfer's Elbow 4 - Straighten both arms while flexing the wrist of the inured arm.

 Golfer's Elbow 5 - Slowly allow the wrist of your injured arm to extend while squeezing the bar. Reset your grip for each rep.

Golfer's Elbow 5 - Slowly allow the wrist of your injured arm to extend while squeezing the bar. Reset your grip for each rep.


Tennis Elbow Exercise

 Tennis Elbow Exercise 1 - Hold bar with injured arm.

Tennis Elbow Exercise 1 - Hold bar with injured arm.

 Tennis Elbow Exercise 2 - Lift uninjured elbow high while grabbing bar, palm facing away. 

Tennis Elbow Exercise 2 - Lift uninjured elbow high while grabbing bar, palm facing away. 

 Tennis Elbow Exercise 3 - Squeeze tight.

Tennis Elbow Exercise 3 - Squeeze tight.

 Tennis Elbow Exercise 4 - Straighten both arms while extending the wrist of the injured side.

Tennis Elbow Exercise 4 - Straighten both arms while extending the wrist of the injured side.

 Tennis Elbow Exercise 5 - Slowly allow the wrist of your injured arm to flex while squeezing the bar. Reset your grip for each rep.

Tennis Elbow Exercise 5 - Slowly allow the wrist of your injured arm to flex while squeezing the bar. Reset your grip for each rep.

NOTE: Even though you should feel sore during the exercise, you shouldn't feel it the next day. If you do, it means something is injuring the tissue still. Is there something in your daily activities that still needs to be modified until you’re healed? Also, try slowing down your Flexbar reps and consider if you started with too high of a resistance level.

HERE’S YOUR HOMEWORK FOR TODAY:

If you’re suffering with elbow tendonitis, go ahead and order the Flexbar right now, it's only about $20.

Then, call your doctor or physical therapist’s office to get an evaluation.  Chances are, by the time you go to your appointment  the Flexbar will have already arrived and  you’ll have used it a few times.

If your tendonitis is feeling better, you’ll impress your PT with your proactive approach and they can help speed the healing process along.

If you’re not feeling better, than it’s a good thing you made that appointment, huh?!

 

Common Questions

FLEXBAR VS. FREE WEIGHTS

I've had many people ask if they can use a dumbbell instead of the Flexbar. And the truth is, some people can if they really understand the biomechanics of what we're trying to accomplish.

But that's like saying you can use your hamper as a step ladder, it may get the job done but not nearly as well or as safely. I'll explain why...

The key to eccentric contractions for healing a tendon is to create enough resistance through a full range of motion without shock loading at the beginning or end of the range of motion.

This is very tricky with free weights because gravity is constant and always pulling in one direction.

With the Flexbar, there is practically no shock load at the beginning of the exercise and because of how it uncoils there is literally zero shock load at the end. Plus, the resistance isn't gravity driven which means it can be more consistently applied through different angles of wrist extension.

SHOULD I USE IBUPROFIN?

No. Because...

“...some treatments to reduce inflammation are contraindicated with tendinosis. Ibuprofen, a nonsteroidal anti-inflammatory, is associated with inhibited collagen repair(9).”

WHAT DO YOU THINK ABOUT CORTICOSTEROID INJECTIONS?

Avoid them. They can be helpful for treating pain for 2-6 weeks but...

“Corticosteroid injections inhibited collagen repair in one study, and were found to be a predictor of later tendon tears(3,4,10).”

I also believe that treating the pain takes away much of the motivation for people to be consistent with their exercise regimen and possibly become careless about avoiding activities that aggravate the injury.

SHOULD I ICE IT?

Research shows it can provide benefits. I will admit, I personally never bother with ice except for cocktails. I've healed just fine without it but it's an "arrow in your quiver" to help reduce pain.

“Ice causes vasoconstriction and is thought to address the abnormal neovascularization of the tendon tissue(3). Clinical experience indicates that icing is helpful for tendinopathies even though the reason why it works is not yet fully understood(3). Use ice for 15–20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon(7,15).”