Hey everyone, welcome to Peak Performance Today I’m talking about a topic that I’m very passionate about because I’ve had to overcome it myself. I’m referring to flexor tendinopathy in the elbow or more commonly known as golfers elbow. This is something that we have to treat on a regular basis with alot of our corporate clients a lot of our these guys do corporate golf days and stuff like that and come into the gym and do a lot of gripping and because of that overuse or repetitive use of the flexor muscles which attach down here in the elbow we get this accute pain and it usually begins with a little bit of pain in here or around the elbow when we grip things and it can develop to an accute or quite serious golfers elbow or flexor tendinopathy and it’s very difficult to get rid of. Unfortunately, once you do have it a lot of the exercises we need to do to fix it will also aggravate the issue. So the first thing as always that we have to do is eliminate the issue or the cause. We have to identify the cause and eliminate it. One of the most common is constant and frequent work on the computer, with the wrists flexing on the typewriter Obviously anything where we’re gripping, golf swing, especially if you have a tendency to hit the ground like I do and dig big holes but I’m obviously not suggesting that you give up golf altogether, but during the time when you identify the discomfort to the time that we re-habit and you need at least two to four weeks absolute pain free before we continue to play golf again. So there is a period during the rehab process where you will have to stop swinging golf clubs around. So first that’s step one: identify the cause and eliminate it be that maybe only temporarily if it’s literally golf that is causing the problem. If you’re in the gym that maybe gripping heavy stuff, deadlifting chin-ups are out, a lot of bicep curls are out. It depends on the grip and what aggravates it. It’s slightly different for everyone so what we first have to do is really identify what is causing the pain what is aggravating it. Remove all of that during that rehab process. The second phase is to increase the conditioning in your wrists and the flexibility. I’ll see if Brad… Are you in close so we can see this? Yep? Yep So, I’m going to get Brad to take you through a few of the exercises that we do everyday with our clients. Now we do this whether you are experiencing extensor or flexor tendinopathy or not just to keep the conditioning up in your wrists. So what Brad’s doing here is, he’s got his palms flat out he’s got his index fingers neutral on the ground and he’s working the mobility and the grip and the strength and conditioning in his wrists here by applying a little bit of his body weight. The more weight he puts down on the wrist, the harder it’s going to be. He’s now inverted his hands so he’s putting pressure directly down onto the wrists but this is stretching out all of his extensors through the forearm here and the other one that he was doing before was stretching out all of the flexors. Now he’s going to go back to the flexors so this one is specific for golfers elbow because now he’s getting a really good stretch up through the inside of his forearm up to the elbow and the attachments just below his elbow, which is generally where the golfers elbow originates from. So he’s going through all of the different angles in his forearm and he’s using his own bodyweight to apply pressure. When you first do this especially if you’ve got symptoms you need to let it settle down first because stretching, it’s like stretching an open wound it’s going to re-open the wound okay? so just go through and do the finger, the hand stretches mostly these ones, first knuckle yeah, yeah yeah We go right through a full conditioning movement workout for the forearms We’ve got this in more detail in the FMS mobility circuit which we can make available for you you guys it’s on our YouTube channel check that out, there’s three videos FMS mobility one, two and three So what he’s doing here is stretching all of the muscles and tendons and conditioning with his own body weight all of the muscles and tendons. So just repeat those movements again quickly So first of all, no no start from the very start First of all we’re conditioning the wrists through here and stretching the back, which is the flexor muscles in the forearm, he’s going side to side, forwards and backwards circles both directions then he’s going to turn the hands over and invert the hands so now he’s stretching right through the top of the forearm forwards and backwards side to side and circles both ways Then he’s going to reverse the hand position and he’s going to do the same forward and backwards side to side and circles both directions and now he’s going to do the first reverse that again so he’s done each different angle I’m rushing it, you can spend more time on it than that yeah, usually we would spend about five minutes on this He’s doing a little bit of wrist conditioning hand and knuckle conditioning and now he’ll do the first knuckle stretch right up onto the finger tips Perfect. Thanks Brad. Alright, so the other thing that’s really important it depends on the severity of the golfers elbow is to get ART Active Release Technique It’s very, very effective You’ll probably need, if you’re in quite a lot of discomfort, you’ll need more than one or two treatments with a qualified ART Practitioner We send guys down to Tom Cartwright down at Cartwright Physical Therapy Tony Battaglia or Joe Lim and other than that, we’ll move onto the strengthening stuff. It is very important that you do not skip any of these phases. If you don’t eliminate the cause and you go in and try and do mobility all you’re going to do is aggravate or open a fresh wound You’ve got micro tears in the fibre the muscle fibre going through all of those mobility movements if you’ve still aggravated it on the weekend playing golf, you’re going to re-open a tear, it needs to settle down first, okay. So step one, identify and eliminate the cause Step two, increase mobility and conditioning in the wrist stretch out all those forearm muscles and get some ART to speed up that process of healing and then step 3, step 4 and step 5 are specific strength training exercises where we use isolated movements so the first one we do I’ve got my whole kit here on the ground is…we’re going to do supination to pronation so we lock the elbow in the side here and then we’re going to rotate supinate, let it stretch right out through the forearm and then 1000, 2000, 3000 to pronation and stretch right out through the forearm. 30 times, so 15 either side and we’ll do that for two or three sets nice and slow this is what we call a clubbell we’ve got at Unity gym a 2 kilo we’ve got a 4 kilo and we’ve got a 6 kilo clubbell so we start everyone on the lowest weight possible 2 kilos and that’s generally plenty of weight. As you progress through you can obviously advance in weight. The next step, which is step 4 is that we start to develop specific grip strength and this is a little bit… no sorry! I’m going to get flexion extension first. Step 4, we get some nice light dumbells. I’ve got some threes here which is suitable for me most likely I’d get people to start on one or two kilos. We’re going to use a nice steady bench and we’re literally extending all the way through and flexing all the way down. I do recommend, if you’ve got any sort of jewellery or a watch you get rid of it so that it doesn’t restrict your range of motion. So you can see, fully flexed I’ve got nice flexibility there all the way up through nice mobility there and the reason is because I’ve increase my mobility by doing step 2 okay after we’ve done that we’re going to go to the flexion so we go right down into the fingertips there, squeezing up to the top nice and slow back down and we repeat those on each side for 12 to 15 repetitions Nice and, squeeze up, nice and slow back down into the fingertips okay start on a very light weight usually you’ll do a little bit more on the flexion than you will on the extension. You have to start light on that and you’ve got to make sure that step 1 and 2 have been done properly first okay step 3 is stipulation pronation step 4 flexion extension step 5 now is where the fun begins we go to specific grip training We’ve got two different ways that we grip train I’ve got one tool here which is for pinch gripping we’ve got lots of different attachments that we can use and we rotate that so this is literally just squeezing as hard as I can for about 30 seconds we want to hold and then repeat the other side one or two weeks of this shape then I move and transition to a different shape there you can make something like this up if you want at home or we need to go we got this from a company in New Zealand called Get Strength for about $300 including postage and they send that whole kit over to you the next one is grip crushing we do this in two ways we can either do repetitions for about 15 repetitions, I’m closing this grip crush tool or we can squeeze and hold for about 15 to 30 seconds so there’s two different ways we can do grip crushing strength but all of these different specific isolated movements are crucial for the development of the strength in your forearms so you don’t repeat the process and end up with golfers elbow all over again and it gets worse every time you get it so it’s crucial that you develop that strength. Now we’re going to go down to the other end of the gym and we’re going to go over our first quite difficult exercise and as again I say if you jump to step 6 here and you’ve missed or haven’t done enough work on step one: eliminating the cause step 2: increasing the mobility, flexibility and conditioning of the wrist step 3, 4 and 5 which is developing strength in all different modalities of the wrist and the movement if you jump to step 6 which is gripping strength where we start to use our body weight and stretching at the same time so this is what we call active mobility you will tear the hell out of your forearms again it has to be done in the right order and sequence so all I’m doing here is gripping tight different angles with the forearms and just gently rocking backwards and forwards letting my grip and my forearms open right up through the arm here, stretching what can happen with golfers elbow is because of the reaction in your forearms you’ve got your radial nerve your ulnar nerve and your median nerve running up through the shoulder into the neck and you can end up with quite severe neck problems and neck pain as a result if it’s not treated in time so what we’re doing here is now that we’ve developed the flexibility and conditioning in the arms and the strength we’re going to open it up and re-establish that really healthy shoulder mobility so I’m just gently rocking forwards and backwards nice and easy, the good thing with the olympic rings, the the gymnastics rings, is that I can alter the grip and change to adapt the parts that are really stiff and not feeling very comfortable in my shoulders and that’s step 6 we’ve now increased the mobility through our shoulders again also increased the mobility and strength in our forearms the last phase, step 7, is to use integrated strength training methods and compound movements that are going to train your body to use strength properly the best, the godfather of that, is the barbell deadlift so using multiple different grips we can use alternator grip for doing our deadlifts we can do a pronated grip deadlift and of course we can do a supinated grip deadlift We’re going to work all different areas of the forearm there we can also use chin-ups we can use bent over row all the big bang for your buck strength exercises need to be added towards the end for long-term, sustainable health in the forearms. I hope you guys enjoyed that and got something out of it Like, share, post, questions, comments and good luck with overcoming your golfers elbow so you can get back out on the course. Enjoy!