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6+ months of elbow tendonitis
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By David Raines
Jun 21, 2013
Legacy (5.11a), Endless Wall, New River Gorge

Has anybody out there had much success fully recovering from chronic elbow tendonitis? Any docs or PTs who've had luck getting patients like me back to full health?

I've made another appointment with an ortho, I'm just trying to understand how people like me tend to turn out.

I've been struggling with elbow tendonitis since last October, in both elbows, from overtraining. I haven't been able to climb since then. I've gone through a couple of rounds of injury, rest, physical therapy, and reinjury. The whole process has left me with a fair amount of muscle atrophy (and visible folds of skin around the crease of my elbows).

I've been in PT twice now. Both times, I recover fairly well, performing light resistance exercises, working on stretches, and getting tissue massages. With in 6 weeks, both times, the pain had gone away, and I could go about my day-to-day life just fine. But about a month after PT, when I tried to go back to strength work (assisted pullups on a machine, with the full stack as assistance, about 1/2 my bodyweight), I reinjured myself within a couple weeks.

The PT had signed off on the exercise (the first time, at least), but in hind sight, I may have pursued it too aggressively.

The pain has jumped around to different spots over these past months. Last fall, I felt pain specifically at the spot where my bicep connects to my forearm. In Janurary, that had calmed down, but my wrist flexors were in pain. After PT, when I reinjured it in March, my brachalias was the thing that was hurting. This most recent time, my brachalias is OK, but my wrist flexors are hurting again.

My PT originally thought that I have a combination of tendonitis and muscle atrophy, and that I'm just reinjuring new things because everything has gotten weak. Now she's not so sure. I'm seeing an orthopedic doc next week.

Anyone have experience with a case like me?

Thanks.


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By Erik W
From Bay Area, CA
Jun 21, 2013
North face of Ama Dablam - taken on approach to Kongma La.

That was me last year for sure. I usually got elbow tendonitis every winter as I trained more in the gym and less outside, but last year my elbows went on fire - both of them, such that I couldn't even squeeze my shampoo bottle without pain (not able to produce any force either). And it did not go away.

Rest alone didn't solve it. When I came back it just flared up within 1-2 weeks again. I finally got it solved though, with 3 actions:

1) Rest. Just has to be step 1. Stop pissing the tendons off.

2) Bodywork. I went to a local bodywork massage therapist known for putting the hurt on athletes. And when I mean 'hurt,' I mean there were times where I almost wanted to reflexively punch the guy he hurt me so bad with his massages. All in my forearms, elbow, and upper arm. Funny thing is, when he showed me how much pressure he was using by mimicking it on my thigh, it was nothing, but my elbows and forearms had gotten so tweaked that even the slightest pressure killed. Anyway, he went to town on my tendons and muscles, breaking up scar tissue with each session. It was remarkable the difference this made. Singly the best thing for my tendonitis.

3) Eccentric exercises. You can find posts about it on MP. Kelly Cordes posted a good link, as I recall. Anyway. After 3 weeks of Rest + Bodywork, I slowly started doing eccentric exercises. Start super, super light. Read up on the philosophy of it. I'd do sets in the morning and sets in the eve. After each, I'd ice for 20min.

With the above I was able to kick the problem. Find a good massage therapist skilled at bodywork on athletes. I was a big non-believer in the stuff, but I'm a serious convert of it now. Be prepared, it'll hurt. Once you get back into climbing, take it easy, and ice after sessions for the first month or so. Good luck.


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By John Johnson
From Boulder, CO
Jun 21, 2013

Here's a great article about elbow problems in climbers, by Dr. Julian Sanders. This article was in Rock and Ice a few years ago:

www.drjuliansaunders.com/resources/feature_articles/dodgy_el>>>


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By John Wilder
From Las Vegas, NV
Jun 21, 2013

I have chronic tendonitis that I manage fairly well with semi-regular visits to my chiropractor for ART and Graston work. I also use contrasting (hot and cold water baths) on my elbow when needed. Do lots and lots of opposition work (push-ups every day, lots of them).

The opposition seems to work best in terms of maintenance once I initially recovered. About every 4-6 months i get a flare up and need to go see the chiro. Sometimes i can deal with hot and cold water alone, but theres no substitute for that graston.

In terms of how i manage it from a climbing perspective- i try to lay off any kind of campus work, or feet cutting unless my arms are feeling really good and i'm in super good climbing shape. Otherwise, its strictly feet on stuff. All open handed crimping. Initially i stayed off the overhangs as much as i could (tough in my gym where 95% of the terrain is overhanging). Got into it easy- about 3 number grades below my original threshold. Took almost 2-3 months, but i got back to where i was and have been successful in exceeding where i was before. That said, I can tell that at this point, where I am is likely where i'll stay from a numbers perspective. Anything harder and i'm going to get re-injured because harder means nasty crimps that i need to wrap my thumb on, campus work, etc, etc- all stuff that is going to put me at high risk for re-injury.

I think the best part of my recovery was re-discovering the joy in easy climbing. I also discovered that if i dont climb and dont do opposition work, my tendonitis flares more easily.

YMMV, of course.


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By thedogfather
From Las Vegas, NV
Jun 21, 2013

I was plagued with elbow tendinitis for several years. I wore one of those compression straps for a long long time. I have not had any issues for the last 2+ years. I do hangboard twice a week and climb in the gym or outside once or twice a week year round. I do antagonist muscle work semi-regularly i.e. probably once a week of push ups or bench press and flys.

So, how did I get better and not reinjure? Maybe coincidental but, I started religiously taking glucosamine. After I started, my tendinitis cleared up in two to three months without any layoff from climbing. I only take one a day but almost never miss. Now I take that and tumeric.

Take it with a grain of salt but I never stopped climbing and my hangboard routine incorporates chins and sometimes weighted chins. (ask my wife - she complains that I almost never take a day off from some sort of training - climbing, hangboard, running, rowing, lifting) Oh, I am 63 years old. I don't pull down very hard but can redpoint low 11's and onsight most mid 10s and did 104 routes in 24 hours at the 24 Hours of Horseshoe Hell last year.


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By matthysj
From Las Vegas, Nevada
Jun 21, 2013

Lots of Vegas replies here...
I've been out of climbing with medial epicondylitis for about 6 months (since December 2012). At first the pain was severe enough that holding a glass or daily hygiene activities (brushing teeth, washing face) caused a cringe. 6 months later I am maybe at 80-90% recovered. I put in two hard days of climbing last weekend and this week my elbow has flared up, but each subsequent flare up is less painful and shorter in duration.
Here is what has worked for me:

1) Rest... for me that meant no climbing for 3-4 months (visited the gym a few times and did some hands free slab walls), and stopping upper body exercises that included my elbow (curls, lat pull downs, etc...)

2) Be diligent about doing the dodgy elbow exercises. I do the exercises about 5-6 days a week. They usually take 25 minutes to complete. I start with the eccentric wrist flexion (from dodgy elbows) exercises. At the beginning I was using just 5-10lbs of resistance doing 3 sets of 10 (lower for 8-10 secs for each rep). I slowly went up in resistance as my elbow improved (currently at 20-25lbs). I follow this up with the pronator exercises (3 sets of 10, 10 sec rep). Again, I started with a light weight hammer and have moved up slightly in resistance as my elbow has improved. Finally, I like to end the workout with reverse wrist curls (4 sets 20 with 5lbs). This strengthens the opposing side of the forearm, but most importantly for me it stretches out the medial tendon. The first two exercises cause me slight discomfort when extending my elbow, and finishing with the reverse wrist curls will stretch the tendon and alleviate the discomfort.

3)Extensor and flexor stretches 2-3 times a day for 20-30 secs

4)Ice for 5 minutes on and off for 20-30 minutes a few times a week. This felt good for me because it would introduce blood to the area when the ice is off.

5)Trying to change my climbing style and improve technique. A sore elbow is a great way to rely on foot work, balance and body position rather than upper body strength.

The above activities have worked for me, but I am not a doctor and your results may vary

Other things I have tried and did not work, or I did not stick with long enough to work:

1) Cross Frictional massage...It did make my elbow feel better, but it is difficult to do effectively with your off hand

2)I bought an elbow strap that clamps down over the tendon. I didn't really buy this for climbing. Mostly for house chores, and so my wife wouldn't give me shit because my elbow hurt too bad to vacuum.

Also, 1 very important thing. STAY POSITIVE!!! It can be depressing not being able to enjoy an activity that makes up a part of your life. My elbow would start feeling better, and then out of no where (maybe slept on it wrong) start hurting like hell. This is challenging because you think you are on the road to recovery and then you have a setback, so stay positive and diligent about the exercises.


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By David Raines
Jun 24, 2013
Legacy (5.11a), Endless Wall, New River Gorge

Hey - thanks everybody for your responses. It sounds like there are other people out there who get stuck with loooong recovery processes. I've got a doctor's appointment Wednesday, we'll see what happens after that. Thanks!


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By slim
Administrator
Jun 24, 2013
tomato, tomotto, kill mike amato.

in the past (between 10 to 15 years ago) i had a fair amount of elbow tendonitis. one thing that i found didn't work - taking a bunch of time off. i know this seems counterintuitive, but when i would take a bunch of time off the tendonitis would go away. however, it would return almost instantly when i started climbing again, despite trying to get back into it slowly.

what i have found over the last 10 years is that i do better if i just tone it down a bit, but still climb. this goes for tweaked fingers as well as elbows and shoulders. i have had strained pulleys in my fingers, strained tendons in my forearms, occasional elbow tendonitis, torn labrums in shoulders, shoulder tendonitis, upper bicep tendonitis at the shoulder, arthritis in both shoulders, etc, etc, etc....

i know i will probably get blasted for this, but i think stopping climbing cold turkey isn't the way to go. a steady PT plan (stick with it permanently for maintenance) and light climbing - that's worked really well for me.


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By Jon Powell
From LAWRENCEVILLE GEORGIA
Jun 25, 2013
stone depot

Mine was pretty bad and 2 years later I have almost no issues with it. Train smart and you can fully recover from this


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By David Raines
Jun 25, 2013
Legacy (5.11a), Endless Wall, New River Gorge

Not quitting climbing in the first place would have been smart. If I had dropped down to climbing 1x a week, and staying <= 5.9, I could have probably worked through it in a month or two.

Instead, I quit climbing entirely (I was burned out anyway, after a long, hard, successful season), but kept lifting. I tried a variety of schemes to "work around" the injury (ring pullups instead of pullups on a straight bar, dropping pulling motions, but keeping pushing motions), but all of them backfired. At one point, after I couldn't lift a barbell any more, But instead of all that, I should have just chilled out and done some light climbing until things got better.


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By David Raines
Jun 25, 2013
Legacy (5.11a), Endless Wall, New River Gorge

Yeah, Jon Powell, I think I'm young enough yet that my tissues can recover from this. It will probably just take a long long time, and in the meantime, I need a new hobby. :)

If I'm not spending every day thinking about when I can return to climbing, maybe I can start making better decisions about my rehab.


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By Rohan de Launey
From South Lake Tahoe
Jun 25, 2013
Luther Spires

Long Moderate free soloing, up to 5.10 slab, and lots of eccentrics twice a day plus stretching out good 3-4x a day..biceps triceps and forearm. Does wonders for the lead brain and really dials in your smears.. Have had elbow and forearm issues in both arms for just about a year. Started this program 2 months ago after nearly 9 months of not climbing and going to PT's. have been slowly able to do more and more. I have found that expecting to be pain/irritation free is unrealistic, you will climb, it will hurt a bit, do your exercises and it will feel better in a day or two, climb again. Slowly slowly getting better. Rest doesnt get it done. IMO if you can afford it seek out a recommended climbing PT who has fixed elbows before!!


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By Kiri Namtvedt
Jun 25, 2013

I went through this a couple of years ago; I had ever-worsening elbow tendonitis, saw a physical therapist who gave me some advice and stretches. Nothing was really helping until I saw a chiropractor and had my elbow adjusted! The combination of a series of adjustments along with making a conscious effort to not sleep with my arm curled under my head did the trick for me!

PT, massage, etc did not seem to be helping.


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By JohnnyG
Jun 25, 2013

Try one week of a) complete rest--no lifting, or bike riding, or climbing, or stretching...just rest it! b) regimented icing c) lots of ibuprofen or other anti-inflammatory d) good nutrition--for some reason I favor red meat. Goal is to get the inflammation to go away which will allow healing.

Next week slowly build in some movement. A few pushups, some hanging, wicked easy boulder problems. Easy range of motion things. Very gentle stretching. The exercises should be dirt easy, like you didn't even get a workout. Goal is to get a little bloodflow in there, but not stress anything.

Next week build up a little more. Stress the tendons a little. By the end of this week, you should be back up to normal. On the forth week you will be cranking after a good warmup.

I suffered for a couple years of on and off tendinitis--it really limited my climbing when I was young and lived in yosemite. Total bummer. Finally this 3-week regimen worked for me. It turns out I wasn't really resting when I though I was resting, and I wasn't building back up slowly afterward. Eventually I figured out this regimen, and I had to do this regimen a few times over a few years when I had a flare-up. Now I never have problems, and I'm climbing stronger than ever.

Sometimes it can seem daunting to take a whole a week totally off, followed by a wussy week, and then a wimpy week. But it's nothing compared to the months you've been stymied so far.


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By stredna
From PA
Jun 25, 2013
Top o' the Preist

well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-te>>>

Bought a green theraband after reading the above article (also mentioned earlier from a previous MP post HERE and use it 3 times a week when climbing 4 days a week. I just do 3 sets of 10. Remember when your using it that you're supposed to be stretching not pulling it, so stretch it slow and easy.

Also reverse wrist curls get thrown into the mix.
I do not ice or heat.

I still feel the elbow pain, but very seldom and only when I've been hammering it. The pain possibly returns when I flake out on my excersizes. But for all 'intense' purposes, the pain is gone!


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By John Keller
Jun 25, 2013

I'm also among those who've had problems for a number of years. The initiation and initial attempts to manage sound very much like yours. Over and over I would recover well enough for the day to day but any serious attempts to regain strength and form and it was back to square one.

Getting desperate after several years, I tried dry needling. It's intensly painful but works extremely well. It's become so popular that PTs all over the front range and elsewhere have been picking up the practice. I've been using it off an on for several years now.

The idea is that tendons don't heal well because they dont' get much blood flow. All the descriptions of serious deep tissue work of various kinds are attempts to increase blood flow and break up scar tissue. The dry needling makes micro-traumas that force the body to increase blood flow to the affected area. When its done to tendonitis, it helps heal the existing injuries.

It's been working for lots of people and is totally worth trying.

Luck


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By John Keller
Jun 25, 2013

To add to my previous post, I had tried pretty much everything that has been mentioned, cross friction massage, straps, various specialized exercises, 6 months with a pt hand specialist. My feeling is that it all worked up to a point but it was a point that I couldn't seem to get beyond until the addition of the dry needling. I don't need the strap anymore, still ice pretty often, do a bunch of the eccentric exercises (all from my pt) and get needled only periodically when I've pushed it too far. I am slowly working back up towards previous form. Don't know if I'll get all the way but after years of not getting anywhere, I'm finally making progress and the only difference is the needling.


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By Jeff Thilking
From Lynchburg, VA
Jun 25, 2013
Rap

As a therapist at a local PT clinic, we have good luck with ultrasound for that specific condition. I think for the most part, ultrasound is a pretty ineffective treatment, but seems to work great for tennis elbow. FYI, just in case you get referred to PT.

-Jeff


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By David Raines
Jun 25, 2013
Legacy (5.11a), Endless Wall, New River Gorge

John Keller - I hate to hear that you're perpetually stuck like this. :(

Two questions:

Q1)
If I could ask, how far have you recovered? What have you been able to start doing since you took up dry needling? Even if you've just been able to handle bigger weights in PT, that would be worth knowing.

Q2)
Also, how long would you wait after being strong enough to do day-to-day stuff without pain, before you tried climbing or more strenuous activities again?

For me, the answer to Q2 was "about a week". But I have a theory that if, after I'm back to pain free day-to-day activities, I gradually increased my weights over a period of a year or more (say, doing a cable row at a single plate, then adding a 1/2-1 plate a month until I'm rowing about my bodyweight, likewise with bicep curls and tricep extensions) that might give my weakened tissue time to regenerate. Maybe also getting periodic tissue massages and dry needling, whatever else.

Thanks.


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By Jeff Thilking
From Lynchburg, VA
Jun 25, 2013
Rap

JLP wrote:
So - correct me if I'm reading these posts wrong - you pull on a whole bunch of weight in just a few isolated directions, get injured, screw around between doing nothing and playing with weak little rubber bands and chick weights for a few months (PT - designed for old people), then go back to what you were doing - wrong - and - surprise - you end up injured exactly the same way? I suggest Crossfit!


PT has many different target groups, not just old people. We deal with a large athletic/sports medicine population. Crossfit is awsome, but prob won't do shit for someone with this issue, and will prob cause more issues. At the same time, I'm not going to waste someones time in a PT appt. when they can do most things on their own. One or two visits to try some ultrasound or friction message, and you can take care of the rest. If it doesn't help, thats cool man, try another method. But it was a good try without much wasted time.

"IMO, most climbers with chronic shoulder and arm injuries have weak core and upper bodies. It will take several years to fix that."

I think this is a great point and generally the case.


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By John Keller
Jun 25, 2013

David,

When I first really injured it, I was in pretty bad shape. In my case it was a serious overuse injury rather than a specific trauma. I had 'pushed through the pain' for too long and, once I admitted that I was fucked, it took something like 6 months of serious work with the PTs (ultrasound, massage, exercises, etc - all before dry needling was in use) before I got to regular day-to-day without pain. I also did some alignment work with a chiro cracker that helped (find a good one who works with athletes and will do focused work rather than those that say you need regular full body stuff).

For me, it's the flexor tendon attachment at the elbo for the ring finger (pretty common I think). Turns out that that finger is a 'control' finger for all kinds of other activities (ski pole movement, road bike hood grip, etc) so even though I wasn't climbing during the serious work with the PTs, I had to learn that there were lots of other activities that caused continued pain. That sucked, as you can probably imagine but I gained a ton of cool balance and leg work while doing an entire season of backcountry skiing with minimal pole use. ;-)

The problem then was that plateau. Even though I was good on the day to day and not working with the PTs any longer, it was really really easy to re-injure. So I couldn't push to gain strength back and could only climb easy stuff that didn't require much pulling. That was the case for several years, really. It wasn't until another PT friend suggested the dry needling that I was really able to start pushing again. I'm a bit of a old fart so the joints are gettin old anyway and I suspect I may never fully recover. But I'm climbing much harder than before the dry needling and working my way back up to where I was. But I still gotta take care of it regularly.

Good luck.


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By David Raines
Jun 28, 2013
Legacy (5.11a), Endless Wall, New River Gorge

Thanks everybody.

FWIW, I saw the orthopedist again on Wednesday. He thinks that, despite my best efforts to the contrary, there's nothing wrong with me that more rest and home PT won't fix. I should start with 2lbs dumbbells, and build slowly from there. I should be "uninjured" in 5 months or so, and able to continue along with a gradually increasing load in my exercises until I return to full strength (which may take many more months).

Triggerpoint needling was an option if I wanted it, but he didn't seem to think it was necessary / mandatory.

He also recommended that when I go back to compound upper body work, I focus on cable rows instead of assisted pullups, because I can start the rows at a significantly lighter weight.

Also, he thinks that one of my problems is that the months of isolation PT exercises have reprogrammed me to be "arm dominate" when I try and do assisted pullups, and that as I start doing (light) cable rows again, I need to remember to focus on using my back instead of my arms.

The big change I'm going to make is to not try and "jump" strength levels again, but continue along slowly and gradually, and try and accept that it'll just take a while.


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By slim
Administrator
Jun 28, 2013
tomato, tomotto, kill mike amato.

JLP wrote:
So - correct me if I'm reading these posts wrong - you pull on a whole bunch of weight in just a few isolated directions, get injured, screw around between doing nothing and playing with weak little rubber bands and chick weights for a few months (PT - designed for old people), then go back to what you were doing - wrong - and - surprise - you end up injured exactly the same way? I suggest Crossfit! Your problem won't be solved by doing just a couple things for a couple months. IMO, most climbers with chronic shoulder and arm injuries have weak core and upper bodies. It will take several years to fix that.


Totaaly agree. My wife has had back issues for a long time, but hasn't committed to a strength program. Surprise surprise, she hasnt gotten better. Drives me crazy.


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By Will S
From Joshua Tree
Jun 28, 2013

Sounds like most of my 20s, something was always flared up or torn.

I'm with Slim, just resting hasn't been the best for me. My best recovery results have been from doing maybe a week or two or rest, then just cutting way back on vol and intensity, while still climbing on it and gradually increasing back to prior levels over the course of months. Also, doing all the supplemental exercises is extremely important for me.

And stop doing pullups. Seriously. Full-on elbow wreckers IME. I can climb and boulder at project level and almost never have elbow flare- ups. But put me on a pullup bar for 2-3 sets to failure, and by the 2nd or 3rd session of that, my elbows will be screaming.


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By Donald Kerabatsos
Jun 28, 2013

Lots of other things could be wrong other than core and muscular balance. Poor diet and binge drinking can have effects on tendons recovery. Bad sleeping positions (sleeping with your elbows bent and weighted, sleeping on your shoulders) can effect your tendon recovery. Shitty climbing technique (poor crimping can effect elbows, 'bouncing' too much can mess things up).

Slim and others are right man. You have to work through it with a balanced workout, nutrition, and technique reform. You can't just wait for it to go away and hope it to be different next time.


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By Tom Allen
Jun 28, 2013

I've had tendinitis of both my medial epicondyle and my brachialis in both elbows, though not nearly as bad as you're describing. I'd like to second two things said upthread:

1) Eccentric exercises help. In my experience you have to find the motion that hurts, then do only the lowering portion of that exercise. For medial epicondylitis, I grab a pullup bar in a crimping position, pull down with my arm, then allow the crimp to extend into an open-hand grip and finally push my wrist into extension. I wish I could control the load more carefully for this, but the typical exercises (eccentric wrist curls and pronation with a frying pan) aren't as effective for me. For the brachialis, I do palm-down biceps curls, lowering a dumbbell with one hand, then lifting the weight with both hands, plus a little momentum from my legs. In my experience, the load has to be large enough to hurt a bit: for a while a 10 lb. dumbbell was enough, but as I got stronger it quit working. I got a 15 lb. dumbbell, which worked.

2) Recovery might involve some total rest, but the more important part is the gradual reintroduction of activity. Rest will never get to to a point where you can just pull hard again - you have to start slowly and gradually increase loads.


Definitely check out Julian Saunders regarding eccentrics, and Dave MacLeod on rest and recovery.


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