Isometric hangs for elbow tendonitis

I have seen multiple mentions of isometric holds on a pullup bar for rehabbing an elbow tendonitis (golfers). Ollie Torr mentioned it in two of his Nugget podcasts, stating he had never gone wrong giving this plan out to be people. He specifies ("30 second hangs, palms facing out, elbows at 90 degrees" with 3 minute rest, for 4 reps) followed by the same except palms facing you. He then says rather generally, to do it as many times throughout the week as possible. Separately, Eric Horsts page on elbow tendonitis mentions a similar isometric hold on the pullup bar, with elbows 90 degrees, but with a "neutral grip" or palms facing each other on the bar. I have been trying the protocol Ollie had mentioned for about a week and it feels OK, but my elbow ends up a bit achey after doing it. Curious if I am actually delaying my recovery by doing this? Not sure if this is intended more for a prevention/strengthening when you have zero pain, or intended to build up strength during recovery while you are still dealing with some inflammation/discomfort. Anyone have experience with these excercises?

Not a medical professional. But my PT generally says for exercises for tendon issues that pain up to 3/10 is fine, and it means that you're adequately stimulating the tendon enough for proper healing.

I experimented with this in the past year for a very stubborn bout of climber’s elbow.

I ended up not getting too much out of it, but it can also depend on how/where you’re injured. So it’s worth trying, being careful not to go overboard. The 3/10 advice above is good.

For me, I needed a lot of the Armaid, a lot of stretching, and a lot of reverse supination hammer drills. In that order, for months.

It really depends on what is causing the issues, whether easy climbing on it's own would help. For me, my muscles really like to create knots, get excessively tight, and often cramp, even with good hydration and plenty of stretching and yoga. Still, when I went in to the PT for my elbows, he said that the muscles on my forearms were some of the tightest shit he's ever seen. I've been slowly getting better, but a pretty important part of that has been a lot of soft tissues work - pretty much "foam rolling" with a therabar everything in my forearms every day. Just continuing to climb would definitely have not been helpful for me.

Dave Macleod does a good job explaining elbow and other injury / overuse issues in Make Or Break.  It's been really helpful understanding and dealing with tendonitis versus tendinosis versus tendinopathy.  Almost done reading it.  Interested in a used copy?

here's another resource in case you want it: https://drjuliansaunders.com/dodgy-elbows/

mike p wrote:

Dave Macleod does a good job explaining elbow and other injury / overuse issues in Make Or Break.  It's been really helpful understanding and dealing with tendonitis versus tendinosis versus tendinopathy.  Almost done reading it.  Interested in a used copy?

He's also got an hour long YouTube video specific to golfers elbow. In summary, his approach is frequent, high volume, heavy eccentrics. In my experience this approach works.

I dealt with this issue for months, and after hitting rock bottom, I finally got serious about recovery. My experience was very similar to Charlie's (above). The isometric hangs didn't do a lot for me. What worked for me, and quickly, was reverse supination hammer drills. I took the weights off of one side of a dumbbell, and lowered it down to both sides, a million times a day. Never went above 4/10 on the pain scale. And I kept climbing.. pretty soon after, the elbow pain was gone and hasn't returned, and I continue to do those exercises as part of my workout. My suggestion: make the weight heavy. You gotta strengthen your way out of this issue... good luck!

Eric Metzgar wrote:

My suggestion: make the weight heavy. You gotta strengthen your way out of this issue... good luck!

This part is worth repeating. It's gotta be heavy to work. You see demonstrations like the image above with a 2 lb hammer. That's not going to to do anything. Here's my setup:

I also do the wrist curl eccentrics with a more conventional dumbbell. Again, heavy is key.

Golfer's elbow is extremely frustrating ... I remember wishing I could just cut open my arm and pinch the tendon directly.

Here's what worked for me.

- Reverse wrist curls (seated, balancing wrists on knees, palms-down). 2-3 sets of 40 reps; I use 30lb dumbbells.

- Tyler Twist and Reverse Tyler Twist exercises on a generic Flexbar. 

- Finger extensions with a broccoli rubberband or Metolius grip trainer with finger holes

- Armaid or soup can trigger point massage

- And to keep everything else in balance: pushups, dips and military press 

The Flexbar is easy to bring to the crag and you can do the exercises as you're hiking the approach. The off-brand ones are cheap and functional.

The hammer drill picture makes me wince. The reason I have elbow tendonitis is from that movement done hundreds of times a day, from washing baby bottles. Climbing probably didn't help.

So, perhaps strengthening the muscles is key, not doing hundreds of them unweighted in the span of 5 minutes.

Still though, ugh.

Warming up properly and stretching while still warm is something to keep in mind as what to do to keep the elbow problems from coming back or ever happening in the first place.

As far as recovery goes, Fritz nailed it. Those hangs mentioned at the top sound like something one might do if the pain was minimal/just starting, certainly not many PTs would have anyone start out doing those hangs.

The summer before last, I ended up with golfers elbow in my right arm two weeks before a trip to Alaska to fish and climb.  While there, the discomfort got worse, then started in my left elbow.  An orthopedic surgeon stopped by the fly shop the week after I got back - I helped him choose some fly tying gear and picked his brain about my elbows.  He laughed and asked how old I was - I said I just turned 50.  His advice - don't over do it, keep using your arms, but don't do anything repetitive like casting 200+ times a day - the pain will go away in a year.  I noticed the absence of the pain a few weeks prior to heading to Alaska this past summer.  His explanation was, if you lead an active lifestyle, you'll have issues somewhere around age 50.  I'm getting back to pull ups and the hanging strength I had in my mid to upper 40s, but am taking it slowly.

The most convenient pre/rehab solution I've found is only 12 bucks on the evil empire (25 pound resistance). I'm using it right now walking home from the gym.

F r i t z wrote:

The most convenient pre/rehab solution I've found is only 12 bucks on the evil empire (25 pound resistance). I'm using it right now walking home from the gym.

Doing reverse Tyler twists with this thing every day cured my elbow issues when I had really bad golfers elbow.

Same, I dabbled with most of the other suggestions but most effective thing for me was the therabar Tyler twist 

Awesome, thanks for all this feedback. For those that supplemented their rehab with the therabar reverse tyler twists .... how often per day, how many days per week, etc did you guys use it? 

Connor Brass wrote:

Awesome, thanks for all this feedback. For those that supplemented their rehab with the therabar reverse tyler twists .... how often per day, how many days per week, etc did you guys use it? 

I did 1x a day, 3 sets, and 5-6 days/week. Eventually I moved from flexbar stuff to weights. Reverse wrist curls, finger dumbbell curls, and the dumbbell hammer curl. I found that I eventually could not progress further, at least with the flexbar I had. I know there are different 'resistances' to the flexbars but I found it to be best to find weight exercises that I could replace the flexbar exercises.

Connor Brass wrote:

Awesome, thanks for all this feedback. For those that supplemented their rehab with the therabar reverse tyler twists .... how often per day, how many days per week, etc did you guys use it? 

I use it on my five minute walk to and from the gym. With a 21lb generic flexbar, I do a sequence of the following:

- twenty reverse Tyler twists

- twenty elbow bends (squeeze the bar into a u-shape)

- twenty reverse wrist curls with the bar braced against my hipbone parallel to my femur

- twenty elbow bends in the opposite direction.

 Then I switch the side-specific exercises to the other hand, but mostly I focus on my left because it's my problem child.

I get through one set on each side, plus a few extra tylers on my left.

----------

When I get to the gym:

- 25 pushups

- [40 reverse wrist curls with 30lbs if I for some reason didn't flexbar on the walk, skip if I did)

- 2 sun salutations

- 15 reverse bicep curls with an unloaded preacher bar

- 15 dips

- Light hangboarding for a total of sixty seconds under tension

Then repeat the entire sequence, if time allows.

...

With all that said, sometimes I intentionally don't do any off-the-wall warmups before a gym sesh so that I don't become psychologically dependent on my warmup sequence. Sometimes outdoors you don't get the luxury of warming up your fingers and elbows.

Connor Brass wrote:

I have seen multiple mentions of isometric holds on a pullup bar for rehabbing an elbow tendonitis (golfers). Ollie Torr mentioned it in two of his Nugget podcasts, stating he had never gone wrong giving this plan out to be people. He specifies ("30 second hangs, palms facing out, elbows at 90 degrees" with 3 minute rest, for 4 reps) followed by the same except palms facing you. He then says rather generally, to do it as many times throughout the week as possible. Separately, Eric Horsts page on elbow tendonitis mentions a similar isometric hold on the pullup bar, with elbows 90 degrees, but with a "neutral grip" or palms facing each other on the bar. I have been trying the protocol Ollie had mentioned for about a week and it feels OK, but my elbow ends up a bit achey after doing it. Curious if I am actually delaying my recovery by doing this? Not sure if this is intended more for a prevention/strengthening when you have zero pain, or intended to build up strength during recovery while you are still dealing with some inflammation/discomfort. Anyone have experience with these excercises?

Connor I've been on a PT rehab plan for elbow tendinitis for a few weeks now and it's really making a difference. I do the pull ups, chin ups, neutral grip, push up position, and incline pushup position all holding at a 90 degree bend for 20 seconds for 2 sets each. In between all of that I hangboard on 2 pad grips 10sec on 3s off for 3 sets while only hanging off like 50% my body weight (feet on the floor light pull with scapulas engaged). I can send you the training plan if that sounds at all interesting to you. At the end of the day, I'm finding strengthening vs. Shying away has been my mindset shift with this rehab. 

For those of you doing the reverse Tyler twist for golfers elbow, did it trigger the underlying pain when you starting doing it?