The Real Reason Elbow Tendonitis Keeps Coming Back

Posted on January 2, 2023

To watch the full video, click here: https://youtu.be/ppOKif5rMCU

Hey there coaches and athletes. I’m Michael Hughes functional movement specialist and CEO of Gymnazo Edu. Today I’m going to be breaking down tendinitis of this thing called the elbow. I’m going to talk about the three deeper root causes of tendinitis that aren’t focused on the arms, I’m going to dive deep into the biomechanics of each one of these different segments, show you how to identify a cause, and then give you a few solutions that you can test out with your own clients in your own athletes. Before we get started, though, please make sure to subscribe to our channel for more of our content, where we focus on the root causes of movement and dysfunction, and give you strategies on how to think not just what to think. Alright, so 10 is of the elbow is a pretty common thing that I see with athletes. And it’s gained its name from athletes who play golf and play tennis, but can also show up when people are trying to grab just basic household things or just daily life activities. So what is the standard protocol for treating elbow tendinitis? Well, if you look back and look at all the research, and all the things that are coming out in the YouTube videos, or anything that’s been traditional treatment, it’s rested, don’t do that activity anymore. Maybe put some eyes on it to calm down to localize inflammation, or strengthen the direct area. And I look at all those possibilities of treatment. And I’m like, which one of those actually talk about what’s really going on? Because really, this is just the site of dysfunction. Think about it like this, you’re living in a house, you have a drip from your ceiling. The problem is really the fact that you have a puddle on your floor. So if I just go grab a bucket, put it right there. Am I saying up? My problems fixed? Look at that. I rested it, put some ice on it. And it just didn’t do I just didn’t step there anymore. Problem fixed. No way, you’re like, No, you gotta go to hold your ceiling. But if you know anything about houses and fluid dynamics of water, right, it follows the path of least resistance physics, right? You know that there could be literally a hole on the other side of your roof, but the water is following the path of the rafters and the beams and the two by fours. Because it’s going downhill, the path of least resistance? Well, it’s just basic physics. But we think of a problem always what we see, I don’t blame people for doing that. But as a movement practitioner of one who wants to be specialized in Chain Reaction biomechanics, we have to think about the deeper problem ahead of us. And that’s what we’re going to be doing in this video. So let’s do a few definitions. It’s kind of be on the same page, what we’re talking about, okay, the big, big picture. So the lateral epicondyle dial of the elbow is essentially tennis elbow. And that’s because it’s typically been felt on this type of motion pattern or backhand in tennis, the medial epicondyle of the elbow is typically called golfer’s elbow. And that’s because it’s typically felt as you come through on a right handed athlete, let me say, come through, and pain. And typically those types of activities that are sporting activities, full body motion patterns, that’s honestly the issue is with the full body, even though the pain is here, and here, it’s typically the full body, that’s where we’re gonna help solve this problem of not treating the localized area, is it bad to treat the localized area, it’s not bad, it’s just not going to give you the long term effects that you were really looking for to superly solve the problem. However, there are localized issues as well, like if it only hurts when you grip, like it only hurts here and here when you grip, then yes, it could be a localized problem. It could be just forearm, just upper arm and treating those two areas with the protocol that’s been out there, it can help. But again, we’re looking at truly understanding where the root problem can totally come from. And in my experience, some of the other super common causes for elbow tendonitis have to do with the thoracic spine has to do with the hips and have to do with the ankles. So I’m going to break down what’s going on biomechanical in each of these areas, how to identify whether it’s a strengthening, or lengthening issue, or a stability or mobility issue, and some example exercises that you can perform to help alleviate or eliminate the pain entirely. Let’s kick it off with understanding what’s going on with the thoracic spine. So, if I’m in tennis, right, I’m gonna, I’m speaking from a right hander perspective, if I’m going in, I’m going going through back into my loaded swing here to really to rally through that ball to hit to hit or if I’m grabbing something in my house from across my body and grabbing it and bringing it across what’s going on. From a localized standpoint, my shoulder next joint up is going through horizontal abduction, which means it’s coming across the midline of my body. My scapula is going through protraction it’s really reaching across and kind of sneaking around my ribcage. And what’s happening is based I got the tricep connective tissue just to keep it very, very simple. I got my posterior deltoid of the back of my scapula muscles on my rhomboids, all lengthening through a range of motion. Now again, there’s a lot more details later, but they’re basically just going through a lengthening phase. And then from there, they need to power up and then basically shorten and then go through a power swing. Well, what happens when my arm comes up all the way across my body? I also get thoracic spine rotation. Fair enough. Okay, what about from the medial side? Let’s call it golfer’s elbow right? Was a come through again, for honor rights, right handers that come through on my backswing, what am I getting? Well, from a localized standpoint, I’m also getting kind of a deeper aspect of the tricep, even some bicep even though my arms flexed a little bit. So mostly tricep coming through, I’m getting through my front part of my anterior deltoid, getting through my pec major and minor, I’m getting my my humerus to go through essentially the opposite pattern that I just had. So I’m gonna call it a horizontal AB duction. Just to keep it simple. I’m also getting some some basic relative lifting in it. So I’ve got some other planes of motion going on. And I’m also getting my scapula to go through essentially the retraction phrase. So I’m getting get pulled back and rolling across the ribcage. And then I’m also getting major thoracic spine rotation definitely plays into it. So how do I figure out if it’s a strengthening or lengthening issue? Well, from a strengthening standpoint, I’m gonna use this phrase over and over again, we want to see if the sequencing of power production is in appropriate sinking, right? We want to know like, are they just hitting with the entire arm? They just go in here and whacking it? Are they actually feeding through their thoracic spine. So that’s the first thing I want to see if they’re not doing that just start to teach better sequencing. If they are doing that, then we’re going to want to start strengthening the muscles through the thoracic spine. And I’ll touch that on a little bit later. So but just think about strengthening issue. Can they sequence appropriately lengthening issue, I want to see if their thoracic spine especially with lateral epicondylitis, or tennis elbow, are they getting good thoracic spine rotation to the left, through the left? Now again, this is for the right handed tennis player or pain with the right or outside, right on the lateral side. Because it’s not always about tennis. In fact, you’re gonna see more clients who that don’t have it with tennis, in particular, just normal lifestyle. But can they get good thoracic spine rotation, and I test that by having them sit down? And even if you don’t have anything to sit down on, even sitting down on the floor, and crossing arms across the bottom, say, can you rotate to the right and see how much thoracic spine rotation goes right? Then how much goes to the left, you have to view that and see are they stuck limited going to the left. And if they are, you’re like, Okay, sweet, I got something to work on. Because they need to lengthen through that connective tissue to gain the appropriate power that they’re not getting. And therefore it’s sending a stress signal all the way down to the weakest point or the where the path of least resistance goes to. And that’s how a typical understanding of a lengthening issue or mobility issue can lead to outside or lateral elbow pain. So what do we do about it? Well, we like to think about it from three different possible solutions. Now, not all of these are necessary, but it’s certainly a stepping process to help you critically think about what’s going on. So we’re gonna think about it from a soft tissue component from a stretching component. And then from an exercising or strengthening component, soft tissue lengthening, strengthening, say that again, soft tissues lengthening, strengthening, if you can follow those three different paths, understanding how the whole system works together, that’s going to be very helpful formula, in a sense, not really formed, but a way of thinking to allow you to accomplish a lot of problems with movement dysfunction. So what I would do, I would grab onto a foam roller foam foam ball. And because I cannot rotate to the left very, very well, I’m gonna have to think about, well, what side of my body is actually needing more lengthening? What’s actually going to be my right side, because I can’t go to the left, what allows me to go left my right side, sort of grab onto a ball foam roll on the ground, onto a wall, whatever the case is, and put that tissue, put that ball on that tissue and start to do some myofascial release to get me more unlocking of that connective tissue. Now, where are you going to go will you be purse gonna go on the intercostals,

you’re gonna go on the on the latissimus dorsi. The lab, there’s a bunch of other muscles in that relative zone, but the fascial chains of that area, and you want to lengthen them out. Now if you want more information on how to femoral appropriately we have other videos on that as well. But let’s just keep it at that for now. Now from a stretching component, right, I want to be able to think about as I’m going through this pattern of rotation, there’s two primary motions that I’m going through I’m going through rotation. I’m also going through lateral flexion And you can see as this shoulders lower than this shoulder. So what I want to do is maybe grab on to, if you have a, if some sort of kind of holding on pattern like you know, have you have stretching cages, which is totally fine. But it’s something you can grab onto, to pull you into left rotation, and to start drive in your pelvis in the opposite direction. Again, there’s multiple ways how to stretch this, I’m just showing you one. And we’re just driving through the body, holding on to that position to hopefully give myself more range of motion to my left side. And you can hold that position and drive your pelvis forward and back, hold the position driver, pelvis laterally, there’s a lot of different techniques. But just more that I want you to think about how to think about it. But also want to think about rotation to the opposite. As I’m going route rotation one way, I want to think about the lean to the opposite side. So as I’m fumbling both my lateral trunks, I want to think about how do I stretch out that side as well. So I can reach over the top, slide away, spin away, because as the rotation needs to come from my right side, that lateral flexion needs to come from my left side. So I started to think about how I can get that going. If you’re not really sure how to think about that one, just think just get after both sides, help them rotate one way, help them rotate the other way, help them get one side help them get the opposite, free up to thoracic spine, any way that you possibly can understand that

it’s always going to feed. And we always want to train as much as we possibly can the full person, not just a localized pain. Now, as we’re going about strengthening, how do we bring more sequencing and power through that spot? Well, we like to think about it from two major techniques, even those many is the fact of coiling. And quitting is a very fancy, cool word to think about, I’m going to draw my body to one side, lengthen through what I just did stretching, and then produce a lengthening, which produces a loading to the opposite side. So as I lengthen, I’m going to load to this side, and I’m going to explode out of it. So think about elbow to back pocket, other elbow lift. And from there, I can start to think about that pattern of contracting through my lateral core, through my thoracic spine versus through my arms. If you want to load that up a little bit, we can think about in a different way. We call it type one or type two spine movement patterns, which I want to take my body and think about, how am I going through that backswing. Exactly? Well, I’m reaching one way, and I’m essentially leaning the opposite. So if I load it up, I can power it through and lengthen and then through my trunk, I’m driving through this part of my body, my arms are just holding on, as they’re just basically just levers to create this huge whip through a racket or through anything that I’m just grabbing on to it. The key is to get this to become more engaged, and less gunky. Again, the techniques are pretty much limitless. But it’s the understanding of the strategy that I want you to think about is it’s a two phase pattern, it’s rotation, and lateral flexion. There is also flexion extension involved, but the first two and the frontal plane and transverse plane are the primary two that should be focused on. Okay, so that’s the thoracic spine as it relates to elbow tendinitis. A quick little check in Okay, are you bit lost? Or have you had a bit of an aha moment? Let me know where you’re at in the comments below. Let’s go into how the hips can plane to the elbow. Now again, the process is relatively the same. So I’m going to go a little bit faster, because you’re going to understand the same outline that I’m going to be going through as a way of how to think not just like here’s an answer, here’s an answer. So as I’m going into this same point, I’m gonna go from the lateral the top elbow first, as I’m coming from a right hander, as I’m spinning my arm, through my scapula through my threat, thoracic spine. Now keeping all those things the same. As I rotate into it. What is happening at my left hip, was I’m coming back, grabbing and reaching or looking for a ball. I’m going through three distinct patterns in my left hip, I’m going through flexion in the sagittal plane. I’m going through abduction in the frontal plane, I’m going through internal rotation, and in the transverse plane, which essentially hits two massive muscle groups, the entire glute structure, the post your hip, and the lateral hamstrings. But I have two hips, though. So what happens on this right side? Now let’s say I’m still loaded through both feet, if I’m pivoting through it changes the scenario a little bit. What if I’m still planted? Wasn’t basically going through extension? In the sagittal plane? I’m going through a B duction in the frontal plane, and I’m going through external rotation in the transverse plane. What does all that mean? The abductors are playing a huge part and allowing me to do that the hip flexors playing a part to do that, even through the quadricep. It’s allowing me to do that. What if those things are not? We’ll talk about that. Okay, what about on the inside? Well, essentially, as I take you through the medial side, if I think more of a golfers perspective or from reaching this when coming across sway. It’s the opposite. Just whatever I just said is happening now on the right hip, for the left side, and whatever it just said is from the right side is now happening on the left side. So that’s extensive. Just keep it simple, right? It’s the same mechanics just reversed hips. So how do I figure this out? From a strengthening issue? We’ll get I’m gonna go from the standpoint like, think about sequencing, am I actually moving through the hips? Even if it’s a small thing in a household? As are my pips playing a part? Or is it all upper body focused? Right, 1000s and 1000s of repetitions, not playing full systems start to chew on joints? So even in householder drills, like are they accessing the rotation or the motion patterns from the pelvis? So strengthening issues typically come from a lack of sequencing typically is the key word. What about lengthening? Well, those biomechanics that I just described, are probably not happening. If it’s from coming from the hips, I’m not getting enough internal rotation or external rotation, I’m not getting enough adduction or a production, I’m not getting enough flexion or extension at the relative joints that I just mentioned. So I need to go after those. So what did I talk about, I talked about going after the posterior hip, for coming across the body, or the medial hip to go after the other side. So again, let’s say we want to approach it from a soft tissue point, well, I’m gonna get on the ground, ball, foam roll, or whatever the case is, I’m gonna go after my hip flexors, not as my primary one, but certainly one, finding more extension, coming through my opposite side, I’m gonna go through my adductors, I’m going to make sure I can get all the soft tissue, feeling like it has the bay availability to lengthen therefore, to strengthen balls right on this inside thigh. I’m also going to go through the glutes, no questions asked, I’m gonna find a spot and seek it, do I have the myofascial capacity to even load and strengthen through the area, and I’m also going to go through the hamstrings. Again, just ways to think about this wasting, okay? Is the connective tissue playing its appropriate role. Now get how we foam roll is in a different video. But just waste you kind of think about how to go about that. Okay, what am I stretching techniques? Well, there’s a bunch of ways that we can stretch those same muscles, we can use, again, amazing pieces of equipment like this true stretch. But honestly, most people don’t have that. So let’s just go on ground. So from an on ground perspective, I can make sure that I have enough hip range of motion, I’ll go from a hip flexor, make sure I have hip extension, but as appropriate to the motion pattern that I want. So I want hip extension with hip external rotation. Again, my knees staying fixed. So as my pelvis moves away from it, I’m getting relative external rotation. And then from that, I can also drive in the frontal plane as well to get a little bit more hip flexor, but now play into the abductor. And from the adductor, I can also go through a rotational pattern. Again, there’s other ways to stretch out the adductor, I could do it from a standing position, I can really start to play into it. But again, I’ll let the techniques be unlimited. And for your own own understanding to play through it as it fits to the person in front of you. What about the hamstrings? Well, from a kneeling standpoint, I can kick out, give myself some good stability. Now because it’s, it’s in my backswing, it’s in my loading spot, I want to put that support on the same side. So I can tuck in and really get the appropriate hamstrings, because there’s more than just one. So on play in that one, as for my glutes on a kneeling side, I can cross over, I can tilt into it, get a lot more hip flexion, get some good rotation to play into that hip, right there. From a standing position, I can do the same thing, play into it again, cross over to get my same side, very appropriately. glute, I can do the same thing and load into it as I start to play and give that more of the triplane loading that it really wants. Okay. All right, Michael. So what about strengthening that area? How do I get really appropriate localized strengthening in the rotational or in these points, we’ll certainly can do squats and lunges, and all those things like that, that all makes sense. But I will thought about getting a little bit more creative, a little bit more dialed in a little bit more authentic to the motion pattern of what we think about batting, punching, kicking, throwing, running. So a great tools out there called the torque strap, which is basically the way that you can think about it. Just a nice little loop of, of fabric, put it into one hip, there’s a few different strategies to think about this one, I’m going to wrap it around, make sure it’s around my pelvis securely. And then now what I have is an authentic rotational loaded just through a bungee cord device that allows me to play into authentic proprioceptive ly appropriate strengthening of my hip. It’s an awesome, awesome tool. So when I can think about okay, hips, you drive, you drive and of course I can set the situation up depending on the hip, depending on the direction that I want to go depending if it’s going to be I want to load through and out, and it can help me go through my pattern. Or if I’m golfing, I’m going to kind of let us kind of let it pull me into it. And I can strengthen through that pattern so can know that it’s assisted on the on the strategy that you want to play into it. But it’s super awesome, very helpful when thinking about rotational hip strengthening, that’s directly appropriate to the action in front of you. But let’s say you don’t have that fancy tool, well, I can go to single leg balance, right, I can still say hip, you do the controlling. And let me think about just a rotational drive. And I’m using my pelvis to drive through my body. So I only have one leg connected to the ground. So basically, this is the only hip that is working this leg, just holding itself up against gravity super simple, I can start to challenge my body through just that pattern, it’s against a simple step, can just one technique. But one, another way that we can do it is also about just going to a plank. Now again, plank appropriate to the motion pattern that we want. So if I go to a plank, and I just drive through my pelvis, I can still get the drive the action, the pulse, to help position myself to think about the authentic way that these muscles fire, put it under load, and then start to drive through it. So again, again, techniques are limitless. But it’s a thought process. And I want you to be sparked about like, Okay, I see where this is going, I can see how I can start to problem solve for this. And the last way to think about this one, from the most common ways is the ankle. Now, even though this is less likely, from an elbow tendinitis to come from the ankle, it is still a possibility that I want you to take into consideration. So what happens? Well, let’s say I’m doing a tennis serve, or I’m doing a tennis backhand, or reach pattern to this way. Let’s go to my left side, what’s happening at my left foot, while I’m actually going through relative supination? What’s happening at supination? Well, there’s three distinct different patterns of supination. But essentially, it’s just the rolling of the body that goes into it. Now what if my talus and calcaneal bones can’t play that game? Well, if I can’t play that game, but I’m not going to load appropriately through that foot, which means that the lateral calf that feeds into my hamstring that feeds into my glutes that feeds into my right thoracic spine to my latissimus dorsi, that feeds into the posterior muscles of my shoulder blade that feed into my tricep can’t get the appropriate motion pattern, there’s a leak in the system, there’s a player not playing the game. So after 1000s and 1000s, of repetitions, there could be a breakdown because of a not an effective player that is into that motion pattern. Now again, if I’m stance on to two feet, the same thing can happen from my art from my same side, I not, I may not be able to be able to get excuse me enough, pronation, again, us a lot of different angles happening inflammation, but essentially that pattern right there. So then it feeds into this site isn’t strong enough, quote unquote, this that isn’t mobile enough. And then the exact same thing plays into medial epicondylitis. It’s just the reverse on how it plays again, less likely, but still follows the same path of chain reaction, biomechanics, the kinesthetic chain, and therefore all the muscles that get loaded to therefore unload to produce power. So again, how am I going to test if it’s an if it’s a strength issue, again, sequencing through the ankles and feet, is a way to think about that, you know, when they’re throwing, reaching is all upper body and hips, but are their feet just totally planted. And still, whether you can look at that as actually looking from someone from the backside and say, are their heels moving inside and outside. So if you zoom in, on my heels, you’ll see that I’m actually getting heel motion, sliding that direction, and heel motion sliding that direction. Therefore, it’s a very simple test, there’s a much deeper test to go into. This is a basic way to say like, Are my ankles and feet playing the game? If they’re not more friends that you can bring into the party to help your body move more efficiently, more effectively and essentially, more athletically. So that’s the simplest way to look at is it a strength seeking problem? Or is it a mobility problem? So for those ankles are not moving the way they want to? What am I going to do about that? Well, what are the what’s the soft tissue that connects directly to it? Well, again, from a soft tissue perspective, we can go in and start to think about, okay, well, if I want more, essentially supination I want more lateral calf to be lengthened. So I’m going to kind of toe open and get much more lateral calf will find a lot more pronation that’s essentially going to be much more from the medial calf. Even though the whole calf plays the game. It’s going to be essentially more hyper focused on Testing all those areas appropriately moving, but it may not just be ankle, it could be the actual plantar fascia of the foot. So taking my shoe off, right having a port, I can make sure that that that whole plantar fascia is just has the hydration has the capacity to move through this mid parcels, and through those tassels to make sure that everything’s smooth and working well. So again, how to formula is in a different video, but again, allows you to think about it from that perspective. What about from a stretching perspective? Well, because our joints are in much more of a dorsi flexed position at the ankle, right? The typical calf stretches not going to get it which is the leg behind you. With a knee extended, I want to stretch out my calf from a knee flexed position, which gets much more the soleus and the gastroc. So from there, I can hold on get support and start to drive through my pronation and supination. Even through my adduction and abduction, as I drive my body and the frontal plane and the transverse plane. Again, we want to think about appropriate proprioceptively authentic patterns of what we’re trying to actually create at our foot. And even after just showing you that example. My right sides actually feel much more opened up than my left side. Interesting how that how quick it can start to make a change if being appropriate. Now from there, as the one thing about okay, what how can I use maybe slants in and wedges right. So like on our true stretches here, like we have a slant that takes me more into heel, e-version and more into heel inversion. So I can actually start to position myself to stretch. And to create more mobility. If you do have wedges around your facility, even a two by four, right even a yoga mat roll rolled up because our position is to help create more mobility by pre positioning changing the environment you’re standing on to have that mobility as I’m driving through different planes of motion to create the lengthening and essentially the freedom of motion that your ankles need to create the full kinesthetic chain. What about from an exercise standpoint? Well, from a very specialized piece of equipment, this is not just a balance board, it’s called a baps board. Where it does it follows more authentic ankle biomechanics. Because the ball is not on the direct center, it actually follows much more of an oblong shape. Again at Babs borders as what’s called I can practice more authentic patterns, more funnel playing patterns, then, of course, the important all around. Now on this show, you want to make sure that they’re not driving through their knee, knee can stay relatively stable as it moves through the ankle. And as it moves to the ankle, you’re going to get much more again, relative strengthening. And then if someone starts to cheat their way through it, again, stealing from just no tools, no necessarily just good old fashioned Chain Reaction biomechanics, you can stand on the single leg and actually drive the same side knee or the opposite foot with a chain into the other leg to create more ankle motion. Yes, it’s the same drill that helped me what would the hip but again, a lot of drills do a lot of things. Again, we’re thinking about how much can we create rotation at the ankle joint and lateral motion, which is the primary two players of of essentially pronation and supination. All right. So hopefully you found some or all this helpful, if not, let me know in the comments. So I can provide either more clarity, or context, I want to take a quick second to remind you that these are just a few of the approaches you can take. If you want to get into addressing people’s movement, dysfunctional pain, you have to take an investigative approach, you have to be able to critically think, experiment and see what and why or what is and what isn’t working. Because every single person has their own individual understanding of how they move, and therefore their body has follows that same pattern so each person is different. So it’s my goal to help to try to equip you with the principles and strategies that will help you build these critical thinking and problem solving skills. So you can understand again, how to think and not just what to think. So if you want to build on these skills and work with me and my team, click on the link in the description below to check out the multi dimensional movement coaching program. Lastly, if you enjoy this video and want to keep putting, if you want us to keep putting videos out just like this, please like and subscribe and even turn on the notification bell. That’s all I have for you today. Till next time. Cheers.