Greetings!  Tons of killer updates coming and it was great to meet many of you at the Z-Health/ Dragon Door  “Essential Secrets of Elite Performance”  event this past weekend!  Thanks for all the kind words and anything I can do to help, let me know.

The event went great as the participants got an inside look at Z-Health R Phase, I Phase and S Phase over 3 days and everyone had a blast.

Tennis Elbow: But I don’t play tennis?

If you have ever had tendon pain or forearm pain, it sucks!  I’ve had it in the past and it prevented me from even lifting 1 plate into my cupboard without pain.  To say that my lifting during this time dropped a bit is an under statement.

Notice that we spent tons of time recently on grip (see the link below if you missed out), but OVER USE of grip can potentially cause tendon pain and/or forearm pain.

Killer Grip Series with Adam T Glass

If you have pain, you can NOT be in an optimal state for extreme human performance, period.

Now, this does not mean that you will never see a professional athlete play through pain and put on a good/great performance on occasion, but this is NOT the norm.

When you are in pain, it becomes a top priority to your body and nervous system; eclipsing performance.

An extreme example I have used is to go sprint 100 meters, rest fully, have your buddy “Bruno the Bruiser” kick you square in the nuts and then go run again.  I will bet a ton of money you will not run as fast.

The great part is that your body adapts and we can use that principle to force it to adapt to something better! The technical term is “Davis’s law” which states that tissue will adapt along lines of stress.  Stress= SPECIFIC adaptation to stress.  This is even being used in ACL replacements now to promote better tissue properties.   Check out this post if you want more details

Mechanical Properties Of Tissue and Anatomy

Pain Sucks, I Want a Solution

Tendon pain is not fun.  The cool part is there is a solution as I have outlined below here in the past

TendonOSIS vs TendonITIS

Another option of course is mobility work (I like Z-Health)  via opposite joints as outlined below

Opposite Joints: My Eblow Hurts, You Want Me to Check My Knee?

New Evidence

There was some new evidence published just the other day showing that eccentric exercise works VERY well for tennis elbow (tendonosis aka tendinosis).

Source: Eccentric Exercise Technique Offers Easy, Affordable Intervention for Chronic Lateral Epicondylitis by
Nancy A. Melville (Medscape) from a  study presented here at the American Orthopaedic Society for Sports Medicine 35th Annual Meeting.

Lateral epicondylitis is the technical term, but most know it by the same of tennis elbow.  The study done by Timothy F. Tyler, PT, ATC, and friends randomized patients with pain from chronic lateral epicondylitis into 2 groups: an eccentric group of 6 men and 5 women (average age, 47 ± 2 years); and a standard-treatment group of 4 men and 6 women (average age, 51 ± 4 years).

Both groups received wrist-extensor stretching (I am such a fan of static stretching, cough cough, er, no)  , ultrasound, cross-friction massage, and heat and ice therapy. The eccentric group performed isolated eccentric wrist-extensor strengthening using a rubber cylinder, called the Flexbar (Hygenic Corp) (note, they also paid for the study, and that does not make it bad, just keep that in mind too)

Results

The eccentric group reported an improvement of 76% in their DASH score (Disabilities of the Arm, Shoulder, and Hand -DASH-questionnaire if you really wanted to know) and the standard-treatment group reported an improvement of 12% (P = .01).  VAS (a way to measure pain) improvement was 81% for the eccentric group and 22% for the standard-treatment group (P = .002),   Holy pain relief bat man!  While percentages can be misleading at times, the eccentric group whooped a$$ over the standard, run of the mill, more time intensive and expensive treatment by a high significant (those low p values) amount!

Here is a direct quote from the lead researcher as told to Medscape Orthopaedics

“The eccentric group had a significant improvement in the amount of disability [reported in the DASH score], compared to the standard-treatment group, and there was also a significant decrease in pain, compared to the standard-treatment group,” Mr. Tyler said. 

Sign me up!

So now you have yet another option to get out of pain and back into the gym or your sport with a vengeance!

Rock on

Mike T Nelson

PS

If you want to know the exact routine I used for my elbow pain in the past, drop a comment below.  10 comments by this Wed at 5pm and I will put a post telling you EXACTLY what I did.

Source: American Orthopaedic Society for Sports Medicine (AOSSM) 35th Annual Meeting: Abstract 8345. Presented July 11, 2009.

Other  References

Br J Sports Med. 2007 Apr;41(4):188-98; discussion 199. Epub 2006 Oct 24.

Chronic tendinopathy: effectiveness of eccentric exercise.

Woodley BL, Newsham-West RJ, Baxter GD.

Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand. brettandsteph@xtra.co.nz

OBJECTIVES: To determine the effectiveness of eccentric exercise (EE) programmes in the treatment of common tendinopathies. DATA SOURCES: Relevant randomised controlled trials (RCTs) were sourced using the OVID website databases: MEDLINE (1966-Jan 2006), CINAHL (1982-Jan 2006), AMED (1985-Jan 2006), EMBASE (1988-Jan 2006), and all EBM reviews–Cochrane DSR, ACP Journal Club, DARE, and CCTR (Jan 2006). The Physiotherapy Evidence Database (PEDro) was also searched using the keyword: eccentric. Review

METHODS: The PEDro and van Tulder scales were employed to assess methodological quality. Levels of evidence were then obtained according to predefined thresholds: Strong–consistent findings among multiple high-quality RCTs. Moderate–consistent findings among multiple low-quality RCTs and/or clinically controlled trials (CCTs) and/or one high-quality RCT. Limited–one low-quality RCT and/or CCT. Conflicting–inconsistent findings among multiple trials (RCTs and/or CCTs). No evidence-no RCTs or CCTs.

RESULTS: Twenty relevant studies were sourced, 11 of which met the inclusion criteria. These included studies of Achilles tendinopathy (AT), patella tendinopathy (PT) and tendinopathy of the common wrist extensor tendon of the lateral elbow (LET). Limited levels of evidence exist to suggest that EE has a positive effect on clinical outcomes such as pain, function and patient satisfaction/return to work when compared to various control interventions such as concentric exercise (CE), stretching, splinting, frictions and ultrasound. Levels of evidence were found to be variable across the tendinopathies investigated.

CONCLUSIONS: This review demonstrates the dearth of high-quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies. Further adequately powered studies that include appropriate randomi