Mild Elbow Pain, Poss. Medial Epicondolytis; How long to rest?

[chaddukes]

I have a fairly mild pain in my left elbow near the medial epicondyle. It iquite mild at this point but I want to be sure that it doesn't get any worse. My last upper body workout was 11 days ago. The pain is better, but I can tell that the injury is still there. My question is how long should I wait before lifting again and what can I do to speed up the process? I hate being sidelined by something so small, yet I know better than to try to push through and risk worsening the injury. Also, should I stop deadlifting?

Below is the data.


1. When did the pain begin? About two to three weeks ago.



2. What were you doing at the time? Or did the pain come on gradually over time? It came on gradually over time. At first I could barely notice it. On the next workout I noticed a bit of stiffness in the elbow. On the following workout I realized that this wasn't stiffness, but the beginning of an injury. That was eleven days ago. After that last workout I noticed the stiffness/discomfort in everyday activities, i.e. carrying things, opening doors, etc.




3. Where, anatomically, is the pain? Inside of left elbow at the medial epicondyle.



4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting? Dull, sort of like stiffness or fatigue. Not really even pain as much as just being able to tell that something is wrong.



5. Is the pain constant, or intermittent, or only on certain motions? Only on certain movements or for a while after making those movements. Anytime I use that arm to carry something, or anytime I completely extend my elbow, or grip something firmly.



6. What motions make your pain worse? Any loading. Fully extending the elbow. Also, when doing pull ups it seemed at its worst, which is strange in that I don't feel it now if I flex my elbow.


7. What, if anything, makes your pain better? Most of the time I don't notice it unless doing the above activities.



8. Does your pain radiate to any other part of your body? No.


9. What things could you do before, that you cannot do now because of your injury? Nothing really, the pain is very mild at this point.


10. What is your main concern regarding the pain and its consequences? I don't want this to become something more severe. How long do I rest? What should I avoid? What can I do to speed recovery?


11. Have you ever injured that part of your body before? If so, how? I've felt this before when lifting in the past, specifically after a high volume of pushups, bench press, etc.


12. Is your pain getting worse over time? And if so, how much worse over what time period? No, it is better, but after 11 days I can still feel it.

[Cloud9Fitness]

I suspect medial epicondylitis, too. I have personal experience with the issue. As you are likely aware this can be ligamentous (ulnar collateral ligament), but in weightlifters I believe is usually due to flexor carpi ulnaris or radialis tendonitis. The pain occurs with extension of the elbow, but may worsen with isometric resistance of ADduction or ABduction. The differential diagnosis (for adults) includes stress fracture and osteoarthritis.

Unfortunately, conservative therapy is rest for up to six months in bad situations if you only have tenderness during movement. This time is dependent on the person, but I would recommend a minimum of 3-4 weeks with no weight (ROM only) to allow for some remodeling. Then slowly introduce weights. If you notice discomfort then stop for the day, and return to the exercise again at your next scheduled workout. I personally was on the six-month side because I did not stop like you did until the pain was at rest too (being a doctor I should know better…). Tenderness at rest will warrant Xray first, medication second, and MRI third for most recreational athletes.

[chaddukes]

Thanks for the reply. I wish I could figure out what the cause was so that I can avoid the issue in the future. I have a suspicion that it was a particular exercise that I was doing, but I have no way of really knowing that. I'll avoid that exercise in the future and see if it helps.

[Cloud9Fitness]

Common exercises associated with the medial epicondylitis from tendon injury include tricep exercises with ADduction of the wrist (the 'kick back'), tricep skull crushers with isometric wrist "ADduction" (resisting ABduction from gravity), and Hammer curls with isometric wrist "ABduction" (resisting ADduction from gravity). The muscles involved in these movements have to assist movement across the elbow and wrist, and may be more suseptible to injury during concentric and eccentric/isometric firing over the different joints. It may be helpfully to try exercises with the wrist in full supination or pronation if that seems ot be associated.

[LisaS]

in case it isn't clear from the description what it means to ADduct and ABduct the wrist - ADduct would be cocking/deviating the wrist to the ulnar/pinky side and ABduct to the radial/thumb side.

[chaddukes]

Ah, this makes sense. I added two new upper body exercises recently. I wanted to incorporate more unilateral upper body training so I started doing one arm cable presses and one arm pull downs on a the lat pull down station (I was also doing one arm cable rows, but those aren't new). In each case I was using a motion with abduction. On the pull downs I was going from fully externally rotated at the top of the motion and pulling down to my chest so that my palm was on my chest. On the pressing motion I was starting with my hand in a neutral position and abducting as I extended; like a punch. I don't know why, but it just felt like the right way to do these things.

So, these motions are the most likely culprits. Good to know. I'll stick with one arm rows, and one arm push ups. I'm giving it another week or so before I get back into upper body work. It will be intersting to see if the injury comes back after I eliminate those moves.

Question! Should we train abduction and adduction with lighter weights to strengthen the area or just avoid the motion?

[LisaS]

you're not confusing abduction/adduction of the wrist with pronation/supination are you?
imagine you are standing with arms down & palms facing backward. now rotate your forearm so your palm faces forward. That is supination. Pronation is putting it back.
Now imagine you are standing with your palm facing foward. cock your wrist so your pinky hits your thigh - that is adduction (towards the midline). Abduction is the movement in the opposite way.

I say that only because I'm having trouble picturing what you describe as really abducting or adducting. Going from neutral to palm down - as a punch - would be pronation. It could just be how I am picturing what you are saying.

AFAIK, no one trains abduction/adduction at the wrist but in how you hold dbs as Cloud9 said, your muscles act to resist being pulled in one or the other direction.

[chaddukes]

Lisa, you're correct. I was misunderstanding the term. I had them backwards.

I don't think that I do any motions that incorporate abduction and adduction of the wrist. But, I wonder if I was using too much weight in those single arm movements.

[LisaS]

that's what cloud9 was saying.
imagine you are holding a very very heavy db in your hand in the thumbs up position.
The weight is pulling your wrist down, towards your pinky (adduction). to keep your hand in thumbs up and the db upright you do abduction against the weight just to hold the place.

now bend forward and do a triceps kickback. because this is a thumbs down movement, gravity is pulling your hand away from neutral towads your thumbside (abduction) and you are resisting it by adducting to neutral.

[chaddukes]

Originally Posted by LisaS

that's what cloud9 was saying.
imagine you are holding a very very heavy db in your hand in the thumbs up position.
The weight is pulling your wrist down, towards your pinky (adduction). to keep your hand in thumbs up and the db upright you do abduction against the weight just to hold the place.

I see what you're saying but I've been doing mostly either closed chain (push ups, pull ups) or cable exercises for upper body. I don't think that I do any exercises that would fit what you're describing. However, it did just occur to me that the way that I pick the dumbbells up off of the rack might have something to do with it. I've been mentally going through my routine and trying to think of when I would make that kind of motion. The only thing that comes to mind is picking up and putting down the dumbbells. Also, when I clean the dumbbells to my shoulders for shoulder presses, dumbbell squats, etc. Day after day of doing that adds up to alot of repetitions of that motion.

Thanks to both of you for taking the time to help me work this out. It would have never occurred to me that this motion could lead to an elbow injury.

[chaddukes]

OK, the pain isn't getting any better. It's a bit worse, but still not really what I would call pain. But, I can tell that something is wrong. I've dramatically reduced, practically abandoned any upper body work, especially pushing. It's been 7 or 8 weeks. Is it time to see the Dr.? What would be my options?

[chaddukes]

Doing Deadlifts, shrugs, etc. shouldn't make the situation worse, right? What about DB Swings?

I'm just trying to find what I can do without causing further damage.