Golfer's Elbow(?): pain while chopping vegetables

About four months ago I started experiencing a strange pain while chopping vegetables in the kitchen. I feel a distinct ache in the uppermost/inside part of my forearm. I think it's golfer's elbow, though the pain is not really localized on the "ball" inside my elbow--it's a bit off and farther inside my forearm.

I started doing eccentric wrist curls, as recommend by Dave Macleod and Julian Saunders. I could never make the curls light up the pain. Then I tried fairly heavy eccentric wrist pronators. With these, I feel the tender bit maybe a third of the time. Sometimes I can really feel it, sometimes not.

I experience no pain during or after climbing. Very occasionally I notice it when pulling on big slopers, but generally it doesn't bother me at all except in the kitchen.

I'm pretty sure it is mild golfer's elbow and that I just need to keep it up with the pronators. I'm curious though: has anyone else experienced achy elbows when using a knife?

I'm dealing with golfer's elbow right now, and definitely noticed it while chopping veggies. I'm on the dodgy elbow protocol now and the pronator exercises definitely hit the sweet spot a lot more for me than the eccentric wrist curls.

friend and fellow MP'er CoreyLee was just telling me about this the other day. I'm sure he'd have some info for you he's pretty good about that stuff you can probably pm him. Tell him Germsauce sent you.

I'd recommend either eating whole vegetables or just stick to cheesesteaks and raw fish heads.

Pain in humans is a tricky thing.
Not necessarily indicative of what's going right or wrong with actual internal structures.

Try reading about things like
"phantom limb pain"
"referred pain"

I know ... the perception of pain seems like all you've got to go on.
So you understandably wish to believe that it's a reliable indicator.

Ken

What you are describing definitely fits golfer's elbow, but its hard to know for sure without a hands on exam. It is more typical for the discomfort to be just off the "ball", which is a huge tendon junction and a ton of muscles that originate right there.

Something to consider is that eccentric exercises (IE: muscle is contracting but lengthening: think the lowering part of a pull-up where your biceps and lats are still turned on but getting longer) have been shown through research to be very effective for tendon injuries.

You need to load the muscles and tendons in the area but, figuring out the proper amount can be tricky (its like the three bears and finding the right temperature for porage). Under-loading doesn't stimulate the healing, while over-loading doesn't give you a chance to heal.

I actually just did a blog post about this about a week ago with some other ideas of things to do for golfer's elbow, which you can checkout here

I'm a physical therapy student and a certified strength and conditioning coach. If you want to talk about it more feel free to shoot me a direct message.

Best Wishes on healing up!

Sounds like you need a better, sharper knife!

TBlom wrote:Sounds like you need a better, sharper knife!

agreed 100%

Dan Crusoe wrote:eccentric exercises have been shown through research to be very effective for tendon injuries.

Really? Please tell us which carefully controlled comparative clinical study actually showed that.

I own a recent book written by an expert climber which says that careful studies do _not_ support any advantage to eccentric-contraction exercise for elbow recovery.

I also own an expensive technical Sports Medicine specialist textbook which makes no mention of using eccentric-contraction exercises for elbow rehab. Also says that golfer's elbow usually resolves within a few months anyway (provided it's not re-injured).

Anyway normal "concentric" exercises when performed with the normal cycle of repetitions already _include_ an "eccentric" contraction with each repetition - (it's how you get your limbs and joints back into the starting position before starting the next concentric contraction).

Ken

I don't get much pain while doing the Dodgy Elbow exercises, which seems counter to how he describes them. But they work wonders for me. Make sure to check out his Update to Dodgy Elbows which has some different variations on the exercises to target problems more specifically.

Get an Arm Aid. Just get one. Really.

Thanks all. I will keep it up with the eccentric pronators, self massage, and throw in some heat. So far its not something that has affected my climbing, but I suspect that it could grow to do so. I emailed germsauce's boy CoreyLee and I'll report back if he has any wisdom to share.

Dan Crusoe wrote:Something to consider is that eccentric exercises (IE: muscle is contracting but lengthening: think the lowering part of a pull-up where your biceps and lats are still turned on but getting longer) have been shown through research to be very effective for tendon injuries.

kenr wrote: Really? Please tell us which carefully controlled comparative clinical study actually showed that.

Sorry about the formatting. Have just skimmed these abstracts. Kind of busy but wanted to share some references. References courtesy of Up to Date.

TI

Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.

AU

Mafi N, Lorentzon R, Alfredson H

SO

Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42.

In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric calf muscle training on patients with painful chronic Achilles tendinosis located at the 2-6 cm level in the tendon. In the present prospective multicenter study (Sundsvall and Umeå) patients with painful chronic Achilles tendinosis at the 2-6 cm level in the tendon were randomized to treatment with either an eccentric or a concentric training regimen for the calf muscles. The study included 44 patients, with 22 patients (12 men, 10 women; mean age 48 years) in each treatment group. The amount of pain during activity (jogging or walking) was recorded by the patients on a visual analogue scale, and patient satisfaction was assessed before and after treatment. The patients were instructed to perform their eccentric or concentric training regimen on a daily basis for 12 weeks. In both types of treatment regimen the patients were told to do their exercises despite experiencing pain or discomfort in the tendon during exercise. The results showed that after the eccentric training regimen 82% of the patients (18/22) were satisfied and had resumed their previous activity level (before injury), compared to 36% of the patients (8/22) who were treated with the concentric training regimen. The results after treatment with eccentrictraining was significantly better (P<0.002) than after concentric training. The good clinical results previously demonstrated in the pilot study with eccentric calf muscle training on patients with chronic Achilles tendinosis, were thus reproduced in this multicenter, showing superior results to treatment with concentric training.

AD

Department of Surgical and Perioperative Science, UmeåUniversity, Sweden.

PMID

11269583

| PubMed

TI

Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study.

AU

Jonsson P, Alfredson H

SO

Br J Sports Med. 2005;39(11):847.

BACKGROUND: A recent study reported promising clinical results using eccentric quadriceps training on a decline board to treat jumper's knee (patellar tendinosis).

METHODS: In this prospective study, athletes (mean age 25 years) with jumper's knee were randomised to treatment with either painful eccentric or painful concentric quadriceps training on a decline board. Fifteen exercises were repeated three times, twice daily, 7 days/week, for 12 weeks. All patients ceased sporting activities for the first 6 weeks. Age, height, weight, and duration of symptoms were similar between groups. Visual analogue scales (VAS; patient estimation of pain during exercise) and Victorian Institute of Sport Assessment (VISA) scores, before and after treatment, and patient satisfaction, were used for evaluation.

RESULTS: In the eccentric group, for 9/10 tendons patients were satisfied with treatment, VAS decreased from 73 to 23 (p<0.005), and VISA score increased from 41 to 83 (p<0.005). In the concentric group, for 9/9 tendons patients were not satisfied, and there were no significant differences in VAS (from 74 to 68, p<0.34) and VISA score (from 41 to 37, p<0.34). At follow up (mean 32.6 months), patients in the eccentric group were still satisfied and sports active, but all patients in the concentric group had been treated surgically or by sclerosing injections.

CONCLUSIONS: In conclusion, eccentric, but not concentric, quadriceps training on a decline board, seems to reduce pain in jumper's knee. The study aimed to include 20 patients in each group, but was stopped at the half time control because of poor results achieved in the concentric group.

AD

Department of Surgical and Perioperative Science, Sports Medicine, Centre for Musculoskeletal Research, National Institute for Working Life, University of Umeå, 901 87 Umeå, Sweden. per.jonsson@idrott.umu.se

PMID

16244196

| PubMed

TI

Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening.

AU

Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW

SO

J Hand Ther. 2005;18(4):411.

The objective of this study was to evaluate the effectiveness of eccentric strengthening. Ninety-four subjects (50 men) with chronic lateral epicondylitis were allocated randomly into three groups: stretching, concentric strengthening with stretching, and eccentric strengthening with stretching. Subjects performed an exercise program for six weeks. All three groups received instruction on icing, stretching, and avoidance of aggravating activities. The strengthening groups received instruction on isolated concentric and eccentric wrist extensor strengthening, respectively. At six weeks, significant gains were made in all three groups as assessed with pain-free grip strength, Patient-rated Forearm Evaluation Questionnaire, Disabilities of the Arm, Shoulder, and Hand questionnaire, Short Form 36, and visual analog pain scale. No significant differences in outcome measures were noted among the three groups. Although there were no significant differences in outcome among the groups, eccentric strengthening did not cause subjects to worsen. Further studies are needed to assess the unique effects of a more intense or longer eccentric strengthening program for patients with lateral epicondylitis.

AD

Baystate Medical Education and Research Foundation, Springfield, MA, USA.

PMID

16271688

| PubMed

TI

Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy -- a randomized trial with 1-year follow-up.

AU

Roos EM, Engström M, Lagerquist A, Söderberg B

SO

Scand J Med Sci Sports. 2004;14(5):286.

Achilles tendinopathy is common and treatment with eccentric exercises seems promising. We designed a prospective randomized clinical trial to test the hypothesis that eccentric calf muscle exercises reduce pain and improve function in patients with Achilles tendinopathy. Forty-four patients were recruited from primary care (mean age: 45 years; 23 women; 65% active in sports) and randomized to three treatment groups for 12 weeks: eccentric exercises, a night splint or a combination of both treatments. Pain and function were evaluated at 6, 12, 26 and 52 weeks by the Foot and Ankle Outcome Score. At 6 weeks, the eccentric group reported a significant pain reduction (27% compared with baseline, P = 0.007) which lasted for 1 year (42%, P = 0.001). The two groups treated with a night splint also reported significant but less pain reduction than the eccentric group. Differences between all the three groups were not significant. At 12 weeks, the eccentric group reported significantly less pain than the splint-only group (P = 0.04). More patients in the eccentric group than in the splint group returned to sport after 12 weeks. We conclude that eccentric exercises seem to reduce pain and improve function in patients with Achilles tendinopathy. Our results are in line with previous studies and strengthen the recommendation that patients should undergo an eccentric exercise program prior to considering other treatments such as surgery.

AD

Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden. Ewa.Roos@ort.lu.se

PMID

15387802

TI

Selvanetti, A, et al

AU

SO

Med Sport (Roma). 2003; 56:103.

AD

| PubMed

TI

Eccentric overload training for patients with chronic Achilles tendon pain--a randomised controlled study with reliability testing of the evaluation methods.

AU

Silbernagel KG, ThomeéR, ThomeéP, Karlsson J

SO

Scand J Med Sci Sports. 2001;11(4):197.

The purpose was to examine the reliability of measurement techniques and evaluate the effect of a treatment protocol including eccentric overload for patients with chronic pain from the Achilles tendon. Thirty-two patients with proximal achillodynia (44 involved Achilles tendons) participated in tests for reliability measures. No significant differences and strong (r=0.56-0.72) or very strong (r=0.90-0.93) correlations were found between pre-tests, except for the documentation of pain at rest (P<0.008, r=0.45). To evaluate the effect of a 12-week treatment protocol for patients with chronic proximal achillodynia (pain longer than three months) 40 patients (57 involved Achilles tendons) with a mean age of 45 years (range 19-77) were randomised into an experiment group (n=22) and a control group (n=18). Evaluations were performed after six weeks of treatment and after three and six months. The evaluations (including the pre-tests), performed by a physical therapist unaware of the group the patients belonged to, consisted of a questionnaire, a range of motion test, a jumping test, a toe-raise test, a pain on palpation test and pain evaluation during jumping, toe-raises and at rest. A follow-up was also performed after one year. There were no significant differences between groups at any of the evaluations, except that the experiment group jumped significantly lower than the control group at the six-week evaluation. There was, however, an overall better result for the experiment group with significant improvements in plantar flexion, and reduction in pain on palpation, number of patients having pain during walking, having periods when asymptomatic and having swollen Achilles tendon. The controls did not show such changes. Furthermore, at the one-year follow-up there were significantly more patients in the experiment group, compared with the control group, that were satisfied with their present physical activity level, considered themselves fully recovered, and had no pain during or after physical activity. The measurement techniques and the treatment protocol with eccentric overload used in the present study can be recommended for patients with chronic pain from the Achilles tendon.

AD

Sportrehab--Physical Therapy&Sports Medicine Clinic, Göteborg, Sweden.

PMID

11476424

| PubMed

TI

Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia.

AU

Svernlöv B, Adolfsson L

SO

Scand J Med Sci Sports. 2001;11(6):328.

In a pilot study 38 patients with lateral humeral epicondylalgia were randomly allocated to two treatment groups. Group S (stretching) was treated with a contract-relax-stretching program while group E (eccentric exercise) underwent an eccentric exercise program. Both groups also received forearm bands and wrist support nightly. The programs were carried out daily at home during 12 weeks. Evaluation before and 3, 6 and 12 months after treatment, included subjective assessment of symptoms using visual analogue scales and grip strength measurements. Thirty-five patients were available for follow-up. Five patients, three in group S and two in group E, did not complete the programs due to increased pain while 30 (86%) reported complete recovery or improvement. Reduced pain and increased grip strength were seen in both treatment groups but 12 out of 17 patients (71%) in group E rated themselves as completely recovered as compared to 7 out of 18 (39%) in group S (P=0.09), and in group E the increase in grip strength after 6 months was statistically significantly larger than in group S. In a second study the eccentric training regime was used in a consecutive series of 129 patients with lateral epicondylalgia. The patients were divided into two groups with one group consisting of patients with less than one year duration of symptoms and the other comprised patients with a duration of symptoms for more than one year. The results of treatment were evaluated in the same way as in the pilot study, and also after 3.4 years using the scoring system by Verhaar et al. At the end of the treatment period statistically significant improvements were seen in all VAS recordings and in grip strength. After 3.4 years 38% had excellent, 28% good, 25% fair and 9% poor results according to the score. In the self-rated outcome 54% regarded themselves as completely recovered, 43% improved, 2% unchanged and 2% worse. No significant differences were seen between patients with a duration of symptoms for more than one year compared to patients with symptoms for less than one year. The eccentric training regime can considerably reduce symptoms in a majority of patients with lateral humeral epicondylalgia, regardless of duration, and is possibly superior to conventional stretching.

AD

Department of Plastic Surgery, Hand Surgery and Burns, University Hospital, Linköping, Sweden.

PMID

11782264

| PubMed


Heavy slow resistance training may also be effective.

TI

Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.

AU

Mafi N, Lorentzon R, Alfredson H

SO

Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42.

In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric calf muscle training on patients with painful chronic Achilles tendinosis located at the 2-6 cm level in the tendon. In the present prospective multicenter study (Sundsvall and Umeå) patients with painful chronic Achilles tendinosis at the 2-6 cm level in the tendon were randomized to treatment with either an eccentric or a concentric training regimen for the calf muscles. The study included 44 patients, with 22 patients (12 men, 10 women; mean age 48 years) in each treatment group. The amount of pain during activity (jogging or walking) was recorded by the patients on a visual analogue scale, and patient satisfaction was assessed before and after treatment. The patients were instructed to perform their eccentric or concentric training regimen on a daily basis for 12 weeks. In both types of treatment regimen the patients were told to do their exercises despite experiencing pain or discomfort in the tendon during exercise. The results showed that after the eccentric training regimen 82% of the patients (18/22) were satisfied and had resumed their previous activity level (before injury), compared to 36% of the patients (8/22) who were treated with the concentric training regimen. The results after treatment with eccentrictraining was significantly better (P3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms (Victorian Institute of Sports Assessment-Achilles), tendon pain during activity (visual analog scale), tendon swelling, tendon neovascularization,and treatment satisfaction were assessed at 0 and 12 weeks and at the 52-week follow-up. Analyses were performed on an intention-to-treat basis.

RESULTS: Both groups showed significant (P<.0001) improvements in Victorian Institute of Sports Assessment-Achilles and visual analog scale from 0 to 12 weeks, and these improvements were maintained at the 52-week follow-up. Concomitant with the clinical improvement, there was a significant reduction in tendon thickness and neovascularization. None of these robust clinical and structural improvements differed between the ECC and HSR groups. However, patient satisfaction tended to be greater after 12 weeks with HSR (100%) than with ECC (80%; P = .052) but not after 52 weeks (HSR, 96%; ECC, 76%; P = .10), and the mean training session compliance rate was 78% in the ECC group and 92% in the HSR group, with a significant difference between groups (P<.005).

CONCLUSION: The results of this study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.

AD

Department of Physical Therapy, Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID

26018970

Sorry about the formatting. Have just skimmed these abstracts. Kind of busy but wanted to share some references. References courtesy of Up to Date.

Mark thanks for grabbing some references.

Ken: I definitely agree with you that pain can be a pretty tricky thing. Especially with chronic pain. A cool education video : youtube.com/watch?v=RWMKucu…

You are also 100% right about most exercise having both eccentric and concentric phases. So to create extra emphasis on eccentrics you could focus on a slowing down of the eccentric contraction or get creative in how you perform exercises. An example of getting creative for the calf muscles might be, while standing using both feet to push your up onto your toes, then shifting over to only one foot to lower yourself down. This one, called the Reverse Tyler Twist , is specifically for golfer's elbow