https://podcasts.apple.com/us/podcast/jacked-athlete-podcast/id1462537296?i=1000699196938
“I’ve had quad tendonitis and golfers and tennis elbow on both elbows. So I first got interested in tendons from damaging my own through training like a knucklehead in my early 20s with little regard for what I was doing to my body and not backing off.”
“I can’t think of a single case of a high level college golfer or a young pro contacting me about tennis or golfer’s elbow.”
“I think the reason is, first of all, they have like a long-term chronic adaptation to practicing and playing golf. Cause if you’re playing in college, you’ve probably been playing golf since you were 10 and playing a lot of it until you’re say 20. So you’ve at least eight to 10 years of tons of golf.”
“We need many, many years of repetitive activity to create those adaptations in the tendon that basically allow it to get stronger, allow it adapt to the demands.”
“Many of the people that were contacting me are more like 40 to 65. They’re not in particularly good shape, they maybe play golf once a week and practice once a week or something like that, so they don’t have anywhere near the same training background as the college kid you’re dealing with. And then when I kind of asked them had anything changed when your elbow started hurting, there was almost always like, yes, a very sudden reason I started doing this and a couple of weeks later my elbow was killing me.”
“At home practice stations got way more popular… And they might hit 500 balls in the first week they have it. And then three days later, they’re like, man, my elbow’s sore.”
“So you people who got really interested in increasing their swing speed and maybe three times a week they’re taking like 25 to 40 swings as hard as they can without a preparatory period, they’re already potentially not in particularly good shape… And these were often being done with like weighted swing trainers where it was like a golf shaft with weights on the head, like overload and under load training, which are great, but certainly like can increase the stress on the elbow.”
“If I had to think about the questions I’ve gotten, my guess would be that the most common one is golfer’s elbow, so that’s the medial side of the elbow, on the trail arm. So for a right-handed golfer, that would be their right arm on the inside of the elbow.”
“By the time you’re releasing your hands and wrists, when you’re trying to apply the force that you’ve built from your body into the club, your hands and wrists are moving pretty quickly and it’s a very, very light implement. So there’s gonna be a very quick stretch and contraction on any of the wrist, forearm, kind of hand area basically. And there’s just no way to swing a golf club without putting a lot of stress on the elbow and wrist. You just can’t.”
Jerk from hitting a golf ball versus swinging the weighted trainers: “I honestly haven’t found a huge difference in terms of the stress being offloaded from doing one versus the other. And the reason being is that it definitely makes sense that when you’re hitting a ball, that jerk is essentially like a really quick eccentric contraction… When you’re swinging the weighted speed trainers, you take away the impact, but a lot of the time you’re also adding mass to the end of the shaft. And because the shaft is, let’s say, three and a half feet, like say 40 to 45 inches in length, even small additions of mass to the end of that, really change how it feels on things like your wrists and forearms and elbows.”
“I like for rehab settings… but not getting all the stress in the elbow is using foam golf balls. So when you use a foam golf ball, it’s obviously way lighter than a real golf ball. You tend to still use mechanics that are more similar to how you would hit a ball, but when you hit it, you don’t have nearly as big a collision because it doesn’t have the mass to decelerate you any as much. And I found that doing that is kind of a nice way for people who are working their way back from an elbow tendon injury in golf, like, it hurts when I hit a real ball, or if I hit a certain amount of real balls, it’s basically just a gradual exposure tool, basically.”
“The first main point with golf is like that it tends not to be a problem with say like chipping and pitching… If you’re hitting the ball, let’s say less than like 100 yards, you tend to not be producing enough force where it’s an issue.”
When you’re hitting an iron, let’s just say shots from like outside 130 yards or so, all the way up to their driver… People tend to report pretty significant differences in the stress they get in their elbow, especially if they have an injury.”
“When you hit earth, the earth has some give in it… But if you’re hitting a 1.5 inch thick mat that’s on concrete, particularly for lower skilled players who tend to hit the ground early, they’re going to be rebounding that club off the mat, which doesn’t give into the earth like it would if it was on grass… And because of that, they’re getting a way higher force redirected back into basically everything, but especially their hands and their forearms, their wrists, because that’s the closest segment to the club, which is taking all the force into the ground.”
So that actually adds to the training load and the spike of stress that people deal with sometimes when they start using these home simulators is because they might have just gone from a nice, four or five month summer season where they’re primarily playing golf on the golf course. And what’s funny about that is like if we play, let’s say, a five hour round of golf and someone shoots 85, which would be like a kind of average score for a typical amateur golfer, they might only make about like 40 full swings in spread over four or five hours. And they’re all on grass and like 15 of them are off a tee where they don’t hit the ground but now they get a mat, put it down in concrete in their basement, and they hit like 200 of them in like an hour. So it’s just like, it’s the perfect overload mechanism.”
“It’s funny because they always then assume that they’re doing something wrong with their technique. It’s like, there must be something wrong with my swing. And it’s like, it’s probably more the fact that you’ve like quadrupled the amount of golf balls you’re hitting in this two week period. And we need to think about, you know, just basically distributing your practice essentially.”
“The people who take time off and then come back to golf, they probably don’t play or practice enough to put enough load on their tendons to create issues. Like if you take three months off for, let’s say, the winter and when the golf season starts back up again, if you just play golf once or twice a week, like you’re not going to get an elbow tendon injury because you’re just not, well, you might, but I think it’s low risk because you’re not doing enough to cause an issue.”
“But if you took three months off, and then for whatever reason you decide, this is gonna be my best golf season ever, I’m gonna start going to the range four days a week, as well as playing my weekly golf game, and now you’re hitting 50 or 60 balls off a mat four or five times a week, which you hadn’t done for three months, they’re the people whose elbows start hurting.”
“It’s just, in my experience, the golfers that I deal with, it’s rare to hear golfers or tennis elbow in elite level golfers in my experience. What you actually do see a bit more of is, and I know less about this, but is like hand and wrist issues. Like obviously the hand and wrist is gonna be heavily involved in any impact type scenario as well. And I’ve definitely come across some players with like aches and pains in their wrist and things like that but I don’t even know if it’s tendon, to be perfectly honest.”
“Where I’ve heard of more elbow tendon injuries in elite players is in seniors. I’ve talked to a couple of senior tour players and they have golfers or tennis elbow. I don’t know if it’s a case of they’ve just been doing it for so long and now their physical condition is starting to deteriorate or maybe they’re an example of players who like so their seniors tour in golf is 50 and over. not always, but kind of in general. Players tend to struggle on the main tour between the age of let’s say like kind of 44, 45 to 50. So they often might have like five years of let’s say like reduced play and then they spike it back up when they’re 50 to play on the over 50s tour. Maybe that kind of five year period of slightly less, but they’re still practicing and playing. So it’s kind of a hard one to put your finger on.”
Injections: “It feels better for a while and then a few months later, it just feels the same. When they return to the activity that they were doing, they just have the same problem because the condition of the muscles in their forearm, wrists, and the condition of their tendons just hasn’t really changed. And they’ve gone back to the same level of activity that was too much load.”
“It’s really interesting hearing the amount of things that people try to do other than adjust their training load and rehab. And I don’t blame them because they don’t know. They know very little about exercise.”
“A lot of the time, it’s lacking guidance and is almost all or nothing in terms of, it hurts now, let’s stop. It doesn’t hurt anymore, let’s go back to golf. But there’s no gradual buildup in between.”
“People with elbow tendon injuries playing golf tend to respond really, really well to elbow, forearm, and wrist strengthening exercises, which are all the same exercise, because you can’t do one without doing the other, basically.”
“If it’s case of like, can play golf when my elbow hurts, I’d love if it hurt less. Something as simple as a couple of sets of like elbow exercises before they play. And in general that’s pronations and supinations and extensions and flexions with some sort of load. I’ve had a lot of people say that that drastically decreases the pain they have when they go to play and swing… it’s essentially like a really targeted and comprehensive warmup because you’re loading the exact area that you’re going to use.”
Rehab: “The most stressful thing you can do for your elbows in golf is ripping drivers as hard as you can… So we’re not gonna start there, because that’s probably a bad idea. But we could start with some of those pitch shots that I was saying don’t put a whole amount of stress on the elbow, but are still using it for sure. So we might start with 50 yard shots. How did they feel? Pretty good. Okay, tomorrow do your 50 yard shots and let’s also do some 100 yard shots. How did they feel? Yeah, I could kind of feel it on the 100 yard shots. Okay, let’s do less of them. And then the next day it’s like do your 50 yard shots, let’s try some 75 yard shots. Were they okay? Yeah, they were perfect. And then gradually you’re just building back up.”
“If you did a bout of rehab, whether it’s your strengthening or your golf practice, and the next day it hurts, it doesn’t mean that you need to stop or you’ve done something wrong. It means you might have just slightly overshot it and we need to slightly scale it back and in three or four days or a week’s time, that might be fine and we can actually progress up.”
Golfer’s Elbow: “Palm up wrist curls, and I have them do pronations… So starting with their palm up, holding some sort of stick or something with a weight on the end, and then they’re rotating so that like their thumb starts to point up towards the ceiling. So they’re starting with their palm down, rotating up so their thumb is pointing up.”
Tennis Elow: “The opposite for the people with the lateral issue, which is the tennis elbow. So I get them to do palm down, forearm supported wrist curls. So they would have like their forearm on a bench or countertop palms facing down, they’re using a dumbbell, they’re getting as much stretch as they can with their knuckles down towards the floor, and then they extend their knuckles up towards the ceiling. And then they’re doing the supinations, so they’re holding that stick or shaft or whatever with some weight on the end that they can adjust, and then they’re rotating so that their thumb starts to point up towards the ceiling as well.”
“So it’s essentially just like the opposite two motions of the same exercise for the inside or the outside because you have like the medial side is involved in the wrist flexion and the forearm pronation. And then you have the outside is gonna be more involved in the wrist extension and the forearm supination. They’re the two main strengthening ones that I do… trying to get people to do them reasonably heavy, I think makes the most sense. Somewhere in about a 5 to 10 rep range, I like. Not having the pain too severe, you’re probably gonna feel it, that’s fine. Two to three sets, pretty close to failure.”
“The more elastic, like fast stretch, fast contraction. I honestly think the easiest way to do that is just with swinging because it’s just very specific, it’s easy to get the person to do it. So essentially, like, it’s almost like your dunker. Just scaling the practice to their level is the, like, fast, dynamic side of the equation for them. Just try and build both of those up over time. That’s primarily it, to be honest.”
“I haven’t bothered trying to introduce like kind of faster, more dynamic exercises in let’s say like a rehab setting, just using like tools or whatever. I’m like, you can just do that with a club, like, and it’s more fun, like would you prefer to hit 50 yard pitch shots for 10 minutes? Or would you prefer to like fling your hand around, you know, quickly like they’re like, yeah, I’ll just hit some golf balls gently, you know?”
“I don’t think there’s any issue with doing let’s say one or two sets of heavy wrist curls or forearm pronations and supinations daily. I think that area probably recovers pretty quickly, but I also don’t know if it’s much more beneficial than doing it every other day.”
“And it’s literally as simple as like, start with short shots, start working up to longer shots progressively. If you get to a point where it feels sore, like don’t go beyond that point. Like just scale back from there, hit a few balls at that area, and then hopefully the next time we go back in like a few days, you can go slightly past that point.”
“In golf, we’d call it like working down through the bag. So like you’d start with your wedges up at the top, which are the shorter clubs that don’t go as far. And then you’d work down through like your nine iron, eight iron, seven iron. And like, as you progressively go down, that shaft is longer. There’s going to be more like force because it’s moving faster. You’re hitting the ball at a higher speed. The collision is going to be bigger. So as you progressively go down, it’s going to be more stress and you might find the point that you’re struggling with and just stop going to the point that makes it really sore basically.”
Lifting: “If they go close to failure with the 12 rep weight, because it’s lighter, their tendons are able to deal with it. You know, they’re basically using like almost like the fatigue side of the going close to failure, rather than the max load down in the lower rep ranges and it’s just a lower absolute weight because I think that has a much bigger effect on what’s happening to tendon versus what’s happening to muscle.”
“My big clientele are is middle-aged people that aren’t, you know, super high-level trainers. Like pull-ups are almost like a max effort activity. Like a set of bodyweight pull-ups, they might do two or three, and they might be weighing 210 pounds or something. So that’s just like an enormous stress on the elbow. There’s no way around that. So you just advise them, same thing, let’s try some assisted pull-ups for sets of 12 or let’s do something like, you know, lap pull downs for higher reps.”
“Anecdotally and in my experience, I didn’t see the isometrics working any better than the like just heavy and slow exercises.”
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