Golfer's Elbow, Tennis Elbow and Other Causes of Elbow Pain

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So we're going to talk about elbow pain today. Uh, Dawne Costantino is here with us. Hopefully you spell my name right this time. I probably won't. So, uh, we're doing like a little, uh, dual mic or a single mic thing. So if there's a little echo in it, I apologize. We're trying to make this work the best we can with any setup. Um, by the way, if you're a clinician, you, um, please share this with other clinicians. If you feel like they'll benefit from the information, uh, and the old intentions of this podcast is to, uh, improve what we can do for our patients and improve their outcome, uh, but also to, to better educate our patients and, and, um, let them know what's going on with their body.

So we're going to focus on elbows today. Uh, we're going to do tennis elbow and golfer's elbow mainly as a central topics, but we will talk about other things too. Okay. Sweet. What do you want to talk about first? Dawne Costantino, the elbow. Well, tell me about the elbow. What? So remember, this is this, these are lay public listeners today. So, uh, what is, what do you, what's the first thing you think of when you think about elbow pain? Um, well, I know where my mind goes, but we can always start with just let's, let's go with talking about the general structures in the elbow, things that can cause pain, um, things of that sort.

And then we can kind of head into what we see, what works, things like that. How's that sound? Okay. You want to be the lead right now? I'll, I'll Dr. Google right now. Okay. So Seb's going to do Dr. Google, meaning he's going to search elbow pain, see what comes up. And then we're going to kind of respond to those things. Um, but if you go down into the elbow, obviously the elbow really only has like, I mean, it's main flexion and extension that it goes through. And then you have that ability to move your forearm, palm down, palm up, things like that. Um, so tissues, um, structures in the elbow that can cause pain.

Um, a lot of times with golfer elbow, tennis elbow, things like that. You think about the, the meaty muscles that meet on the inside or the outside of the elbow. Those are the areas that tend to maybe be, um, tender when you press into them. They seem to be the areas that cause pain when you're doing the sport, maybe that is stressing those specific structures. Um, so people will blame tendons, muscles in that spot for overuse injuries and tennis elbow and golfer's elbow. Um, a lot of times too, there are other structures we can look at like ligaments, passive structures, ability to be able to control, um, stress in that area, as well as nerves that run through there.

So there are a couple other things to keep in mind when we're talking about how to look at an elbow, how to treat it and what could be causing pain. Yeah. I think that, uh, you know, the important thing to, I think, take away from the beginning here is that knowing that there is more than just joints and muscles in the elbow. Um, I know that some of our past podcasts have talked specifically about, um, how we feel like a lot of the issues are coming from nerves passing through, or at least feeding or referring to the area. Um, but it is really common. It's really common. So we will end up covering part of that today.

Um, but just know that if you have done some elbow treatment and it hasn't worked, it's like your typical, you know, stretching as well as using some type of, uh, uh, resistance band devices. Like if that hasn't worked, it's probably, it's because it's not really your problem. It's more of a referred type of thing. So Dr. Google cover it, uh, covers. I just, all I put in was elbow pain. So we'll see basically what a lot of you guys are already looking at, um, on your end and what you're reading. So Dr. Google first web MD talks about why does my elbow hurt? Let's see. So it was a one-time injury such as a dislocation, fractured elbow, or sprains and strains.

Those all make sense. Like those make perfect sense to me. Do you have any input on those? No. Okay. So, um, probably an important part here to divide these up, which we did on one of the other podcasts too, was trauma and no trauma. So the mechanism of injury has to, uh, merit the problem. If you say I woke up with a muscle tear, probably not, you know, there was no mechanism. So I woke up with a dislocated elbow. No, you didn't. You fell or it hit it or something. Same thing with a fracture. It has to make sense. There has to be enough force to fracture the bone. And so these are, um, this web MD calls these a one-time injuries, but I'll call them trauma dislocation, elbow, fractured elbow, sprain strains.

Yes. I would agree with all those. Those are things where it's definitely more than probably definitely an elbow problem versus a referral possibly. Yeah, absolutely. Things like that will also come along with, um, possible swelling in the area, discolorations, things like that, inability to actually move the arm. Um, traumas are, are definitely a wild card. So that can absolutely 100%. You know, actually there, there was a guy one kid, one time that came in, he fell off his bike, uh, mountain biking and he fell with an outstretched hand. And so he kind of jammed into the elbow, his elbow hurt, but also his neck and shoulder hurt too.

And so, um, the images elbow, it was negative, uh, didn't MRI, the elbow eventually. So ultrasound and x-ray is negative. So although there is trauma, the force went through something else too, in this case is his shoulder and his neck. So there could be other things referring there also with trauma to, to kind of muddy the conversation a little bit. Yeah, absolutely. We're good at that muddying the conversation. Yeah. Uh, do you have any stories of elbow by the way, recently you have any good people? I feel like I have tons of elbows I'm seeing right now, but the thing about those ones is that they're not just strictly elbow.

I don't think I've ever seen, like, it's just an elbow that walks in. There's either a risk that goes along with it, radiating pain down the elbow or even up. There's always like, Oh, well, there's also shoulder neck and shoulder blade that goes with this elbow pain, but that's not what I'm here for. So I don't want to look at that. So that's a, that's a good point that you mentioned. I'd actually just wrote a new article for the website. It's on tennis elbow. And so, um, within it, I didn't want to discount the possibility that they did have something local to the elbow. Um, but I made a whole category of, uh, bullet points where I called associated symptoms or clues that would lead you to believe this is not truly just an elbow problem.

And so you've already mentioned them numbness of the hand, tingling of, um, into the forearm or, um, uh, heat changes, temperature changes, shoulder blade pain, neck pain, or headaches would be probably some that would be easy. Right. Or bilateral. How can you have a bilateral elbow dislocation? That's, that's, that would take a lot of trauma. Yeah. That's probably like you're in star Wars trying to hold those things out wide in the trash compactor. Sure. I think you just did that movement right now. So I know what you're talking about. Everybody's like, what, if you did it, would you do it with your hands, like palms against it, or would you just put fist?

I feel like it would just break my wrist first. Really? I don't know. But then when you go knuckles, it's gotta be painful bone to bone like that. I think I would do. I'd probably go here. You're like, see, yeah. C3PL could do that. I don't know. Um, I would probably go feet and then do like a leg press. Oh, that's actually a really good way to do it for sure. That way your spine's out of the equation. Okay. So, uh, next in, uh, the web MD categories, wear and tear injuries, which is bursitis, tennis, elbow, golfer's elbow, trapped nerves, uh, and, uh, stress fractures. And that's all they had in there.

Uh, why don't we hit first on maybe bursitis? Do you have any thoughts on elbow bursitis? Um, I think the only time that I've really, I haven't even seen one in person, a true bursitis of the elbow. Um, but learning about it in school, a lot of times what I hear is it's a, it's a pressure thing usually, isn't it? When it comes to bursitis. So you're talking about like on the backside of the elbow or even really anywhere. It could just be like prolonged pressure into those areas can cause inflammation of it. Uh, you know, like, uh, like I've, I feel it's been like 12 years now. I think I've seen really two.

Um, the one that stood out most to me was that, um, no, so notice we first off, you can see some swelling and redness there. Um, but one of them was, it was actually an infection that came from the finger. And so, uh, she had a cut on her finger. And so when there was swelling and redness there, it can trace its way up. And so I sent her out to, um, to her MD and she actually had antibiotics as treatment, not anything like no tissue and stretching stuff. Right. So that was, I don't see a lot of these and maybe it's because of the industry we're in. Um, or maybe they really don't exist that much.

I have no idea. I'm curious. Like, did you go through an exam with her on that one? I did. So I usually inspect when I have elbow stuff. I usually inspect the hand wrist and I look for fingertips or fingers, cuts, things like that. Um, I had heard, I don't, um, this, so one time I went to the lake and so I decided to, um, cut my nails way too short one day. And so it was like, we were kind of in the mud and stuff in the lake. And, uh, I came back and I had like some swelling around my groin. And so I went to the doctor and, and, uh, he said, yeah, it could just be the kind of the lymph stuff doing its thing.

So, cause he saw the cut, like a, there was like some redness around the toe too. So I don't know. That's what I can look for. Yeah. Uh, okay. Tennis elbow, golfer's elbow. We're here. Dr. Google said we can talk about it now. So, okay. Do you want to start on, once you start on golfer's elbow. Creep into the mic a little bit. It's funny because I'll just, I'll, anytime we're talking about things like this, I always just think about the, where the location is. I never really consider it golfers or tennis elbows. So when we talk about these things, I always have to look at, like, which one's on what side of the elbow?

Um, with, it's pretty funny. Well, you know, golfers can have both. Sure. Tennis players can have both. I always have to act out the actual motion to try to remember, okay, which one is being stressed a lot? Well, you know, so funny. So I guess on golfer's elbow, then the, I guess the typical elbow would be the follow through hand inner elbow, but lead hand can hurt too, which would be tennis elbow. Cause it'd be the outer part. So could be either. I think whoever made up the term is absolutely bullshit. So I don't know who made it up. Um, anyways, we were talking about, so golfer's elbow, uh, located on the inside of the elbow.

Um, if you were to go to the backside and find that little bony bone in the back, and then just kind of go more towards the midline of your body, just bring your fingers around. Um, that's kind of where we're talking about there. So there are some, um, flexor muscles that attach into that area and move into a tendon that will go into that, um, spot in the elbow. So, um, true golfer's elbow would be inflammation of that. Right. Uh, well, I guess, uh, see, I don't know. Here's the problem with the term is it's not specific. So if the, the actual term is medial epicondylitis, I don't know if you know, medial epicondylalgia is inner elbow pain.

Just pain. Yeah. Not even like a true structural diagnosis. I don't think so. It's like lumbago is back pain. And so, uh, alga is, is pain in the region. So, so medial epicondylitis would be, uh, acute inflammation of osis is a degenerative problem. It's a degenerative problem. They say, so technically there's, there's different things happening. One is nonspecific. The other one, the other two are more specific to the duration. The person has had it. So, um, so technically the term is garbage because it's not specific in my opinion. Well, both. Yeah. But both of those don't even really talk about what's causing, like you can have swelling and inflammation to a certain area, but it could be caused from a couple of different structures too.

Right. Yeah. Yeah, it could. Uh, so I think though, like if we kind of boil this down a little bit, and this will, this will carry over into your tennis elbow thing too, is, is that if it's an itis, you have not had it more than a month. Like if you, this is a new thing, you know, there's some swelling, a little irritation there too. And it, you know, and it's right up at the bone area. Yeah. You could have it, by the way, it would have a positive imaging finding because you'd see a lot of blood flow into the area. Um, like an ultrasound, what do you call, uh, I think you'd call hypervascularity.

You'd see vessels forming because it's a new inflammatory process, which is a normal thing. It's like having a party, you know, it just happens. It brings in new good stuff, but also it swells and hurts and that's okay. Um, the OSIS is technically a quote unquote degeneration of the tendon, the common tendon of the flexor group, but the, the protocol is pretty simple. It's loading. It's progressive loading, which sometimes hurts, but it doesn't have to. Um, but in that case, uh, technically the, the issue is still at the tendon itself. It's not anything referring there for either one. The issue being is like, you've reached a threshold at this point.

It's causing pain. It's causing some sort of inflammation, irritation in that area. Um, and really no matter what's causing it, unless it's something big, bad, and scary that we're worried about, um, we need to transfer the energy elsewhere. So it's not continuing to be an overused thing. So that's what he's talking about. We're loading, but if your rehab is only looking like it's only at the elbow and down, um, I feel like, you know, uh, better rehab for lack of a better way to say. But we'll go up the chain. Well, so I think that, um, the only thing that changes for me a little bit, if we truly do have a tendonitis versus an osis in, I, and this goes for most of the places in the body is that you can, it's, I think it's okay to immobilize it and use like your little braces and ices and I'm okay with that for like five days, but beyond five days, it's kind of like you're running out of time to do that.

Like you shouldn't be doing that as quite as much. Um, if it's an osis or something older, um, we can start loading this thing today. There's no reason to not. Now, if you had a tear and a retraction, maybe we're having a different conversation, but most things that are itis, osis, golfer's elbow, um, or a tennis elbow is not necessarily that there's not a, there's not a big reason to not load the tendons and muscles that go into the area. 100%. I agree. Okay. What do you mean shifting load away from the area? So when there is, you know, wear and tear overuse words that are used in diagnoses like this, shifting the load means, well, for some reason, this specific spot has been used a lot and it is failing on you because it's reached its threshold.

So shifting the load, um, maybe below the joint into the hand, seeing if we can create, um, more tension and energy transfer there or up the chain into the shoulder, into the shoulder blade, into the neck, something of that sort where, um, 100% of the effort is not at the elbow. It's being transferred maybe evenly or spread out along the chain. Yeah, I think so. Um, I always like to think of it. There's 10 guys digging a hole or sorry. There's one guy digging a hole, nine guys watching, you know, the guy that in the hole gets really tired and he gets quote unquote overused or, you know, so on.

And you could just easily shift the load to some of the things. Uh, and that's the way the body's intended to work. Like things don't work in isolation. You need to group things up. Um, what is it? Uh, things that fire together, work together, muscles that fire together. I don't know. Shit. I don't remember. Always the good analogies and then the terrible at remembering certain clothes. Yeah. I don't know. 100% though. I agree. It can be done better with help. Yeah. So tennis elbow then, uh, by the way, I guess we should, uh, digress a little bit. Uh, I said the word degeneration. Um, can you talk a little bit about, you feel comfortable talking about that?

Like, is it really degenerating? Is it like, what's happening there? And should we be afraid of that? No. Why not? Because degeneration is a normal process of life being human, things of that sort. I wouldn't, wouldn't always jump the gun and say that degeneration, um, unless it's caused from like some sort of like crazy inflammatory arthritis, that's degenerating the bone away or things of that sort. If you're just seeing aging changes, like they'll say osteophytes or, um, things like that in the area, that's a normal process. That doesn't, that doesn't necessarily mean that's the true cause of the pain in that area.

That's my opinion. Yeah. I think degeneration is something that I'll probably feel I'm very angry in this podcast, but I don't think anybody should have ever named anything that, um, it's, it's like, you'll never, you'll never recover from this disease syndrome. You know, it's like, uh, it's, it's a, I think it's bad wording. Um, sure. There might be some changes happening in the tendon itself, but it doesn't mean it's painful and it doesn't mean that it will, that you'll be in pain forever. So, um, if, if you're kind of reading it as that, uh, I would change your mind because you can feel better sooner than you thought possible.

You just need to have a good plan. Uh, tennis elbow, you want to talk about tennis elbow? I mean, I think we'd say all the same things as golfer's elbow, except the difference in location. Well, so maybe we, maybe tell me the location and then we can talk about the different nerves that pass through because we didn't talk about that yet. Okay. Um, so location, take the bony part of the elbow on the backside and instead go out away from your body and you'll come across the extensor tendon on the like thumb side. If your palm is facing up towards the sky, it's the thumb side of the elbow that we're looking at here.

Okay. So there are, um, there are other muscles that hatch in there too, uh, but mainly the extensor group of the wrist. Um, but also the, you call it the supinators, the ones that open your hand, uh, and the differences of nerves too, that we, the, the reason why I'm bringing these up is because you guys might be looking at some, some articles and then they mentioned these things and you're like, Oh, I didn't know that was there too. Yeah. It is normal for a part of the radial nerve will pass through the supinator and go in that pretty much very neighboring area over there. Um, and it can simulate tennis elbow.

Um, you might look up things that say supinator syndrome. Now, is that really the problem? I'm not quite sure, but I think to just understand that the nerve can create some havoc in the area too. So, uh, on the inner side is a lot of people will be diagnosed with cubital tunnel syndrome or an ulnar nerve entrapment because that passes right by there too. And it actually goes right around, um, the bony area where the flexor group attaches and then through a couple of the flexor muscles, they say, uh, I'm sure that's different on everybody because everybody's a little different with anatomy, but I thought we would mention that.

Uh, okay. So when you want to talk about rehab of these, because I think everyone's like, oh, this is a lot of good information, but what do I do? When do I want to talk about it? Let's talk about it right now. That's a great lead into it. Well, I, okay. Are there other structures you want to talk about first? No, I mean, I, I see, uh, I see some things on Dr. Google. I don't know if we need to go. We, you want to, once you start talking about rehab, I'll see what else Dr. Google wants us to talk about. Okay. So, um, I'll kind of, I won't make it super duper long, but, um, let me start by saying if someone walked in the door with elbow pain, this is kind of how we would approach it.

We would always go up the chain and start from the central source, which is usually neck, look into the shoulder blade, upper trap, shoulder itself. Look at those movements. Look and see what else is going on up there. And then move into the elbow and kind of stress into that spot. Um, most of the time, the way that I approach rehab with things like this, depending on what we find in exam is finding stability closer to the spine. So, um, allowing the elbow to move freely, properly, um, and better by allowing everything above to do some work as well. So I don't know, scapular stability type things, making sure that this elbow pain is not being a referral from the central spine.

So somewhere from the neck. Um, so we're going to make sure that we kind of focus there first. Um, we'll probably do most of the time. What I see is I do a lot of shoulder blade work and things like that. But, um, eventually we get down into more local stuff into the elbow. Um, but that usually goes along with a lot of the shoulder blade things. It's always all encompassing that most of the X I'm like sitting here looking at your elbow. Most of the time I'm like staring at your elbow. Like, Hmm, what do I do here? Oh, is that my, is my anchor tattoo you're looking at? Your barbed wire. Yeah, my terrible barbed wire tattoo that goes around my bicep.

Oh my goodness. Anyways, I was thinking, so if we go a little more local to the elbow itself, um, most of the time, the rehab that encompasses, you know, stressing the shoulder blade, the shoulder, the neck, the upper trap, things like that will always entail. Um, what do you call it? Loading into the elbow at the same time. Yeah, you can, we can't really leave the elbow out of the equation, nor do we want to. And, um, so I would agree. I think looking at least for an exam, like everybody who has an elbow, um, problem should be examined the neck, the shoulder and the elbow, probably the wrist and hand too.

Like I remember doing a, uh, there was an exam that I took where we were, uh, so it was a proctor and everything and they were, they were watching. And so I'd studied a lot for shoulder. Right. And so, cause I'm like, they're going to totally give a shoulder. And so I was like, I got to do next shoulder elbow. And so with the time doing, it's like 15 minutes. And so I was like, great. I'm, I'm so ready. And they're like elbow. And I'm like, God, I'm like, I got to do a whole nother region. Like this is so annoying because I get it now, which is burning up time. And so, uh, yeah, elbow cases, you gotta, you gotta have an exam all over the place to, to confirm there's nothing going on there.

Now, does that mean needed an MRI and x-ray of all these spots? No, you don't probably don't need any imaging at all. Um, but you need to have someone who will look there for you. If you don't, you're missing out on some possible easy wins. Um, from a rehab perspective though, uh, I like to, to work on a grip a bit, um, in different types of grips. And, uh, I, I know with, with wrist and hand problems, uh, I like to work on the small flexors of the, of the hand or the, sorry, the small intrinsic muscles of the hand. Um, yeah, that, that tends to work really well. And it, and it sends a lot of effort up the chain.

It sends it all the way up the shoulder. 100%. Yeah. Most shoulder rehab, shoulder blade rehab that will encompass the elbow. Um, you'll notice it'll make it more challenging. And that like transferring energy that we keep talking about when you, when you get the involved and ask you, I don't know, squeeze a ball or squeeze the weight harder or grip the floor, things like that. You'll notice all this other stuff starts to work a lot better too. Yeah. So I know that like one of my thoughts would like, is say we really do have the tendon and the elbow having a problem or the insertion point. Um, I think if we not only share the load up and down the shoulder, uh, shoulder blade, wherever, right.

But even locally around the elbow, like you can create like a co-contraction type of thing that happens. And we do that with spines a lot, um, even shoulders and hips. Like you want to make sure that one side is not working more than it needs to when the other side is being lazy. Yeah. I'm trying to think co-contraction around the elbow. Give me an example. Firm grip. Okay. So firm grip should do it. Right. Yeah. Um, and, and this is, this is where, um, when like maybe our rehab might differ a little bit is that, uh, I know that there's been a push over the years to do like only eccentric loading or lengthening contractions or isometrics or concentric contractions of that muscle.

That's the quote unquote problem. Um, but you're ignoring the other groups and you can get more stimulus to the entire joint and the muscles around the supporting cast. If you just firmly grip something. And so a lot of people, you could just make them feel better just by doing farmer's carries. Yep. 100% or even, um, you know, we talk about shoulder blade stability. You think about, I don't know, poles or, um, when people call these things low row or like, sorry, things like that. Yeah. We'll notice, um, we'll do simple things like that. And yeah, you can just try that at home and see if it helps you, but we'll put like a ball into somebody's hand and say, you know, grip it really firmly, try to pop it with your fingernails, things like that.

And, um, it just, it changes the whole dynamic of rehab and going, going from the top. I know that you've probably had, I think you've, I think you told me a story, but you've had elbow people who have responded well to a simple burgers exercise. So you want to describe burgers maybe so they can try if they wanted to, um, you sit up straight in your chair and try to think about bringing your shoulder blades, uh, together in the back, but not elevating the shoulders. Maybe thinking about putting them down into your back pockets of your pants. Um, so you feel like you're squeezing in between kind of low and between the shoulder blades elbows to your side with them, bent palms up and you're going to, I think Dawne Costantino's forgetting where the mic is.

She's like, I feel like we're just having a conversation looking around the room for like someone else's elbow tattoo. Mine's right here. It's apparently not good enough. I'm picturing a body and how I would describe this and showing it. This is why we need the microphone that attaches to your head. I can move around my bad. Okay. So sitting up straight shoulder blades down and back, squeeze together in the back elbows to the side of your body, palms up, and then just think about rotating your palms out to the side of your body while still squeezing and not allowing the elbows to come off from the side of you.

You'll feel more of a squeeze, um, in between the shoulder blades in the back and you just kind of keep doing reps of that rotation. How else would you describe this? Um, uh, I have two trays of soup and I'm trying to move them away from my face and then serve them to people on the sides of me. On the sides of me. Perfect. There you go. Love it. So, uh, yeah, you got to move real slow and careful, right? With some intention. Uh, I'm going to play patient for a little bit. Uh, so Dawne Costantino, we're doing shoulder work. When are we going to do something for my elbow? And why are we doing this? Don't I need a stretch or something?

Um, not necessarily. So why are we working on the shoulder? Because we're looking right now, we're saying that this is an overuse thing in your elbow, right? So, um, why would we continue to stress it, overuse it in that area? We need to think about, um, asking the helpers, the other nine diggers of that hole to do some work. So that's why we're doing this. Okay. So you're saying that doing the shoulder exercise will help out my elbow. 100%. I think it would. And I don't need to stretch it. I don't think so. Let's try it. Have you tried stretching it? Uh, I did. And it was not working. Okay. So why would we keep doing it?

Uh, cause someone told me that I needed to, cause it feels really good to some people say that. It feels better afterwards. It feels tight. And I've been told when something's tight, we stretch it. I think that's what people get a lot. Yeah. So what do you mean? Like, I guess, I guess, uh, I'm going to keep playing patient because it's just easier. Yeah. Someone, someone told me to do it. I see videos. It makes me feel better. It just doesn't stick. Do you have a better stretch? Um, I can show you some and we could try it. Um, but if we tried for this long for you to keep stretching it, if it gives you temporary relief and you want to keep doing it, that's totally fine.

As long as it's not making you worse, but if you've done it this long and it hasn't helped you, let's just try something different. Now, do you think I need a brace? No. How come? Hey, you can, you can do this to me after. Um, I'm going to be the person that has way too many questions. Um, a brace can come in handy sometimes depending. I mean, this is really hard because it's like, it depends on who you are as patient, but a brace can be helpful. If it helps you do it, but we, I don't want the brace to be doing the most of the work for you. We want to ask, um, muscle groups to be doing the work.

So, so I guess I'll step out of patient right now. Are we, we're doing real elbow, not referred elbow, right? I don't know. That's why I don't know how to answer these questions. So we're doing real, we'll say real elbow. No, we'll say referred elbow. Okay. We'll do referred elbow. Do I need a brace? No. Why not? Because it's not your elbow. So what is it? Um, well, referred elbow means that it is something like a nerve or no, it is a nerve that is referring pain into this area, meaning it's coming from somewhere else and nerves don't like compression. Um, so putting a brace on it, things like that is not going to help with this nerve.

My mind is spinning. I came in for my elbow. I don't want my neck work done though. Did a brace and did stretching work for you? No. Okay. Then let's do something else. Okay. So you're just going the trust route. Okay. Do you want to play patient now? Sure. Uh, what case are we, what case do we have? Um, let's go true elbow then. Oh, okay. How did you hurt it? Um, playing golf. Okay. Oh, you're the patient. Um, why are we doing, why are we doing Rose? Rose? Um, well, so does Rose, do Rose hurt you? Okay. So, um, at the moment, it's funny, it's hard to jump in right in the middle of it, huh? I don't know what we talked about beforehand.

So, uh, so yeah, doing Rose can help build support in other areas. Okay. Um, also Rose will help out with reaffirming your grip. Remember how it hurt to grip. Yep. I'm going to make sure that, you know, now what you feel. So, uh, it hurt to grip before, so it doesn't hurt to grip this way. Does it? No. Okay. So I'm teaching you to use other muscles of your elbow to help out that one muscle as you do things like gripping. So gripping doesn't hurt you. Okay. Well, so gripping my, uh, club while golfing doesn't hurt. It's just the swing that hurts. The swing. So why aren't we working on swing? Uh, cause I'm not a golf coach.

I mean, I mean, here's the thing. Like, you know, we like, like we have people come in sometimes who are looking for running analysis and swing, uh, swing coaching and so on. And like the easiest example I can give you is, is that when we're talking about running analysis with people or get analysis, um, if I stabbed you in the leg and told you to run, would your get analysis be odd? 100%. Okay. So pain will corrupt your movement a hundred percent of the time in that case. And so, yeah, we can look at your swing if you want to, but currently the pain that you are experiencing is probably corrupting things in the movement.

So I don't want to go there yet. Let's just do an order process. Let's get the pain to reduce. And then we can go with that and we can talk to your swing coach. Sounds fair. Good. Can I see you next week? How much does it cost? Oh, we're going down that route. Just kidding. Okay. So, um, let's go down Dr. Google one more time. Unless, is there something else that you think we need to hit before we start shuffling around? There's a Google's full of these questions. I feel like I had a lot of stuff in my head, but we've jumped around a lot. So I don't even remember what's in there anymore. Well, I think we covered some good stuff.

I think maybe if we just clarify first of, so there's trauma and non-trauma. Okay. Trauma, definitely x-ray, go see somebody. You might need to put a cast. Who knows? You might need a lot of things. We are not really good at trauma. So we're good at the other camp, which by the way, most of you will be non-traumatic. Um, those are categorized as like your wear and tear overuse, blah, blah, blah. Right. But also too, which things that are often not times talked about is the possibility of referral. Okay. Non-trauma doesn't mean the muscle. It means things that are not broken and torn. Um, a lot of times these people will not have positive x-rays or MRIs.

You don't need to find multiple images before you start care. You just have to start get a thorough exam to stress, uh, stress test, the neck, the shoulder, the elbow, and the wrist. Yes. I'm looking at your sailor tattoo on your wrist. Um, so, uh, but yeah, and most of these are very easy to reduce. They're super easy. Um, a timeline. What do you think a fair timeline is for, for reduction of pain by 50% and then returning back to golf? What do you think are fair timelines for most people? Um, so I'd say if this is something that just happened, just occurred and you're super acute, then give your body the natural time that it needs to just heal.

So, um, I don't know, maybe no more than four weeks to see changes in pain. If there's no change in pain after that, then we're going to look into this being more of a chronic thing. If this has been chronic, it's been going on for a while. Nothing's been helping. Um, 50% improvement within four weeks with what we can show you, um, to work on returning to sport. I always have different answers in you because it always really just depends. So I never give a definite when it comes to that. Yeah. I usually tell them to, to number one, if you can do things throughout the day, like putting away dishes and opening doors and yeah, we can, we can, uh, like we need to focus on that first, like things throughout the day.

Now, if you feel good throughout the day and all of a sudden you only have it during a swing or something like that, then, then we can figure out that timeline a little bit, a little bit better. Um, but yeah, I would focus on ADLs and things that you're doing normally first. Yeah. I think a lot of times my conversation with people and things like that too, is, um, the only way we're going to know what's working is can continue to do these things. So, um, I'm not looking to take you away from your sport right away. I want to see if, uh, we can keep you there and not change anything. Um, and if we need to tinker with maybe stay away from this, but still do you're free to do all these other things in your sport too.

And we'll, we're going to keep you there. We're going to try our best to keep you doing the most activity, not take you away from it. Yeah. I don't think there's no reason to decondition the whole person and athlete just for the sake of an elbow, you can turn your hips and act like you're swinging a club if you want. I mean, nothing wrong with your hips, right? Um, okay. The, uh, uh, why don't we do this since, uh, we can, I turned the computer to you so you can, you can quiz me if you want. Why don't we just go through these questions that people tend. You ask and we'll find the good and the bad.

Okay. What does tendonitis to the elbow feel like your turn? Do you want me to read it? No, no, no, no, no, no, no. Uh, I want you to answer it. Um, could feel achy, could feel probably sharp and shooting at some times. Um, maybe some burning, uh, feels kind of swollen, like maybe lack of range of motion. That's probably what I would describe. Okay. Which one do you want to ask me? What do we got here? What causes elbow pain without injury? Without injury. Okay. Dr. Google says inflammation, uh, of the tendons. And I would disagree with that. Actually, not mainly not to not just, not to say that I don't, it doesn't happen, but it's not as common as you think, as we mentioned earlier, like, so I've, I've really only seen like two bursitis is, but probably the, one of the first things you're going to see on the internet is talking about bursitis.

Um, so elbow, uh, I'd say about, if I were to guess about half and half, half is referral half is half is the, uh, um, is local tendons that are working too hard because something else is not working. So, uh, what causes elbow pain without injury? Um, could be a lot of things. I don't think it's a solid answer with that, but, but it's, it's, it's, uh, it's certainly important to consider the referral. Yeah. 100%. Okay. I'm saying that a lot today. 100%. I agree. I, I concur. Dr. Leonardo DiCaprio, do you concur? Uh, what is a natural remedy for elbow pain? These are things that are natural remedy.

Apparently ginger tea, apparently. Oh, I mean, I guess that could help with inflammation, right? I guess so. There's a lot of different routes you can take with that natural remedy. Maybe in the free beginning, when it first hurts rest, um, a little bit. A little bit of movement, just tailor back on what you've been doing as well as if you want to go the nutritional route, some anti-inflammatory stuff. Sure. Yeah. Cool. All right. What is my question? We'll do this just for a couple more times. Then we'll start wrapping up some. I want these to be harder for you. I can, I can hear, uh, I can hear you whispering in the mic.

Um, does elbow tendonitis go away? Yeah. Yes, it can. Yeah. Tendonitis will go away. And as we mentioned, as we talked about earlier, uh, itis is new and it's like when you burn your skin or sorry, when you do a sunburn, it's a natural inflammatory process. It will naturally go away on its own unless you keep pissing it off. So, uh, most of it will go away on its own. Uh, and if it doesn't, and it hangs around for a little bit, uh, yes, there are easy, uh, sorry, there are simple things you can do to make that go away as well. Uh, we've had good success with things here. I'm sure other practitioners have good success with elbows as well.

And so don't just let it hang out and assume this is going to be this way forever because you're just burning precious time at that point. Okay. One more, one more. Damn it. It's not really asking good questions anymore. Uh, okay. I have elbow pain when bending my elbow. We've got a lot, honestly. Why don't you talk about that then? Because I think that's probably a correlated topic. Sure. Okay. So, um, I'm not going to lie. 100% so far of all of my elbow cases, um, have been, have had associated symptoms up the chain. So there's a reason why we chase it. Um, and they've been nerve related. Um, and I like how when you talk about it, it stresses you out and you have to rub your face because the idea is that people that it's like, I should never bend my elbow again.

I think a lot of times, some of the, um, advice that they're getting somewhere else is saying like, put it in a brace, don't fall asleep with it bent, um, don't bend it at all. Don't load it. It's just like this constant taking people away from what they should be able to do naturally. Um, so what was the question? I have elbow pen pain when bending my elbow. Okay. So, um, should I just never bend it again? No, we should 100% be able to do that. Um, that is a movement that your body should naturally be able to do. So if we need to take a, take it away for the time being to promote healing. Sure.

But this is not something where we're like, don't bend it the rest of your life. It sounds extreme, but I think some people will interpret advice of not bending the elbow like that, where they really think that they can't. We, you know, they're, so there, they could be misinterpreting, but also too, I have seen papers written and people hand them to me. And it says in this case, maybe not elbow, but do not lift anything over 10 pounds over your head ever again, you know? And so they might be giving those specific instructions to not bend their elbow. Um, and so I know clinicians might probably can listen to this.

I would just caution you on how you word things to people because they could take it literal. Um, don't ever bend again. Sounds like a pretty steep request because I'm pretty sure I got to drive my car home, you know? Yeah. And that's, it's kind of funny how you can, I mean, sometimes I do this, I think it's more for my own humor, but, um, people will tell me it hurts when they bend their elbow. They do it. They show me it hurts. Um, and then we do some form of exercise where they don't realize they're bending their elbow the same exact way and it doesn't hurt anymore. So there are ways that we can accomplish this.

It's, it's funny how sometimes you have to trick people into it, but, um, you can bend your elbow and we'll get you there. And when people say don't, maybe it's just a temporary amount of time. Don't think that the rest of your life you can't. Yeah. I think it's typically temporary that they, that they're talking about. Um, and there are times where we say, don't do that for a week and then do it again. Um, but I know I have had people who have came, you know, once. And so I used to just say, you know, don't do that. And then they don't come back. I'm like, shit, I'm that guy, you know? And so now I'll say your elbow can't tolerate bending right now.

Later it can, you know, try to let that. Sync in enough to, they understand that it is actually helpful for them to bend their elbow at some point in time. Just maybe at this point in time, it's not. Yep. 100%. If the, uh, if the injury has healed, we're doing rehab properly. Um, you'll bend your elbow again and your brain's going to remember that it was painful. So it might send some signals, but the more and more you explore it after injury has decreased, the more you'll realize, oh, I can do this again. Yep. Dawne Costantino, the motivator. So what do you want to, do you want to cover anything else before we finish up here?

About surgery and that ulnar area. I feel like I get that question a lot. Cupid little tunnel surgery, opening it up, things like that. What do you know about it? Yeah. So I should probably mention that we have a couple podcasts already specifically on ulnar nerve that you guys, if this is a question that you have, you should listen to those. And we do actually have, uh, an ebook as well with a bunch of videos. Um, and it really comes down to identifying that that is the correct site. And it's really hard to say that it is the correct site because there's always a possibility of other things happening.

Like a double crush is a thing that, you know, people believe happens where it could be at multiple entrapment sites. And even if that is the case, if you move the nerve from its location, it doesn't change the second crush. Now I'm not going to say I diagnosed a double crush, uh, really that often, but I do try to pay attention to the person's symptoms or associated symptoms a little bit more. So if you have numbness of your fingers and it is not just the pinky and ring ring finger and includes the thumb, the index, the middle finger, or even the back of the hand, this is not a single nerve entrapment.

It's something else. And so it's really hard to give wholehearted suggestion to go have a re, uh, something moved if there's other things going on. And so I would attack the other things first and you might find that that thing will just naturally go away. Um, uh, I would say that for people dealing with elbow pain or an associated numbness to the fingers, the ring and pinky finger, uh, I would say that easily 70, 80% of the time it's from the neck. Like it, and if no one's looked at your neck, they need to look, you need to find someone to look at your neck and help you. And by the way, that doesn't mean an x-ray and MRI, it means stress testing the neck and actually treating it as such, assuming it's the neck, because why bet against the house?

I mean, if you're willing to go do a really, uh, a more invasive surgery in, in lieu of just doing something simple just for a week to see if it works, I think it's a ridiculous idea. So, um, yeah. Anything else? No, it seems like you're going to get angry if I ask any more questions. Yeah, it's, it's just, it's, it's tough. Like, cause I, it's, it's such a common question and I get it. I totally get it, but, and people have been told that they have that. And, and it sounds like there's more exam that needs to be done. Like you can't just look at an, an elbow and say, it's an elbow. You need to do the other things too.

It's called a ruling in and ruling out process. And I think everybody has the responsibility to do that. Um, and patients, if, if you are unsure, if you've been looked at like that, just ask questions. There's nothing wrong with asking your provider, what's going on. Hey, do you think it's my neck? Do you think it's my elbow? Whatever. You just ask them questions. Like most people are open for questions. Yeah. Um, kind of wanted to just talk about the, if it sounds like we're really frustrated about certain things, or if it sounds like we're like kind of mocking certain things that people say, it's not that we're trying to be like rude or mean.

It's most of our time it's spent trying to convince people that they can move their bodies or just going against, um, we're trying to just work with people, certain mindsets. That's fearful of certain things, fearful of injury. And we understand the reasoning behind that, but, um, most of the time our frustration is just coming from, you know, having to work with all of those, all that bad advice and beliefs that people have in their brains. So, yeah. Yeah. Thanks. You always lighten it up. The, uh, but yeah, it's not, um, I mean, there's, there's good clinicians everywhere. Like, and everybody's had their first elbow problem and everybody goes through their investigation in their own.

It's like, I always kind of think of it. Like if I were to tell her, you're a 15 year old boy on the planet to not do back and buys and chest and tries, like they wouldn't, they wouldn't listen and I wouldn't listen either. And so everybody has their own kind of growing process. We're trying to, trying to expedite it. And, um, we don't always get this hour, 45 minutes to talk to patients in depth about what it could and couldn't be. And sometimes I know we're kind of lighter on our words when we're talking with people directly, but sometimes you need, I feel like the need to be stern because they don't, they're, they're, they're not hearing how serious we are about it could be referred.

You know, it's like, we're being like light and jokey and you wear a t-shirt to work. And I do too. It's like, you know, we're in a smock, you know? So, uh, I think this is our opportunity to, to really get in your ear a little bit and give you some considerations of what we, uh, what could be going on. Yeah. We're not claiming to be experts of everything too. I think everybody that you see out there is trying their best with what they know and what they've seen and all of that stuff. So, um, just if one thing isn't working for you and you've tried it long enough, try something different and just be open to it.

Especially before we get too invasive and cutting people open, it's just scary how quickly we jump to that. Hey, and there's a time and place for that. Don't get us wrong. I know we didn't, didn't go over the details of when surgery is needed. Um, but it's certainly needed in some situations. We're not experts in that either. Um, I'm sure other people have done podcasts on that section. And so just kind of use these podcasts and information that we've got and put them all together with what everyone else has. Uh, I'm sure there's a, is there a systemic reason, like an organ reason is anything you refer to the elbow?

I know that with, it does with back shoulder, you know, neck, stuff like that. So I mean, there's even other things that could be creating elbow pain. And I think the, the only, the, I guess the major takeaway I want everyone to understand is that it's not your, probably your muscle. I mean, it could be, but there's a large possibility that it's not. And once you kind of unveil that curtain, you'll be exposed to all these different treatments that could work and it could really change your life. Yeah. I like it. Do you want, do you want to close us today? I forget what you always want me to say.

Oh man. How many of these have we done already? I don't know. So far and few between that we do it though. Okay. Um, well guys, uh, and ladies, um, if you would like our help, we are located in Orange County, California. Is that where you wanted me to go? No, I actually, I forgot about that. Okay. You just chime in whatever I forget. Okay. Um, we're located in Orange County, California right now. We are seeing people virtually and in person. I think most of my elbow cases I'm seeing are all virtual and they're responding really well. Just coaching people through exercises. Um, we have a lot of stuff on our website, YouTube channel.

You can check out, see if it'll help you out from home. Um, but reach out to us if you'd like to ask us questions and, um, like to see, you know, what kind of input we have. We're here for you. Uh, thanks for being part of the movement. That's the thing. I'm going to get you a t-shirt. Thanks for being a part of the movement movement, y'all. We'll see you next time. Bye.