Flexibar & Tennis Elbow Treatment - What does it do?

Discussion in 'Health & Fitness' started by Chas Tennis, Sep 20, 2012.

  1. Chas Tennis

    Chas Tennis Hall of Fame

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    This video from the supplier of Flexibar describes an exercise that claims some improvements in tennis elbow pain from a Flexibar eccentric exercise. There are also references.

    http://info.thera-bandacademy.com/flexbarelbow

    Some TW replies have had positive comments about the Flexibar for TE treatment. Also, eccentric exercise treatment is a research area with some current interest for chronic tendon injuries such as Achilles Tendon injuries.

    Any thoughts on how eccentric exercise treatment might work for TE with the Flexibar? Effectiveness? Have you found other research from neutral sources on the subject?
     
  2. charliefedererer

    charliefedererer Legend

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    Several have posted here that they found the Flexbar helpful in preventing an early recurrence of tennis or golfer's elbow.


    Strengthening the forearm muscles means there is stronger elastic muscle to prevent the twisting motion that occurs in the tennis swing and contact.
    The stronger muscle is better able to absorb the shock of contact, rather than transferring it down to inelastic tendon insertions at the elbow.


    Here is a diagram of the muscles of the forearm. Notice that they don't go straight down the arm - there is a slight spiral from right to left.

    [​IMG]

    The Flexbar works these mucsles in the spiral fashion that they seem designed to work in.



    The red Flexbar is very easy to twist. It has the optimal design to be used early in the process of recovering tennis elbow. In this early phase (after the worst pain and inflammation have resolved), the gentle motion helps keep the tendons gliding past one another, rather than abnormally fusing to adjacent tendons and tissue. ("Healing" protein fibers sometimes do fuse to adjacent structures, then these adhesions have to be broken down - leading to another bout of inflammation from pulling the structures apart.)


    The stronger green and blue Flexbars can be used later in therapy to actually build muscle strength.



    I first heard of the Flexbar when Chess9 posted the following article from the NY Times: http://well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-tennis-elbow/

    Here is a nice article with an interview of Timothy Tyler of how he came to use this fairly inexpensive Flexbar to substitute for much more expensive machines that used eccentric exercises: http://www.medpagetoday.com/Orthopedics/Orthopedics/15048

    Here is the actual article: http://www.thera-bandacademy.com/elements/clients/docs/Tyler et al JSES 2010__201009DD_123442.pdf

    From that article, the following appears at the end:

    "Disclaimer
    None of the authors, their immediate families, and any
    research foundation with which they are affiliated have
    received any financial payments or other benefits from any
    commercial entity related to the subject of this article.
    We would like to thank the Hygenic Corporation for
    the donation of all the flexbars for completion of this
    study."
     
  3. Greg G

    Greg G Professional

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    My experience with the flex bar is very positive! Had this nagging GE/TE combination for a few months now. I would say a moderate case, which I could and did play through. ;). I tried stretching, heat, ice, acupuncture, it would not go away. I found a local distributor for the flex bar. Used the green for a week- TE is almost completely resolved! The GE is much better, but still needs some post play care (ice). But definitely much better compared to before the flexbar exercises.

    I think it's the eccentric component of the flex bar exercise that really has a good effect on the injured muscle/tendons.

    Oh and take it slow. Do not overdo it, or you could give your other arm TE/GE!
     
  4. Limpinhitter

    Limpinhitter Legend

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    I CURED my TE by learning to keep a loose and relaxed grip through contact on every shot. When your grip is loose and relaxed, the shock of impact terminates in your hand and does not transfer to your arm.

    There are also the side benefits of added power and more consistent clean ball striking. Tightening the grip at contace reduces racquet speed and alters your swing path causing off center hits.
     
  5. Frank Silbermann

    Frank Silbermann Professional

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    I have found it very effective. I have also found eccentric exercise helpful in ameliorating a number of other small injuries, e.g. a sore achilles tendon, plantar fascities, and a minor groin strain.
     
  6. Chas Tennis

    Chas Tennis Hall of Fame

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    Is Radial Deviation Part of the Flexibar Exercise?

    I just purchased a blue Flexibar to learn how it works and try some exercises. I don't have TE.

    When I do the exercise for TE I notice that the exercise causes radial deviation of the wrist -slightly uncomfortable to the wrist - along with the flexion. The demo Thera-Band website shows this same radial deviation at 0:04 & 0:11 sec of the main video.

    http://info.thera-bandacademy.com/flexbarelbow

    Inconsistent - the small video in the upper right - girl in the blue top - does not have this same radial deviation but only wrist flexion, which I assume is how the exercise with the Flexibar should be done. Also, the instructions received with the Flexibar show this same exercise and girl in the blue top, no radial flexion.

    If I move my arm out to the side I can almost eliminate the radial deviation.

    Probably the blue bar is too heavy for my forearm & wrist but I have no problem twisting it. Maybe supporting muscles are weak?

    Can any Flexibar users comment on the inconsistent videos regarding the final position of the wrist?
     
    Last edited: Sep 24, 2012
  7. jgrushing

    jgrushing Rookie

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    I see the radial deviation that you're talking about. I try not to do that. Initially, I had difficulty getting the right amount of twist in the bar to have an efficient "unloading" process. I've gotten better at it--not sure how much it matters.

    My exercise is definitely targeting the right area as it is sore in these first few days. I am optimistic that this is part of the rebuilding process for the muscle/tendons. I've had a moderate, but recurring, case of TE over the last several months. Really hard to get over it.
     
  8. Chas Tennis

    Chas Tennis Hall of Fame

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    Tendinitis or tendinosis

    I am not certain of the use of these terms so research on your own -

    There is the issue of whether the TE is tendinitis (more inflammation?) or tendinosis (healed tissue with defective scar tissue, fibrosis..?...) or some mixture of the two conditions. Obviously this gets very complicated, unknown, and risky especially if the elbow is still under heavy stress with exercises or tennis.

    Tendinitis -
    http://en.wikipedia.org/wiki/Tendinitis

    Tendinosis, Eccentric treatment is mentioned as an area of research -
    http://en.wikipedia.org/wiki/Tendinosis

    ?
     
    Last edited: Dec 14, 2012
  9. charliefedererer

    charliefedererer Legend

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    Work your muscles in many different ranges of motions, as the Flexbar is good not only to strengthen the flexion/extension muscles but also muscles that are responsible to stabilize the wrist during radial/ulnar deviation. (Ulnar deviation occurs during groundstrokes and serves, so more stabilization is a good thing.)

    The Flexbar can thus be used not only to protect the elbow from tennis elbow, but also strengthen muscles that will protect the wrist.

    You can get the most out of your Flexbar by doing exercises with your arms outstretched (mostly flexion/extension) as well as bringing your arms in closer (more ulnar deviation).

    You will find that if you start with dominant wrist in front of you already fully extended flexed, you will work mainly flexion.
    Start with your dominant wrist neutral, and there will be more ulnar deviation as you twist.

    Try all of the above to work on different muscle fiber groups within the forearm musculature.
     
  10. charliefedererer

    charliefedererer Legend

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    Here's my take.

    The initial bout of tennis elbow is tendonitis.

    Healing of microscopic tendon tears involves the body laying down protein fibers.

    In those who get such severe tennis elbow that they come to surgery, they usually have had multiple epsisodes of healing and tearing, healing and tearing, healing and tearing.

    The result is a tendon largely relpaced by a tangle of "healing" fibers - tendonosis.


    Normal tendon fibers:
    [​IMG]

    One small group of tendon fibers that have undergone fibrosis (tendonosis):
    [​IMG]


    Advanced case of multiple tendon fibers that have undergone fibrosis (tendonosis):
    [​IMG]
     
  11. Chas Tennis

    Chas Tennis Hall of Fame

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    CF, That is a very clear description with illustrations and you pin-pointed important issues.

    As for the Flexibar or other treatments, I hope that there will be treatments that will produce improvements in the chronic tendonosis phase but, as usual, the solid research, independently repeated, to back up conclusions is not here as far as I can see.

    For myself, I don't believe in exercises or stretches with tendinitis. Also, I have posted what I read about new acute tendon injuries - if stressed - possibly becoming tendinosis in a very short time. Again, I wish I could find this issue discussed more often by Drs and researchers. It seems that there should be a very simple rule given the uncertainty of TE & GE injuries - 'not certain of the injury - then stop playing for 3 months or more and see a Dr'.

    There is some logic to eccentric exercises possibly breaking up tendinosis since eccentric contractions disrupt muscles more than concentric contractions. But in view of its importance why isn't there more research on eccentric treatment? Why isn't there more use of eccentric treatments by the medical community? I'd be surprised to hear of someone with TE that was being treated with physical therapy using primarily eccentric treatment. I would not be surprised to hear of cortisone shots.........

    TE & GE are probably so difficult because many people probably have some mixture of the three conditions that you identified, all at the same tendon attachment- healthy uninjured tendon, inflamed tendinitis and old scar tendinosis (fibrosis).
     
    Last edited: Sep 24, 2012
  12. charliefedererer

    charliefedererer Legend

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    Tennis elbow is a nightmare to study scientifically.

    Science demands objective standards to measure.

    There is no good objective test for tennis elbow; no x-ray, blood test, CT scan, etc.

    And as you suggest, there is a great variety to the extent of tendonitis and tendonosis in most patients, and no good scientific way to separate those with largely tendonitis and those with tendonosis.


    Who is going to do a study on tennis elbow, and what two treatments are going to be compared?


    Most tennis elbow isn't even caused by tennis, but by occupations that involve repetitive arm movements - mechanics, carpenters, etc.

    Compliance in those whose livelihood being told to stop working rarely happens unless the condition is nearly devastating.

    Sadly, speaking with friends suffering from tennis elbow from playing tennis, and from reading about those suffering on these boards, compliance in tennis players is not much better.


    As stated by Timothy Tyler, eccentric exercise involved using expensive machines prior to the use of the Flexbar.



    It takes time for inflammation to dissipate.

    Hence the popularity of the "magical" cortisone shot that makes inflammatory conditions feel better quicker.

    For a job, for an "important" match or season, impatience wins out over a more proper approach.
     
  13. CurlyW

    CurlyW New User

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    Flex Bar Workout

    Having had TE surgery about a year ago I am looking for a workout routine with the Green Flex bar?

    I am a little hesitant as the arm is doing pretty well but looking to strengthen the arm in addition to some light weight training.

    Thanks
     
  14. mikeler

    mikeler G.O.A.T.

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    I found that the flex bar worked great for my GE but tended to aggravate my TE.
     
  15. charliefedererer

    charliefedererer Legend

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    If you have any pain with the green, you should drop back to the red.

    The red flexbar seems like only a "wimp" would use it, but the big study on tennis elbow used the red precisely because it would promote proper radial arm motion, but under little stress.

    If you had surgery only a few weeks ago, I would have urged you not to even think about using the green first.

    But at one year, you may be able to use the green - but back off if any pain occurs.

    How about checking with your surgeon and/or therapist who have seen you recently and see what they recommend?



    Even if you have to start with the red, don't rid of that green.

    Hopefully after a few weeks with the red you will be able to graduate to the green and start getting your arm muscles really strong enough for a return to tennis.
     
  16. blakesq

    blakesq Professional

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    the flexibar cured my Tennis Elbow but killed my wrist. Be careful about overdoing it!
     
  17. CurlyW

    CurlyW New User

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    Green Flex Bar

    Thanks will do!
     

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