Article relevant to tennis elbow recovery

[WildVolley]

Saw a clip online from a big podcast talking about grip strength training and tennis elbow based on research on engineered ligaments. The claim is that relatively brief training at sub-maximal effort can lead to a large improvement in ligament strength. The information is from the following paper.

https://www.researchgate.net/publication/315534630_Minimizing_Injury_and_Maximizing_Return_to_Play_Lessons_from_Engineered_Ligaments

The basic takeaway is that you can improve connective tissue strength with brief periods of loading. For grip training with respect to rock climbing, a series of 10 second efforts followed by 50 second rest for about ten minutes were described. The recovery from this exercise should be at least 6 hours, but 8 was also mentioned. So you could do these brief isometric exercises twice a day.

Training for tennis elbow recovery could be performed with isometric twist holds on something like a Theraband Flexbar or perhaps a fixed object that you can grip and attempt to twist. The efforts would only need to be held for ten seconds with about 50 seconds of rest between the repetitions. Then give yourself at least 6 hours of recovery before doing another round of training.

The paper also mentions supplementing protein, collagen (gelatin), and vitamin C to build ligament and tendon strength.

 

[WildVolley]

I looked into this some more and see some implications for recovery from injuries such as tennis elbow. The first and perhaps most important is that while tennis elbow may heal best by taking a break from tennis, rest alone is the wrong treatment. Since ligament and tendons can heal faster from even small loading, it is best to lightly load a tennis elbow injury to hasten healing and reduce the formation of scar tissue. The collagen and vitamin C supplementation should occur prior to loading since connective tissue has very little blood flow and it appears that nutrients can more easily get to the tissue during the loading.

The other implication is for strength training. Connective tissue plays an important role in gaining strength and in athletic performance. The shocking result seems to be that it can be trained in a short period of time and without coming close to maximal loading and while using isometric exercises. This suggests that you can do this training almost every day unlike maximal efforts to build muscle.

Here's a video of the professional rock climber entering a grip strength contest after doing this training along with the regular rock climbing and other training he was doing.

 

[PKorda]

I looked into this some more and see some implications for recovery from injuries such as tennis elbow. The first and perhaps most important is that while tennis elbow may heal best by taking a break from tennis, rest alone is the wrong treatment. Since ligament and tendons can heal faster from even small loading, it is best to lightly load a tennis elbow injury to hasten healing and reduce the formation of scar tissue. The collagen and vitamin C supplementation should occur prior to loading since connective tissue has very little blood flow and it appears that nutrients can more easily get to the tissue during the loading.

The other implication is for strength training. Connective tissue plays an important role in gaining strength and in athletic performance. The shocking result seems to be that it can be trained in a short period of time and without coming close to maximal loading and while using isometric exercises. This suggests that you can do this training almost every day unlike maximal efforts to build muscle.

Here's a video of the professional rock climber entering a grip strength contest after doing this training along with the regular rock climbing and other training he was doing.

I'm confused what is the shocking result or even how this varies from what was previously known, which was take a break from tennis (typically roughly 3-6 months depending on severity) but do exercises w/ a Theraband and light weights to strengthen the tendons. What am I missing?

 

[dannyslicer]

What am I missing?

Nothing.

 

[WildVolley]

I'm confused what is the shocking result or even how this varies from what was previously known, which was take a break from tennis (typically roughly 3-6 months depending on severity) but do exercises w/ a Theraband and light weights to strengthen the tendons. What am I missing?

This is much more specific than that advice. It also suggests that the 3-6 months stuff can probably be thrown out the window.

Here's what surprised me. Unlike training muscle, load doesn't seem very important. Unlike training muscle, response to stimulus is fairly quick. If you want to get muscle hypertrophy, going to failure seems the most efficient method. For healing and thickening connective tissue, major results were seen with ten isometric holds for 10 seconds each done twice a day. The recovery period is quick enough that you should be doing the rehab every day twice a day unlike muscle training in which some muscle groups need more than 48 hours to fully recover. Also, this research suggests you should start your tennis elbow rehab as soon as you are experiencing symptoms assuming you can perform some light exercises.

Maybe this isn't news to most people, but I was under the impression that training connective tissue was much like training muscle.

 

[PKorda]

This is much more specific than that advice. It also suggests that the 3-6 months stuff can probably be thrown out the window.

Here's what surprised me. Unlike training muscle, load doesn't seem very important. Unlike training muscle, response to stimulus is fairly quick. If you want to get muscle hypertrophy, going to failure seems the most efficient method. For healing and thickening connective tissue, major results were seen with ten isometric holds for 10 seconds each done twice a day. The recovery period is quick enough that you should be doing the rehab every day twice a day unlike muscle training in which some muscle groups need more than 48 hours to fully recover. Also, this research suggests you should start your tennis elbow rehab as soon as you are experiencing symptoms assuming you can perform some light exercises.

Maybe this isn't news to most people, but I was under the impression that training connective tissue was much like training muscle.

Not buying the 3-6 month stuff can be thrown out the window, this would go against my personal experience (have had TE several times, but not in many years), and for the most part of what I've read of the experience of others.

Think the other stuff is fairly obvious, at least to me, but it's good that you learned it for yourself.

 

[johnmccabe]

One takeaway is to play through it somewhat. Not totally resting. My experience would agree with that.

 

[Fintft]

What worked for me is something I read here: straight arm lifting (20 LBs or 9kgs in my case), at least 2 sets of 5, laterally and in front. Granted I only had a twinge, but now I went back to full bed poly from gut/poly hybrid.
I was already using a chest expander and lifting the same 20 LBs, but not this way. Apparently is good for shoulder as well.

 

[WildVolley]

What worked for me is something I read here: straight arm lifting (20 LBs or 9kgs in my case), at least 2 sets of 5, laterally and in front. Granted I only had a twinge, but now I went back to full bed poly from gut/poly hybrid.
I was already using a chest expander and lifting the same 20 LBs, but not this way. Apparently is good for shoulder as well.

The straight arm lifts will stretch the tendons attached to the extensor muscles, so that stretch and load is probably beneficial for loading that tissue and encouraging it to heal faster. According to that paper, it is ideal to have protein/collagen components available in the bloodstream prior to the exercise.

If the research I cited is to be believed, the big takeaway is that the load isn't that important, but these should be done twice a day with at least 6 hours between the workouts.

 

[WildVolley]

One takeaway is to play through it somewhat. Not totally resting. My experience would agree with that.

Depending on how severe the injury, I'm not sure playing through it is practical. But you're correct that the current research says that rehab should start very quickly. The benefit of the training cited is that it can be done at a very low level. The return to play research seems to suggest that getting the injured area into motion as soon as possible without causing reinjury hastens the ability to get back into sports.

Connective tissue has very little blood flow, so it is important to move the area to increase blood flow and also get the lymph system functioning. The lymph system, unlike blood flow, relies on movement to clear damaged tissue and bring nutrients for repair. I think this is the idea of using a TENS system around an injured braced joint. The muscular contractions can help move lymph fluid. I think it is more common to avoid putting a brace on the injured area because this probably slows healing to the extent it limits movement around the elbow joint.

 

[johnmccabe]

Depending on how severe the injury, I'm not sure playing through it is practical. But you're correct that the current research says that rehab should start very quickly. The benefit of the training cited is that it can be done at a very low level. The return to play research seems to suggest that getting the injured area into motion as soon as possible without causing reinjury hastens the ability to get back into sports.

Connective tissue has very little blood flow, so it is important to move the area to increase blood flow and also get the lymph system functioning. The lymph system, unlike blood flow, relies on movement to clear damaged tissue and bring nutrients for repair. I think this is the idea of using a TENS system around an injured braced joint. The muscular contractions can help move lymph fluid. I think it is more common to avoid putting a brace on the injured area because this probably slows healing to the extent it limits movement around the elbow joint.

In my recent episode, I stopped playing for 2 weeks. Outside of those two weeks, there were days the elbow noteably felt better after light hitting.

 

[PKorda]

If you're able to play through it, that's great, but you had a very mild case. For anyone who has something more severe playing through it will be unlikely to work. It may not make it worse but it will not recover until you are able to rest it
for an extended period, in conjunction with doing exercises.