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Golfer’s Elbow Pain Relief (Brain-Based Strengthening!)

Video Highlights

-- Working on low tissue capacity via strengthening exercises
-- About Tendon Neuroplastic Training
-- Wrist flexion, extension exercise and pronation

Hi, I’m Dr Cobb of Z-Health Performance. We are back talking about Golfer’s Elbow. If you’re new to Z-Health, we’re a brain-based education company and that’s going to play a big role today as we talk about what’s called tendon neuroplastic training. So, if you are a doctor, therapist, or coach and you’re interested in blending Neuroscience with biomechanics, check out all of our free resources, subscribe to this channel etc.
Alright, we’ve spent five videos now talking about different ways to approach working with Golfer’s Elbow and as I mentioned in the beginning of this series, whenever we think about an issue like this we have a couple of different problems. We have local tissue capacity issues and we have kinetic chain dysfunction. So we’ve talked about a lot of different possibilities. So for this last video we’re going to now talk about working on local tissue capacity via strengthening exercises. And it’s critical at this point, I think, to talk more about how the brain plays a role in this. If you have not heard about this concept called “Tendon Neuroplastic Training” it’s from the work of Dr. Ebony Rio, brilliant researcher, and what she has found is that in people with chronic tendon issues, there is this regulation in what’s called “Cortical Activation.” So in other words, our brain has to tell our muscles what to do and sometimes the level of activation or the timing of activation becomes problematic. In people with chronic tendon issues, through her research, has come up with this really elegant solution (that she’s now proven in a couple different papers) that if we use an outside timing source as we are doing basic strengthening exercises it basically requires the brain to pay a little bit more attention. It drives more cortical activation and improves the motor timing so the translation of all that is that as a brain-based practitioner you’re going to use metronomes for people doing strengthening exercises. From the Z-Health perspective we’ve been using metronomes for almost 20 years based on experience, but it’s very cool now to start to see some research coming out. This is supportive of this idea that utilizing outside sources of timing requires the brain often to work harder. Whenever we do that, we can see changes throughout the musculoskeletal system in terms of pain and performance. So the basic exercises are going to be driven by the use of a metronome. 

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Metronome. I’ll zoom in myself so you can see it and what this is now currently set at is 20 beats per minute. Right, so if I turn it on it’s just going to be playing in the background. 20 beats per minute is really really slow but the idea is that if I’m doing a strengthening exercise that’s going to give me a three second eccentric three second concentric version of the exercise. So in most of Dr Rio’s research we’ve seen that three maybe four second concentric eccentric exercises seem to be really effective but remember it’s being driven by the metronome. Whenever we start talking about building local tissue capacity for Golfer’s Elbow, when we know that we’re going to need to work on our flexors, we’re also going to need to work on the muscles that are involved in wrist pronation. So the way that you would set this up generally is you take the arm, brace it, (usually people do this over a table or a bed) and if we were doing wrist flexions. We would start at the bottom and now I’m thinking about the metronome. So when I hear it, go on the next beat, to, three, two, three. So right now, I’m kind of counting in my head but really what I want to do is follow the rhythm of three. 
Now on video this is a little bit more challenging because in a studio setting I would have the metronome up so that the client could be watching the bar move because we have the visual as well as the auditory stimuli. Both matter but you can imagine three seconds down, three seconds up, and I’m going to do typically 15 repetitions of that, and I’m going to take a break. This is actually very fatiguing for a lot of people when we include the metronome into the work. So your two exercises that you would use the timing process which would be wrist flexions and extensions and notice that I’m letting my fingers curl just a little bit and I’m including them in the motion. 
The other one then would be pronation. Now with the pronation exercise (yes you can use a little dumbbell) it may be more effective to use something like a hammer so that I’m actually getting more weight toward the outside. But I would again be following the same three second concentric, three second eccentric rule. If you want to get very excited about it, uh, when you’re at the end of the eccentric, you can also add in an isometric hold; either at the end of the eccentric or into the concentric. For me, timing of the exercise (meaning how many repetitions I do, etc.) is less important than the idea that I’m going to be utilizing the metronome. So if I again bring it in, you can see that as it’s running. There’s a moving bar and as I said whenever we’re doing metronome style work, I think it’s very very useful to have both the visual and auditory component based on how the brain processes information. 

So these tools are fantastic for increasing local tissue capacity but increase local tissue capacity by utilizing increase and hopefully improved brain control of the problematic area what we’ve seen experientially is I can give people you know, have them test the medial epicondylitis with palpation. It’s a 5 out of 10 pain and then we do some resisted flexion and pronation and they go, “Yeah that’s a 7.” And then I can just have them do 10-15 repetitions of the wrist curl and then some resistant pronation without the metronome. And then I have them go back and test and sometimes they’re like, “oh it’s better,” and sometimes they’ll go, “didn’t make any change” or it’s even worse and then immediately test them utilizing the metronome and we may see three to five point drops in their pain levels simply because we’re increasing brain activation by utilizing this outside tool. So I really want you to take this into consideration; you can actually apply the metronome in all the strengthening work that we’ve already shown you for Golfer’s Elbow. I just wanted to kind of save it for last in this particular series because I wanted to focus on the kinetic chain issues before really digging into the brain and local tissue capacity idea. 
So this is going to wrap up our brief series on Golfer’s Elbow. I hope you found it really useful and that you’ve been able to build a nice catalog or library of exercises that are very effective for you. Wish you good luck in your ongoing rehab!

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