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Video Highlights

-- How we look at tennis elbow from a brain-based training perspective
-- Why using a metronome may be a key element in your rehabilitation
-- One of our favorite "go-to" exercises that we use daily with clients

Hi, I’m Dr Eric Cobb with Z-Health performance and today we’re beginning a series of videos on tennis elbow pain. If you are new to Z-Health we are a brain-based education company we work with doctors therapists and movement coaches from around the world. So if you find this information interesting make sure to check out our free resources and subscribe to this channel. Okay, let’s talk about the elbow. If my Palms face forward and I have pain on the outside that is commonly called tennis elbow or known it’s also known as lateral epicondylitis. If I have pain on the inside it’s called golfer’s elbow or medial epicondylitis we’re going to focus on the tennis elbow side for the next few videos.

Now when we look at this particular issue it can be incredibly problematic if you have it. The pain can be very severe to the point that you know turning a doorknob picking up a cup of coffee can be excruciating and you do not have to play tennis to develop tennis elbow it’s just something that sometimes shows up with poor technique in tennis.

But basically what we see as a big driver of this is anytime we’re gripping really hard and then we’re going through full flexions and extensions of the wrist. So what we want to talk about throughout these set of videos are exercises that we have found to be extremely effective but before we dive into that I want to give you some ideas about how we look at this from a brain-based perspective. Whenever we do functional MRIs and look at the brain of people who are suffering from tendinopathies whether that’s the elbow the knee the ankle what is very commonly showing up is a lack of coordination in the brain’s control of flexors and extensors.

In order to move well, our brain has to excite some muscles and inhibit others. And in tendon issues we see that the capacity of the brain to do that has been diminished. This is opening up some extremely cool approaches that are starting to maybe give us more of a window into how to solve these tendon issues because whenever you look at the research literature there’s really no consensus on what do I do for tennis elbow?

You can find 100 different versions of exercises but in general what we see is that not every exercise works for every person and it can take a long time for this to heal. Whenever you look again at the research about 89 percent of people will be out of pain within one year, but one year of not being able to play tennis or use a hammer at work or type on your keyboard or pick up a cup of coffee without pain is a very long time. So we’re going to show you based on our experience and what we know from a lot of this current research some approaches that are very effective.

So the first thing I’m going to have you do is you’re going to need to have something available to you on your iPhone your iPad or whatever device you have and that is a metronome that gives you some visual input.

I like to use one called Pro metronome I’m not affiliated with the company just works well and I’ll show you how we’re going to use this in a minute.

This is based off research from Dr ebony Rio a brilliant researcher looking at tendon problems and she’s one of the first people to help us identify this idea that the brain is not synchronizing movement correctly and she has offered a very elegant solution. Because what we do know about the brain is that there is a big difference when I am self-regulating or self-timing my own movements versus when something else is giving me a rhythm to move to.

So she’s developed a whole approach called tendon neuroplastic training you can go read about that you can Google it. It’s a pretty simple idea but it’s a great brain tweak to add to the hundreds of exercises that are out there.

We have seen great results by adding this into what we already do so I’m going to just talk about this briefly and I’m going to show you my first favorite exercise to get people started for dealing with tennis elbow pain.

So in general what we’re going to be doing is we’re going to take our metronome and we’re going to set it to 20 beats per minute. If I start the metronome you’ll be able to hear it probably through my mic and you can see I’m getting a visual representation as the metronome is moving.

Now why we would use this is? Let’s say I was doing kind of a classic therapy exercise have dumbbells in my hand and I’m just doing flexion and extension motions. Rather than timing them myself or counting to one thousand one one thousand two one thousand three instead I’m going to listen and follow visually. Whenever we do this this helps re-train the brain to synchronize motor activity appropriately so the idea here is that any exercise I show you in these videos I want you to try to whenever possible to do it with a metronome particularly a metronome that offers you auditory and visual guidance.

Because anytime we add in these additional drivers of stimulus that require the brain to work a little bit harder than self-time motion we tend to see really good effects. Another thing to remember is that whenever you’re doing any tennis elbow work it’s incredibly important that you test and then retest after the exercise. So let’s say right now if you put your arm out you extend your elbow and you make a fist you go Ah that’s a level five pain or level eight you’re going to do the exercise with a metronome or whatever we’re doing and then you’re going to retest. What we should see is that the exercise immediately diminishes or at a bare minimum does not increase the pain level.

Any exercise that I suggest that increases the pain level you probably want to remove from your menu for a period of time and try to find other approaches throughout here that are more useful for you. So again we’re trying to keep the pain level the same or more preferably diminish it. All right so our first exercise is a very interesting one it’s very simple.

Instead of working on the extensors themselves we’re going to work on their counterparts which are the flexors because often again what we see is hard gripping which requires the flexor muscles to become very active can sometimes overpower the extensors or disrupt the rhythm to stabilize the elbow. So one thing that we’re going to do is I’m going to show you how I want you to grip. So we’re going to take a band and we’re going to attach it at a low point I just have a band a light band it’s sitting on a kettlebell all right it’s attached to a kettlebell and it’s going to be off to my side.

Now the most important part of this particular exercise is we want to avoid a heavy grip which is why I like to use bands and not dumbbells for this first exercise. So you’re going to take your band and you’re basically going to hold it like a bear claw all right. We’re not making a full fist we’re letting the band sit against our fingers we’re curling the tips and we’re lightly laying our thumb over it. So you can think about a paw or a claw grip instead of a fist.

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Now from here I want the band basically pulling directly to my side and once I have a little bit of tension I’m going to turn my hips 45 degrees or so to the band. So now my shoulders back behind me I have my little bear claw grip and now I’m simply going to begin doing some wrist flexion movements. Wrist flexion meaning I am pulling the band along the line of my pelvis I’m not turning my wrist and pointing backward I want this to follow the line of the pelvis.

Now as I do this it will probably be common for you to want to make a fist avoid doing that keep that bearpaw grip as you go through the exercise. Now the reason that we’re doing this is that on your symptomatic side often one of the muscles involved in your flexor groups becomes a little bit overactive compared to some of the supportive muscles. If I use this particular grip what I should feel is a lot of work happening along the thumb side of my forearm and along the pinky side of my forearm and not very much happening in the middle which is what we’re trying to achieve. If you feel a lot of muscular fatigue or effort in the middle we need to keep working on your grip or pay attention to the angle. Now if we were to combine the two I would turn my metronome on and then I would be doing a flexion for three seconds and then back to neutral for three seconds. So again every time we do any exercise we’re going to be using the metronome again to try and help the brain regain some capacity to coordinate the movement. So after I’ve done that I’m going to do three sets of 15 with 30 seconds of rest during each rest period go back and retest and see how your elbow feels. This is one of my great or one of my favorite starting exercises for people and it often works very very quickly so give this one a shot and let us know how it worked.

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