Julie Pitois LMT, CAMTC
Why do we got an elbow here? 

Mike Julian LMT, CAMTC
Okay. Well, I couldn’t just bring the elbow. So I brought the whole arm. 

Julie Pitois LMT, CAMTC

Mike Julian LMT, CAMTC
Cause we’re going to talk about elbows today. 

What is tennis elbow? What is golfer’s elbow?

Julie Pitois LMT, CAMTC
Or specifically elbow pain and specifically more than that tennis elbow and golfer’s elbow. 

I hear a lot about tennis elbow and it’s like, I don’t even play tennis. 

Like why do I have tennis alone? Like, I don’t even understand. 

Mike Julian LMT, CAMTC
They must’ve been in a past life. You were a tennis player. 

Julie Pitois LMT, CAMTC
Or golfer’s elbow. Like how do I have vein here? I don’t swing anything. 

Mike Julian LMT, CAMTC
Everyone on a golf course. 

Julie Pitois LMT, CAMTC
Right? Today we’re going to talk about moving down that arm into elbow, Pedro. 

All right. Your joint here, elbow joint is made up of three bones is the humorous bone, which is the upper arm. It’s got this radius and owner, which are two bones of the lower arm. 

It’s a hinge joint, which means it flex OSHA. Do you want to do your bicep flexes and extends, dang it flexes and extends, right? So it’s a hand is joint. 

The radius and the Alma, it actually the radius rotates over the ulna and allows for a rotation or pivot. This is called pronation and supination Right. 

This is why we can actually grab and move and grab and pull or screw in a light bulb or doorknob or wherever. And so what happens? 

What happens then is that we have, once you get to the very bottom, we have these two little bones on the, either side of the elbow. 

Julie Pitois LMT, CAMTC
They let her do that. The bone on the outside and the bone on the inside is called your condyle and epicondyle. 

What’ll happen is these muscles in your forearm and in your tricep. In your forearm here, the flexors and extenders come up and attach through these condyles or epicondyles. 

It’s called, what’s called epicondylitis or inflammation of the tendons overload. Yes. 

The muscles, the tendons ligaments hold everything together. What happens then to this little simple joint that creates so much pain, 

Mike Julian LMT, CAMTC
There’s usually a strange kind of irritation that’s happening in the tenders. That’s the most typical is that there’s a strain in attendance and it just gets inflamed. It starts creating pain on either side of your elbow. 

Julie Pitois LMT, CAMTC
Okay. Yeah. So, so who is that? Who here has had elbow pain? 

Something my, me too. Oh my God. I’ve had it so bad. 

It’s that burning pain, that pain that searing that white hot flash pain that comes when you’re trying to like shake somebody’s hand or grip something, or even like, oh, I got to try and pick up a cup of coffee, breaks my heart because I couldn’t do it. 

It makes me want to drop the coffee cup. 

Mike Julian LMT, CAMTC
I had it, I had it back in the day, playing baseball. 

I remember being out there on the coach. I played third base when I was on third grade, go and fuel the ball, throw it in the cross, the first base, and then just let my arm and hand cause the pain. 

I didn’t want anybody to see that I was in pain cause I wanted to keep playing. So I just let it hang there. I’m just like inside, just dying because of the shipping pain that’s coming. 

Julie Pitois LMT, CAMTC

Mike Julian LMT, CAMTC
We would lather all, have you guys ever played back in this ladder? Would that icy hot? There’d be a tub of it in the dugout. We just blathered on and go out and play. Not really taking care of it. Just trying to get through another price. 

Julie Pitois LMT, CAMTC
Well, and think about this, you guys, so it hurts and then you rub it. You’re sitting there like doing this thing all the time. 

I’m going to rub and I’m going to rub and I got rubbed. See, even guitar playing, that’ll get you to, but there are a few ways that people can have elbow pain, right? More so than just tennis and golfer’s elbow. 

You can have a fracture, you can have a break. You can have bursitis today. We’re going to focus on the chronic pain that lateral and medial epicondylitis, which is golfers and tennis elbow. 

First and foremost, strains and sprains, you talked about it before. You’re going to file the sprains under like, Ooh, I think I pushed this a little too far, one too many strings on a guitar. I’m just going to do that because that looks really. 

Mike Julian LMT, CAMTC

Julie Pitois LMT, CAMTC
Too many stones on a guitar too many times. I’ve grabbed people, too many things that, that I I’ve just done too many stuff like, listen, you can, this isn’t about pur athletes. 

This isn’t about just people who play racket sports. This is about anybody who does overuse. 

This is the baker. Who’s rolling all the time, Doing the mouse all the time. I have a friend of mine who owns a pasta shop and he was getting it from rolling pasta all the time. 

He would have just horrible lateral epicondylitis was amazing pasta, but so sprains and strains is what happens when you tear of the muscle fiber. You have these muscle tendons that run across the elbow, right? 

If you put too much strain into it, too much chronic overuse, what will happen is you’ll tear some of the little muscle fibers and you’ll actually strain it. 

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A sprain hits the ligaments, which hold the bones together

Julie Pitois LMT, CAMTC
If you do it a sprain, oh, that’s never going work there. If you do a sprain, that’s hitting into the actual ligament itself, which is holding the bones together. 

A sprain and or strain, elbow sprains are really common in athletes who throw, they do rackets sports, or they play a lot of contact sports. 

Those are usually the ones that are going to get a lot of those. You have your wear and tear injuries, which is kind of where our focus is today. 

Over time you repeat certain movements over and over. They put a lot of wear and tear on the elbow, right? Just doing just flexing. 

As much as Mike flexes is shocked that he doesn’t have more elbow issues, but you can do anything from playing sports to working in an office to, like I said, rolling out the dough, there’s everything. 

What actually is tennis elbow, and golfer’s elbow are both types of tendonitis. 

Julie Pitois LMT, CAMTC
Tendinosis for sake of today, we’re going to call it tendonitis, but it’s really kind of a tendinosis or even a Teno synovitis. If you want to get really specific, 

Mike Julian LMT, CAMTC
Those conditions are more of a hostess cause more chronic condition. Yeah. I, this is more acute inflammation, 

Julie Pitois LMT, CAMTC
Right? But you can go from OSIS sites. Absolutely. Yeah. 

What that means in big picture is you have damage in the tendons around the elbow and it’s all from overuse. 

Despite the names, this isn’t limited to playing golf or playing tennis, just to get it out there, you’re more likely to get them based on all the arm motions that you’re using. 

The actual sports specific, the main difference between the two is the tennis elbow is on the outside. The golfer’s elbow is on the inside. 

This would be the lateral epicondylitis, the medial epicondylitis. So lateral epicondylitis or tennis elbow. 

What that does is it involves the muscles in tennis and tendons from your forearm, this guy, because I’m fully strated in there. Your forearm extends the muscles, extend your wrist and your hand and your fingers. 

Your forearm tenders are your extensors right there. They extend all the muscles from your fingers, your hand, your wrist, all the way down and your flexors, which extend this way. 

Julie Pitois LMT, CAMTC

If we’re gripping, if we’re squeezing, if we’re over squeezing, we have a tendency to do some overuse injury on there with tennis elbow affects people most commonly between 30 and 50 years old overused. 

Remember it takes a while for us to get up to that point. If you’re doing a lot of this while it’s a horrible joke that I could say right now, but I’m not going to do it. 

Listen, people who have repetitive motions of the wrist and the arm are the ones that tend to develop tennis elbow. Listen, let’s talk about the kinetic chain. We haven’t talked about it enough lately because we never talked about the kinetic chain.

Remember the kinetic chain is the top of your head all the way down to the bottom of your feet and what happens from your feet to your head and your head to your feet. 

Julie Pitois LMT, CAMTC
Right? And how we actually move. I want you to think about that. I want you to remember when we talk about injury in one area, how it affects the rest of the body, right? 

Yeah. Thank you. It goes up and down the chain. Last week we talked about the full shoulder. We talked all about how the shoulder, different types of shoulder injury, biceps, tendonitis. 

We have a rotator cuff, potentially. We have you name it a lot. The labral tear, potentially how to add a really how to really self-assess if you have a sprain or strain or anything else going on in here. 

So think about this. If we told you that there was a direct relationship potentially between the shoulder and the reason why you have tennis elbow or golfer’s elbow, what would you say. 

Mike Julian LMT, CAMTC
I’m listening? 

Julie Pitois LMT, CAMTC
Is that what you were saying? Thank God. One of us is listening. 

So listen, speaking of, yeah. Remember how much we talk about posture and how much the body plays into everything else that we do. If let’s think for a minute about this nice little shoulder back here, the shoulder normally sits right on top. 

The shoulder joint is a ball and socket joint

Remember, we’ve got the humerus. Funny enough. We have the humerus attached to the elbow too. This humor is at the top, attaches to the shoulder joint. 

The shoulder joint is a ball and socket. It’s freely movable. Remember it’s moving back and forth. These muscles in the front pec minor pick major you’ve got subscap underneath. 

You’ve got lat is all doing this job to pull forward. So let’s say you’re lifting heavy. You’re picking up things. You’re doing a lot of guitar, work, guitar work. I don’t the guitar work. 

Julie Pitois LMT, CAMTC
I don’t guitar. You’re, you’re picking up things. You’re doing a lot of computer and your shoulder starts to sh to actually move forward. Chronically. 

Now the shoulder doesn’t move back into its place. All of the muscles in the front are really, really tight. The muscles in the back are it really elongated. 

They’re not doing the job to help you pull back. What happens down this line, it puts a lot of tension and stress right into this elbow joint. 

It asks more of the elbow joint than just let’s flex and extend and pronate and supinate. 

Mike Julian LMT, CAMTC
A lot of this. Well, so much of this is not just a one-off little string. If that happened, it would go away and then you’d be fine. 

Promise if it keeps reoccurring. That’s what we’re really looking at is why does it keep reoccurring? It’s not just because he keeps straining right here. 

Right, right. Something else is happening somewhere else. That’s what we’re all about is figuring out what’s really the main box. 

Julie Pitois LMT, CAMTC
Right? Exactly. If the shoulder isn’t in the right spot, it’s going to put more stress into the elbow. 

That is going to put more stress into the sh to the muscles because everything is expected to work harder. Its job is to just attach here and help here, right? 

With just rotation and extension. But now it’s extended. We don’t have the rotation in the shoulder. 

We don’t have the retraction in the shoulder. All of the stress is getting put into the elbow. So how do we fix it? 

Mike Julian LMT, CAMTC
Make it all better? Well, I usually just wave my hand around and then it goes away. How about this? 

How we w first thing isn’t necess, but let’s find out what it all is going wrong. All throughout the chain. All look at the hips. Let’s look at the feet. 

Let’s look at everything that’s going on with the person to find out what’s not operating correctly and get an operating plan so that this doesn’t keep reoccurring this education. 

Julie Pitois LMT, CAMTC
Well, and then think about this. 

You guys, once this becomes irritated and it becomes into like tendinosis, and it’s really irritating. Let’s say you have it on the outside. 

We don’t really think about what’s going on up here while we want to do is rub here and not. 

They tell you just rub here and it’ll make it feel better or stretch your forearm. It’ll make it feel better, which it might make this feel better, but we have to work up. 

Mike Julian LMT, CAMTC
How about ICIC cockpit? It scrape it and to make it all better. I heard it a lot. It might make it feel better for a moment. And then it’s going to reoccur again. 

Julie Pitois LMT, CAMTC
Oh, it’s a white flag and just make it fall down. Once you get tendinosis in here, you are going to have to do some manual work. 

It’s really, what’s going to have to happen because this has now created its own pain pattern. That’s going on. That that does not enjoy what you’re doing. 

We can’t just not use our arm or hand to squeeze. We’ve gotta figure out a different way to do it. 

Mike Julian LMT, CAMTC
I mean, you can use a straw to drink your coffee, but that’s not the right way. That’s not the American way you got to lift that sucker up. 

Julie Pitois LMT, CAMTC
Yeah. Listen, it’s going to take some good manual therapy to calm the area down. 

However, you also need to work on and stretch all the muscles that attach to the front side of your body. 

That means the pec minor, the pectoralis major that subscapularis in here, the lack that comes into the back, the biceps tendon. Oh, of course. 

An injection fixes everything. Cause that’s what we do. That’s right. You’re going to be fine right along with all of the Bengay. 

Mike Julian LMT, CAMTC
Whatever. Yeah. 

Julie Pitois LMT, CAMTC
So think about this. A pec, minor, pec, major biceps, tendonitis, anything that’s pulling it forward when you got to get this guy back. 

If you relax, this puts this back into its own natural space, right? We can actually start to work down and open this up because if we just keep going after that at the ouchie spot, all we’re doing is basically pouring gasoline on a fire because we’re not actually working the area that started it. 

You can’t fix up a squeaky wheel without figuring out where the squeak is. Like the squeaky wheel is coming from something other than squeak this week is just the noise. 

If that makes any sense. So it doesn’t. It does. 

Mike Julian LMT, CAMTC

Julie Pitois LMT, CAMTC
Gosh, I thought it did. You’re going to start by retracting your shoulders back. 

Mike Julian LMT, CAMTC
It was so far forward. I had no idea. 

Julie Pitois LMT, CAMTC
Restrict your shoulders back. That’s going to put the stretch into the prac and pec minor. 

You’re going to bring your arm up over your head and you’re going to squeeze and retract back. Pull your shoulder blade down as you, most of the time, go into a doorframe to extend back this way. 

You’re going to be able to extend back this way, squeezing from your shoulder blade. Remember we’re working the backside to squeeze open up the front side. If I’m here, I’m squeezing back and then rotating. 

I’m going to go into a biceps tendon stretch. Hello, help me out. And then we’re going to go. I know biceps tendon stretch this way to help out . We’re team stretching right now. 

What that’s going to do is it’s going to relax all of this and give us a chance to really go in here. The other thing too is, remember you have your extensors and your flexors. 

Julie Pitois LMT, CAMTC
If you’re stretching like this, it is not going to get, this is not going to take care of everything because remember that tendon has to cross the joint. 

You have to do it with a straight elbow instead of a bent elbow. You also have to go into both the pro nation and the super nation, because that is the range of motion that it goes. 

You have to follow the range of motion, the area that you’re working. Do you have a squeaky elbow? Mark is very funny today. 

The other thing you’re going to do is once you’ve gotten all this is you’re going to lightly kind of go in and work that area lightly. You’re going to go in and do of east centric motion, which means a negative motion with of resistance. 

If I was to stretch this area, I’m going to put of a resistance into my hand and then come down. 

Julie Pitois LMT, CAMTC
What that’s going to do is it’s going to help realign these muscle fibers. Once everything has calmed, 

Mike Julian LMT, CAMTC
If you don’t bother coming down, everything else that’ll never truly go away, 

Julie Pitois LMT, CAMTC
Right? So golfer’s elbow and tennis elbow. Golfer’s elbow would be this one, tennis elbow would be this one. 

Remember you’re still doing the same thing, but you’re coming through on the inside as well. Golfer’s elbow is the same basic thing. It’s just rotating a little bit more. So it’s more biceps. 

Tendon. It’s still pack and pack minor. You’re still doing the grip. You just have to go into the opposite direction. It usually means the reason why golfers get it as their shoulders are sitting forward. 

And they’re immediately rotated all the time. And they’re the ripping. The other thing too, I want you to say our, I want to say is if you are using a racquet and a racket sport, anything away from the midline of the body makes it way more. 

It’s a true weight when it’s sitting right into. If the more that you put the racket out of the midline of your body, just the arm is going to wait three to four pounds more, and then you extend it from a racket and that’s going to even way more onto your forums. 

Julie Pitois LMT, CAMTC
The more that we grip an overgrip, because we’re not strong enough in the shoulder girdle to support it. 

We’re asking these guys to do way too much work because this one isn’t strong enough. Again, it really goes back to the shoulder. Girdle needs to be stronger. 

All of the support system muscles need to be strong and put into the right place so that we don’t have to grab the heck out of something because it’s the grabbing and the over compressing of the exertion. 

That’s creating a lot of this that’s going on. Does that make sense? Hopefully it does. Okay. So yeah. 

The other thing too is if you’re having pain and the pain doesn’t go away and pain, doesn’t go away. The pain doesn’t go away. You’ve tried all of this call your doctor because we’re not here to tell you not to call your doctor. 

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Tennis elbow and golfer’s elbow are chronic overuse injuries

Julie Pitois LMT, CAMTC
We’re here to make sure that you know that this is a chronic overuse pain. However, if you have elbow pain that doesn’t go away with rest, nice or pain that doesn’t go away. 

Even if you’re not using your arms, that’s it. That’s a red flag. Stop call your doctor. You may have something else that will not. These won’t hurt unless you’re actually screaming. 

Mike Julian LMT, CAMTC
It should be maybe a dull ache, but pretty much nothing. 

Julie Pitois LMT, CAMTC

If you, yeah, if you have intense pain, swelling, heat, or bruising around your elbow, go see the doctor because you could actually have torn something. You got a chip to bone fracture and you got a bursitis. 

You could have a lot of stuff going on in here that you want to go get checked out. 

The other thing is if pain, swelling or redness gets worse, especially if you have a fever too, ER, baby, gotta go. 

If you have problems using your elbow, such as difficulty bending your arm, you get to go see the doctor. Yeah. This isn’t about just like you can heal by himself. It depends on situation. 

If you have a chronic overuse issue such as your tennis elbow or your golfer’s elbow, you get to take care of. 

Mike Julian LMT, CAMTC
Just because someone has diagnosed you with tennis elbow does not mean you’re a professional tennis player. Especially if you’ve never picked up a racket, 

Julie Pitois LMT, CAMTC
No, it just doesn’t. Listen. I had the worst case of lateral epicondylitis a few years back because I was doing a lot of heavy lifting. 

I was really lifting in downstairs in the gym a lot. I noticed that the more that I was doing, cause I was playing around and doing a lot of negatives and I symmetric holds and my shoulder just couldn’t cut it. 

I was sore that I had to have a friend come over and I wouldn’t let her work on this area at all. I made her only go after my shoulder because she was trying to kill me on the side. 

As soon as she pulled the shoulder back, this went away within like days. A lot of it really is, this is the reaction to something else. 

Not either over gripping because your stroller is not strong enough or your shoulders not strong enough because it’s not in the right position. 

Julie Pitois LMT, CAMTC
Think about here and here, this guy is just getting the brunt of all of the stresses being applied to the upper body. It is. 

So anyway, I hope that helps. I hope you got out of that one. I hope that you now know that if you’re squeezing too hard and you’re working out at the gym way too much, it doesn’t mean you can’t work out. 

It means, think about where your shoulders are in relationship to this. Think about pulling everything back and really opening your chest up first and not squeezing so hard. 

Shouldn’t have to squeeze that hard, whereas with these muscles are for, so if it helps great, if it, doesn’t sorry, we’ll be back next week with hopefully something else that helps. 

And, and anyway, I hope you have a fantastic rest of your week and we will see you next Wednesday on tissue talk. 

Julie Pitois LMT, CAMTC
Have a great one. Bye.