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  1. #1
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    Strained Tendon on inside of elbow joint?
    I'm at week five of a sust/dbol cycle--stopped dbol at week four. I've been making great gains--so you can understand my frustration when I seemed to have strained my tendon on the inside of my left elbow joint making it painful to do chinups and curls--anybody else had this injury? What's the best way to treat it and when I resume curls and chinups should I just go light--any recommendations? Are there any substitute for curls for working biceps that might be less painful?

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    Tendon Injuries
    By Brian D. Johnston



    Tendon injury is a common affliction with resistance trainees, ranging from tendinosis to spontaneous rupture. Typical causes include cumulative microtrauma, and forces that exceed soft tissue integrity. This article will explore why these mishaps occur, and provide rehabilitative requirements for reinstating full functional capacity in such an event.



    *** ***


    Anatomical Structure and Architecture
    Tendons consist of fibrous connective tissue that connect muscle and bone, which transmit force generated by the muscle, thereby producing joint movement or torque. The contact area between muscle and tendon is called the myotendinous junction (MTJ). The contact area between tendon and bone is called the osteotendinous junction (OTJ). The OTJ is somewhat elastic to resist compressive and shear forces, yet rigid enough to provide tensile strength. The architecture of the MTJ resembles finger-like processes).


    Folding of the tissues at the MTJ considerably increases the contact area between the muscle and tendon fibers, which essentially reduces the applied force per surface unit of the MTJ during muscle contraction. The contact surface of the MTJ is about 35% larger in the more powerful fast-twitch fibers, than in slow-twitch fibers. This arrangement permits more intense contractions generated by fast-twitch fibers, without increasing the force applied to the surface unit of the MTJ. When a healthy musculotendinous unit stretches, agitation seldom occurs in the midsubstance of the tendon but rather in the MTJ, the OTJ or in the muscle belly. Also, it is the MTJ that is the weakest zone in the muscle-tendon unit, making it vulnerable to injury


    Tendon strength surpasses bone strength, with its capacity governed by its thickness and collagen content - not maximum tension its associated muscle can generate. The greater the cross-sectional contact area of muscle and tendon, the heavier the loads that can be applied prior to tissue failure; and the longer the tendon tissue fibers, the greater the fiber elongation before failure. A short tendon is not as strong as a long tendon, since it absorbs less total energy than a long tendon, although its energy-absorbing capacity per unit volume is higher than that of a long tendon.


    At rest, tendon fibers exhibit a wavy formation. This formation disappears when under tension, resulting in straightened tissue. When tension abates, the tendon resumes a wavy appearance.


    Causes of Tendon Injury
    Tendons are most at risk of injury when: 1) force is generated by the muscles as it is being stretched during eccentric movement - i.e., depth jumps; 2) when force is applied quickly and obliquely - i.e., dropping quickly to the bottom position of dumbbell pec flyes; 3) if the tendon tenses before injury, resulting in reduced elasticity - i.e., bracing yourself before a fall; 4) if the tendon is weak in comparison to its muscle - i.e., steroid use; 5) if the muscle group is violently stretched, or overstretched, by external stimuli or forces - i.e., ballistic stretching; 6) if the muscle contracts rapidly and powerfully against overload, and the degenerated tendon bears the damaging stretch - i.e., explosive style lifting from the bottom position of an exercise, 7) a limb and its parts (joint, soft tissues) moves violently and passively from a position of flexion, extension, adduction, or abduction against a strong muscle contraction, resulting in a forcible stretching of the unit - i.e., football tackle; or 8) insufficient healing or remodeling time passes before undergoing further strain - i.e., exercising too frequently.


    The Effect of Too Frequent Exercise
    Intense exercise alters the quantitative properties of tendons, making them larger, stronger, and more resistant to injury. Tissues proceed through a period of transient weakness as it adapts to exercise, yet the tissue's mechanical strength will diminish at some point during remodeling. This situation is reflective of both muscle and tendons. First, there is a degradation; second, there is a compensation; third, there is an overcompensation or supercompensation. Most importantly, since tendon tissue breaks down structurally before remodeling, the tendon will be weaker than normal, and susceptible to injury during this period of transition. Without adequate recovery, exercise-induced inflammation and fiber damage may occur. If a tendon ruptures during movement that would normally not cause a rupture, it is the result of a weakened or degenerated state prior to the rupture. This is often the result of cumulative microtrauma (constant wear and tear without adequate healing). However, even a healthy tendon can tear if the forces are extreme. Compared to muscle tissue, the ********* turnover (repair and regeneration) of tendon tissue is several times slower due to poorer circulation and vascularity. Consequently, adaptive responses of tendons to training are likewise slower than those of muscles.


    Tension Under Stretch
    Elastic fibers are barely existent in human tendons, making up about 2% of a tendon's dry mass, and being mostly elastin. Elastin contributes primarily to the recovery of the wavy collagen fiber configuration after muscle contraction and tendon stretch. However, if elongation exceeds approximately 4% of its original length, minor damage to the tendon tissue could occur. Moreover, acute stress resulting in an 8%+ elongation may cause tendon rupture. Injury to a tendon results in inflammation, edema, and pain. The consequence is tendinitis, tendinous bursitis, insertitis, peritendinitis, or any combination. If the damage progresses, without adequate recovery and proper rehabilitation, tendinosis, partial tears, and complete ruptures may ensue.


    Impact Forces
    Impact forces, from low to extreme, are often responsible for tendon degradation and injury. When running, the forces placed on the lower leg and heel can exceed two times body weight, producing a shock wave with every step. For instance, a 160 pound runner at 1500 steps per mile absorbs about 150,000 tons of force each foot per mile. Patellar tendon ruptures in skilled weight lifters often undergo a force of approximately 15-17 times that of body weight.


    Cumulative Microtrauma
    It is estimated that as much as half of sports injuries are due to overuse, with musculotendinous units being the most commonly affected. The cause of overuse injury is repetitive strain of the affected tendon so that the tendon is unable to remodel during recovery. Consequently, the tendon is unable to endure further stress, and its structure begins to fail, resulting in inflammation, edema, and pain. With resistance trainees, tendinitis is most noticeable in the forearm near the elbow, and in the shoulder. Shoulder tendinitis is more debilitating, resulting from impingement of the rotator cuff due to repetitive use, and impact forces resulting from internal rotation (i.e., bench presses). The supraspinatus tendon is often the most affected muscle in the rotator cuff group.


    Tendon Strains
    A strain injury occurs when a tendon has been stretched and microscopically damaged, with macroscopic disruption of the tendon fiber bundles. Within four hours of a tendon strain, fibronectin and fibrin permeate the damaged area. Within 24 hours, there occurs inflammation with hemorrhage, edema, muscle cell necrosis, and proliferation of leukocytes. Tendon fibers also break down, with macrophage phagocytosis, and continued inflammation. After about a week, inflammation decreases, capillaries and fibroblasts (tenoblasts) increase, and granular tissue forms. Approximately three weeks after a strain, the inflammation and proliferation of capillaries and fibroblasts gradually disperse so the remodeling phase can begin. Remodeling after a tendon strain can last a year or more after injury. During this period, granulation tissue matures into scar tissue, and vascularity decreases. However, it is common for the healing process of a strain injury to incur further stress, resulting in constant biomechanical deficits.


    Partial Ruptures
    A partial tendon rupture suggests there is macroscopic disruption of the tendon fibers, and the tendon is partially intact with its associated muscle. In the acute phase of a partial rupture, tendon swelling is the most prevalent symptom, and scar formation begins 3-4 weeks after the injury. As the damaged site gradually fills with scar tissue, it is unlikely that normal tendon structure and functionability are reestablished. Rupture at the MTJ is also characterized by muscle-cell discontinuation and hemorrhage. This is quickly followed, within 24 hours, by leukocyte and macrophage perforation at the site. Soon thereafter, necrosis of the muscle cells and homogenization (blood formation) of the myofibrillar structure occurs. The myotendinous collagen fibers disconnect from the contractile elements of the muscle-cell endings.


    The problem with most partial tendon ruptures is that there is only slight discomfort or no symptoms. As a result, the initial stages of disruption are often ignored, leading to more serious problems, or a complete rupture. Tendon strains and partial tendon ruptures are somewhat mild injuries, but unfortunately tendon injuries generally result in long-term pain and disability.


    Complete Ruptures
    Complete tendon ruptures are rare, but do occur with resistance trainees who engage in plyometrics or other ballistic/explosive practices. Over the past ten years, and at an increasing pace, numerous bodybuilders and strength athletes have completely ruptured tendons in their pectorals, biceps, and patellar area. A few of the more famous cases include the torn biceps tendon of Tom Platz, former Mr. Universe, the torn pectoral of Kevin Levrone, current Mr. Olympia contender, and the many muscle and tendon tears of Mr. Olympia, Dorian Yates.


    Complete tendon ruptures greatly increase the amount of intramuscular connective tissue, which impairs intramuscular blood circulation. Consequently, there is a decrease in capillary count which then leads to a further increase in intramuscular connective tissue. This whole process repeats itself in a vicious cycle, leading to further macroscopic loss of muscle extensibility, contractility, and other tensile properties. During the first stage of a complete rupture, within days, atrophy of the myofibrils begin, sarcomere length decreases, mitochondria enlarge, glycogen content of the cells decrease greatly, and the nuclei and the motor endplates are no longer detectable. Stage two begins within two weeks after a rupture, characterized by myofibril disintegration, disruption, and disorientation in both fast twitch and slow twitch muscle cells, with no observable difference between fast and slow twitch muscle cells due to extreme atrophy. After successful surgery and effective rehabilitation of a complete rupture, it can often take a year or more for complete healing of the musculotendinous unit.


    The Effect of Steroids
    Tendon injury is more prevalent with anabolic steroid users than with non-steroid users. In most instances, tendon collagen dysplasia (abnormal development of tissue), dissociation, and rupture are in direct proportion to the magnitude of anabolic steroid administration. Although tensile strength of tendons can increase after short-term use of anabolic steroids, long-term use decreases tendon elasticity and energy absorbing capacity, as well as tensile strength. Similarly, it is probable that long-term use of the male hormone testosterone will likewise decrease tensile strength of tendons.


    Injury Prevention
    Although the passive elements of the musculotendinous unit can likewise absorb energy, it is the active component (muscle) that is most important for injury prevention. Hence, activity that results in extensive muscle fatigue and weakness - i.e., high-volume training - diminish the contractile ability of muscle, predisposing the unit to a strain injury. Even at light weight loads, injury is more likely during high-volume than high-intensity training, particularly if the weights produce high kinetic energy from uncontrolled eccentric movement. Training errors, due to fatigue of long workouts, and progression that is too fast, contribute to a majority of overuse injuries. (NOTE: a stretching routine may decrease potential soft tissue injury by increasing the length to which a muscle can stretch [viscoelasticity] before failure occurs. Stretch after a training session, and not as part of the warm-up; since stretching also producing tension, thereby contributing to muscle fatigue, and could reduce force output during high-intensity sets. This is most important with fast-twitch muscles, since muscles with poor endurance fatigue easily, and absorb less energy than unfatigued muscles; this makes them more prone to injury, especially during high-volume training. It should be emphasized that an optimal length of musculotendinous tissue will eventually be achieved with a sound stretching program. Beyond a specific length, further stretch is of no anatomic or physiologic value. In other words, it is not necessary to obtain incredible degrees of flexibility, but to optimize your flexibility within your capabilities and requirements, then maintain that level.)


    Rehabilitation
    In the event of an injury, a brief layoff is essential, accompanied by appropriate intervention, i.e., RICE therapy, anti-inflammatories, etc. When recommended by your physician, it is best to incorporate proper functional rehabilitation through high-intensity, low force exercise utilizing well-designed machines, such as those manufactured by MedX and Nautilus. Free weights should be avoided due to their uncontrolled and balancing nature, which only serves to aggravate the injury. Regardless of most physiotherapy intervention practices, it is not necessary to exercise the injured area every day. One set, once per week is often adequate, as suggested by various studies conducted at the University of Florida's Medical Center, and so long as the set is carried to the point of momentary muscular failure, in a slow and deliberate manner. Implementing more exercise than this only serves to make inroads into your recovery ability, which is even more vital for a slow-healing, injured tendon.


    Athletes involved in high-impact sports, i.e., hockey and football, should note that prior injuries predispose the musculotendinous unit to further strain. Premature return to strenuous activity could therefore cause reinjury, and long-term disability.


    Resources and Suggested Reading
    Human Tendons: Anatomy, Physiology, and Pathology. László Józsa and Pekka Kannus. 1997. Human Kinetics.
    The Lumbar Spine, the Cervical Spine and the Knee: Testing and Rehabilitation. 1993. Arthur Jones.
    The Stress of Life. Hans Selye, M.D. 1984. McGraw Hill.




    EP
    Stone Cold..............................Never Too Old



    Disclaimer: Steroidology.com does not promote the use of anabolic steroids without a doctor's prescription. The information we share is for entertainment purposes only.

  3. #3
    Junior Bodybuilder trendkill's Avatar
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    i did the same thing, just like the artical said, try useing the machines for your bi's i found just useing the vast array of prechercurl machins in my gym it did not bother my injury at all, but a dumbbell would cause pain, so i did this for 2 weeks and i felt good after. i'll continue with machines for another few weeks till im all good... give it a shot. go easy at first.

  4. #4
    Hybrid Athlete Golden_Muscle's Avatar
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    Ha! I have that exact injury right now! And it sucks. Its been about 2 months now and its very slowly getting better. It even hurts to flex my bicep.

    As soon as its better, my biceps are going to grow like damn weeds because im gonna blast the shit out of them.

    Dont worry bro, you will be fine to work bis in about 3 months, hehehe.

  5. #5
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    Thanks SC for posting the article. I appreciate the two other posts too--I think I'll hit the machines and lighten things up till it feels better--I hope it doesn't take three months!

  6. #6
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    It's medial epicondylitis; I prefer to call it tendinosis or tendinopathy, because it's more of a degenerative process at the teno-periosteal junction (the tendon-bone interface) due to trauma, than it is an inflammatory process.
    The wrist flexors in the forearm attach by a common tendon to the medial epicondyle of the humerus (it's the big bony bump you feel on the inside of the elbow). The wrist extensors attach in a similar manner to the lateral epicondyle on the outside of the elbow area.
    These are often called golfer's elbow, and tennis elbow, respectively; the majority of the ppl w/ these injuries play neither golf of tennis!
    It's easy to damage the tendone here doing bicep work, especially if you are recruiting the wrist flexors somewhat. Any exersize that isolates the biceps more and takes the wrist flexors out of the equation will be hepful. Avoid DB curls!! Or anything that uses a lot of pronation/supination type motions.
    I disagree w/ SOME of the assertions in SC's article. These injuries, if they become chronic, are often amenable to treatment w/ proliferant injections into the tenoperiosteal junction (what the article refers to as the osteotendinous junction), in order to stimulate healing and the deposition of new collagen. The over-use of RICE, and ofantiinflammatory drugs, has the potential to inhibit complete healing. These modalities are great for getting ppl up and running as quickly as possible, but the trade-off can be a chronic, lingering problem that waxes and wanes over time.

  7. #7
    Allmost Good Looking Green888's Avatar
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    i would like to hear from the injured guys in this post, how long did it take to heal...and what did you do to recover?

    because, i have this injury now

    hurts when i work biceps, do chinups, pres the dumbells up in first rep in dumbell press for chest and even when i flex my biceps

    Regards Green888

  8. #8
    Pro Bodybuilder mattd46612's Avatar
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    Impossible to know what it really is and how long it will put you out. I was having problems with my left elbow last week and I left it rest a few days now its ok. Or it could be something that bothers you from here on out. Try getting a tight sleeve or brace for it, lay off what bothers it for a week or 2 and wears the brace for your other exercises.

  9. #9
    Pro Bodybuilder Slayer's Avatar
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    I suffered with that same problem for almost a year. Here is what I think helped me.
    1) I used one of those rubber/foam/velcro forearm straps. It holds the tendon in place so it it not as easily aggravated.
    2)When I did bis and pulldowns, I did them on the same day and took 600mg of ibuprofin about an hour before working out. It reduced the inflamation so that the tendon did not "rub" as much and get aggravated. I did the bis and back on the same day to give me the most recovery time possible.
    3)Iced down the area twenty minutes after training.

    I also did two cycles of deca. I certainly can't say whether the deca did anything, but it seems like it did. At the very least I think it put enough fluid in the area to minimize friction for the length of my cycles, which gave me more time to heal. IN any event, the problem has gone away......at least for now...(KOW).

  10. #10
    Allmost Good Looking Green888's Avatar
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    thx for the info
    ....i have had mine for a month now, i think i will try avoiding biceps work for some weeks, wierd thing is i dont feel it when working back (only chinups and narrow pullups).

    ....and try using ice and wrapping the elbow.

    i have just ended a cycle of omnadren, naposim, winstrol 1 month ago, i did not feel anything when using.
    it is allmost certain the strength increase that was to much ...and now i pay for it

  11. #11
    the one and only BEACH
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    i believe i had the same injury around a year ago based on you description. i feel for you man, i was trying to train through it for a while and would literally lay in my bed after the gym rolling in pain. it was by far the most pain ive ever felt in my life. from what ive gathered from other posts and talking to people i know - its mainly from going up in weight so fast due to strength gains and the tendons not being able to keep up. i know that isnt a medical explination but...it made sense to me deffinatly give it some rest and use the machines at a lower weight while it heals.

    good luck!
    Beach

  12. #12
    Allmost Good Looking Green888's Avatar
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    Quote Originally Posted by Deep South Chris
    i believe i had the same injury around a year ago based on you description. i feel for you man, i was trying to train through it for a while and would literally lay in my bed after the gym rolling in pain. it was by far the most pain ive ever felt in my life. from what ive gathered from other posts and talking to people i know - its mainly from going up in weight so fast due to strength gains and the tendons not being able to keep up. i know that isnt a medical explination but...it made sense to me deffinatly give it some rest and use the machines at a lower weight while it heals.

    good luck!
    Beach
    thx a lot bro
    .....i skipped biceps today, but feel real bad about it.
    oh well, life goes on

  13. #13
    Olympian Bodybuilder DocJ's Avatar
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    Quote Originally Posted by buffdoc
    It's medial epicondylitis; I prefer to call it tendinosis or tendinopathy, because it's more of a degenerative process at the teno-periosteal junction (the tendon-bone interface) due to trauma, than it is an inflammatory process.
    The wrist flexors in the forearm attach by a common tendon to the medial epicondyle of the humerus (it's the big bony bump you feel on the inside of the elbow). The wrist extensors attach in a similar manner to the lateral epicondyle on the outside of the elbow area.
    These are often called golfer's elbow, and tennis elbow, respectively; the majority of the ppl w/ these injuries play neither golf of tennis!
    It's easy to damage the tendone here doing bicep work, especially if you are recruiting the wrist flexors somewhat. Any exersize that isolates the biceps more and takes the wrist flexors out of the equation will be hepful. Avoid DB curls!! Or anything that uses a lot of pronation/supination type motions.
    I disagree w/ SOME of the assertions in SC's article. These injuries, if they become chronic, are often amenable to treatment w/ proliferant injections into the tenoperiosteal junction (what the article refers to as the osteotendinous junction), in order to stimulate healing and the deposition of new collagen. The over-use of RICE, and ofantiinflammatory drugs, has the potential to inhibit complete healing. These modalities are great for getting ppl up and running as quickly as possible, but the trade-off can be a chronic, lingering problem that waxes and wanes over time.
    Good post doc...I would submit that excessive supination is the main culprit with this injury in weightlifters. Train biceps light for awhile and concentrate on rowing movements for back, ditch the pulldowns/chins.

  14. #14
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    I am one of the injured guys. I had the same injury to the inside of my left elbow. My Doc after months of complaining gave me a cortisone injection which lasted maybe a year. It cam back he gave me another one which didn't work at all. I opted to have the surgery. After a cple months back in the gym post operative, he had to give me another injection. Good Luck

  15. #15
    Allmost Good Looking Green888's Avatar
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    Quote Originally Posted by bigjd69
    I am one of the injured guys. I had the same injury to the inside of my left elbow. My Doc after months of complaining gave me a cortisone injection which lasted maybe a year. It cam back he gave me another one which didn't work at all. I opted to have the surgery. After a cple months back in the gym post operative, he had to give me another injection. Good Luck
    wow, i hope my injury is not that bad
    ....i think it sucks, that it hurt even when hitting a front double biceps pose.
    that is proberbly not a good sign :S

  16. #16
    Allmost Good Looking Green888's Avatar
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    http://www.sportsinjuryclinic.net/cy...tendinflam.htm

    acording to this link, heat and rest should do it!
    does anyone know if you can buy an ultrasound machine for home use?

  17. #17
    Lift, eat, sleep and grow Jimmykick's Avatar
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    Roughly 6 weeks ago I was trying to swing my son's very heavy baseball bag with my left arm into the flat bed of my raised F250. The truck was to my left and I got about halfway up and I felt a real tightening BEHIND the elbow but immediately inside the elbow bone there (draw a line from the back of your elbow towards your triceps). So I injured the area directly behind the elbow. dumbell kickbacks are nearly impossible but I fight through them knowing that I could be causing further damage but also trying to overcome the injury as well. I am on a cycle and I cannot bring myself to take time off training right now. It's very painful when using it and not too terribly bad when inactive. Just throbs a little. Anyone ever had this injury and what did you do for it?

  18. #18
    Allmost Good Looking Green888's Avatar
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    http://www.sportsinjuryclinic.net

    try locating the injury by pointing on the map here.

  19. #19
    Junior Bodybuilder slyfalcon's Avatar
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    tennis elbow blows too. got it from over sqeezing the bar. Hurt like a mf. pain on outside of elbow. used ice and rest 1 week. still painfull but got through it. used a heavy rubber band around outside of fingers for rehab and seemed to work ok. still have some discomfort though no pain now. it sucks being injured not only because of the pain but it sets you back and it always seems to happen when your getting good gains

  20. #20
    Olympian Bodybuilder drk_diggler's Avatar
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    try squating...

  21. #21
    Allmost Good Looking Green888's Avatar
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    Quote Originally Posted by drk_diggler
    try squating...
    gr8 comment! tsk tsk tsk

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