Dear Doctores,
first of all, I listen to your podcast all the time, I love it!
Austin, I love your profile picture!
I just started working out in the gym and at home (rower and Kettlebells) last September. But I do have some previous training experience from years ago, different stuff, on and off.
In the gym I am currently doing a generic newbie program, mostly machine exercise, but I want to learn the basic barbell moves step by step. Right now I focus on learning kettlebell movements though. I added kettlebells to my portfolio to help me with training consistency while travelling (a lot) and I came to like it. By the way, I’m female.
Anyway, I signed up, hoping you could give me some tips with my recent “arm problem”.
Almost 6 weeks ago I fished my 12 kg Kettlebell from under the back seat of my car and somehow tweaked my left forearm doing it. I immediately felt some pain and knee that this had not been a good move. In the following 4 weeks I did the 10.000 swings challenge and that went pretty well. But whenever I did overhead presses as auxiliary movement, mostly towards the end of the challenge, my left forearm hurt. Noticably but not intolerably, so I just ignored it. It didn’t get better but also not worse.
Now, couple of weeks later I feel it has gotten worse since, bothering me in the day to day, even with very light load or sometimes no load at all.
Could this now be secondary pain? I know I should probably go see a doctor or a PT after 6 weeks. Now, in my place (Germany) it takes months to see an orthopedist and mostly, they are not very competent and just want to prescribe quack that insurance doesn’t cover (for a reason). I may rather see a PT but wanted to give it some more time.
As a layperson I don’t know for sure what it is that hurts. Looking at pictures, I suspect the M. Brachioradialis, relatively close to the elbow.
As the pain doesn’t seem to go away on its own I was thinking of the following strategy based on what I understand from the pain + rehab podcasts: I identified the dumbbell biceps curl (with thumb up) as a good way to provoke the pain. I do 3 sets of 8-12 on each side, 15 lb on the right side (reasonable for me), 5 lb on the left (only little pain). I hope this helps desensitize the thing. Also movement and blood circulation should help. And maybe the body understands that what is ok for the right arm is also ok for the left arm. Any thoughts?
Thank you!
Best,
Susanna
Susanna,
Thanks for coming to the forum and the kind words. Much appreciated!
Sounds like your L arm/elbow is experiencing some pain. I hesitate to diagnose you from here, but my suspicion is that you have some epicondylitis, likely from overuse as a result of the 10,000 swing challenge.
As far as how to manage this, I think you’re on the right track. I would consider adding some direct forearm work, e.g. wrist extension/flexion, forearm roller, etc. and direct triceps work.
I do have concerns regarding the duration of symptoms. You may benefit from a consultation with our pain and rehab team to expedite your recovery. Shoot us an email at support@barbellmedicine.com and we can get you sorted.
-Jordan
Thanks Jordan for your nuanced reply and the exercise recommendations!
Pretty certain by now it is brachioradialis. Your concerns now make me more concerned. Will try to get a referral to PT from my primary care physician to hopefully avoid having to wait for an orthopedist. I will also consider your suggestion regarding consultancy.
Thanks again!
Sounds good. Did not mean to increase your level of concern. To clarify, I think the 6-8 week duration so far indicates that additional steps in management. (e.g. further activity modification) vs. its likelihood of resolving on it’s own. Hopefully that makes sense!
Dear Jordan,
Sure, it makes sense absolutely.
I think I’ll cut down “suspicious movements” like rows and such and continue some light exercise of the affected area (hammer curl, reverse curl, triceps, have no access to forearm roller)
I tried to get a PT prescription via primary care, but she requires me to see an orthopedist. I was super lucky to get an appointment for next week, which I wouldn’t have anticipated.
Cheers
Hi Jordan, I’ve adapted my training plan, avoiding any pulling with bent elbow, like rows (even if they didn’t hurt really). I also stopped the light hammer curls (seemed to make it worse) and taking a break from kettlebell entirely. Symptoms seem to alleviate slightly.
Now I just had the orthopedist appointment. With his palpations and tests he didn’t provoke any pain. He seemed pretty weak though.
From the description of the symptoms he thinks it is tennis elbow. I am surprised due to the location of the pain. But he thinks it radiates into the brachioradialis. He took an X-ray to rule out any lesion to the bone structure and “maybe you have arthritis”, which almost made me laugh. Yeah, I’m almost 47, maybe I do, but will this have caused the issue?
X-ray came back flawless, everything fine, no bone lesion, no water cumulation, no arthritis.
They went on to wrap my entire elbow and forearm in a moist bandage (zinc…?), which I have to keep on for 3-4 days, it is supposed to cool and I don’t know what else. And an anti-inflammatory drug (Etoricoxib) for 5 days. He then started the expected pitch of shock wave treatment for this kind of “chronic” cases (it is super popular - as a good source of income), which I brushed off and I got a PT prescription. I am supposed to present again if it doesn’t improve in 10 days, in that case they will potentially extend diagnostics (MRI).
So far, so good. Hope to get an appointment with a local PT soon.
Save for the mysteriously-soaked bandage and shock wave suggestion, seems about right.
I would consider some form of rowing, albeit lighter, likely with tempo, and/or unilateral, would be in my plan for you, as I would want to expose you to that movement in a controlled, gradually progressed manner.
Hoping this resolves soon!
Hi Jordan,
Thanks!
I got a row ergometer, would that potentially work?
Or better a machine/cable?
Can I keep deadlifting as usual? No pain so far.
Cheers
Susanna
I definitely would be deadlifting, making changes to tempo, style, and subsequent loading to make sure you can tolerate it.
Rowing for conditioning may be fine, depending on symptoms, though it’s not really resistance training, you know? I’d plan on keeping some more traditional lifting stuff in there in both the vertical and horizontal pulling. Whether it’s machine, cable, or free-weight based is mostly up to personal preference, resource availability, and what you can currently tolerate. I predict that free weight stuff may be more difficult to modify compared to machines, and probably represent exercise that’s closer to unrestricted training.
After calling 6 or so PTs I finally got an appointment for next week. Hope the fact that these were the only ones with capacity short term is not a bad sign…
Tempo for DL means slower?
For upper back/lat I currently do cable pullovers as pulling exercise which works fine as always.
I do triceps cable pushdowns as you recommended, no issue at all. I may still add regular machine row with reduced load (although it doesn’t really hurt, just being cautious).
What hurts is kettlebell OHP. I think that’s what may have aggravated the thing initially, not the swings (I do the OHP with slightly flared elbow). I did quite a lot of them beginning of the year (during the swings challenge), ignoring the pain. I was just over-motivated to get less weak shoulders…
Hammer curls/Zottman curls also hurt. I would say these are the main pain provoking movements in a training situation. In day to day it can be things as simple as putting on a jacket or turning the door knob, very light stuff.
I looked up the mystery bandage, it’s a zinc paste bandage. Maybe a German thing? Now that it’s dry it’s slightly compressing.
Technically, lifting tempo refers to the cadence used. It can be faster or slower depending on the comparator. That said, we typically mean slower tempo when we say “tempo work”, e.g. 3-0-3 tempo deadlift with a 3-second eccentric and concentric phase.
I do not think cable pullovers are sufficient for rowing-type exercises generally speaking, as I would push for exposure to compound horizontal and vertical rowing exercises. In other words, I’d want to use the arms too.
I would wager you can do some curl variation as an entry point, as well as pressing some weight, at some tempo, through some ROM overhead.
I hope I’m not coming across as a contrarian. Rather, I’m pulling back the curtain on what we do with our pain and rehab clients. Fortunately, we don’t have an offensively long waiting list 
Hi Jordan, sorry for late reply. No, you’re not coming off as contrarian.
I’m in the middle of the physio. 3 sessions so far, 2 more this week, one next week. Trying to be patient and don’t want to judge yet. Will report back how it goes…
Hi Jordan,
it’s been a while. So, how did it all go?
It would be so funny if it wasn’t sad and indicative of our medical system nowadays.
The physio back in February was 100% useless. The practitioner was a newbie and she was really not good (German physio education sucks…). Anyway, all she did was manual therapy, i.e. poking my muscles and tendons to the extent I got bruises and it made it really worse. When I asked about exercise her advice was as precise as saying “just don’t do anything with your arms”. For the last session, the boss himself took over, but that was not any better. He bruised my arm, just from the other side. Also he tried to sell shock wave therapy and offered taping. Then he went on to say that he had tennis elbow twice himself long ago but since he is doing keto he hasn’t ever had any problems again. Then he went on to talk about his conversion to Buddhism (no joke). Now I also know about the psychiatric disorders of his sister and he considers it’s her own fault as “people want to be depressive”. OMG. Needless to say I’m not going there ever again.
Fed up of all physio for a good while I just went on with my gym training with as little restrictions as possible (mostly rows). Just pausing kettlebells. In April I had a routine GP visit and that was a good opportunity to ask for another PT follow up prescription (although my arm had started getting better on its own).
I changed the practice, needed to wait a few weeks.
But what a night and day difference! A practitioner with close to 40 yrs experience.
By the time I got there the arm was much better but meanwhile I had developed some nasty pain in/around the rib cage on the right hand side (I had ignored it for a while thinking it is just doms, I suspect the deadlifts). Plus my left shoulder has been pretty unstable for years, which I couldn’t fix with the typical shoulder rehab exercises.
I basically told her all my aches and pains. First thing she saw that my hip was inclined and my shoulder as well (probably compensatory). Must have been very obvious (now that I think of it I was told so by a singing teacher years ago as well). She mentioned this kind of stuff happens a lot after trauma and can manifest years later. Yeah, I fell off my bike and broke the left clavicula long ago, maybe that’s it.
She also found a subluxated first rib on the left (non painful) side and found my upper back to be weak (yes, she said “weak”). It seems that my lat tends to take over stuff that the upper back should do. So, she prescribed lot of stretching, a specific exercise to fix the hip alignment and upper back isolation work. She prescribed to go on with my normal training (reduce load as necessary) but do the alignment exercise before and during training. And she fixed that subluxation. Now, a couple of weeks later I’m doing pretty fine! My hip is good now according to her. But it feels off. Apparently I was so used to that inclination that it felt normal and now my proprioception lags behind. When I do the DL as I normally would I feel that extra strain on the right side ribs cage. I have to intentionally put a little more weight on the left side than I normally would, breathe a little more to the left side than I normally would, go a little deeper on the left side than I normally would so I feel the same tension in the hamstring. And then it’s completely fine. It still feels weird but it seems to work.
I was able to improve my left shoulder stability a lot as well. Overall, heading in the right direction I would say. And my arm, not yet at 100% but getting there. No restriction in the gym but I will wait a bit more before returning to kettlebells.
So a tragic comedy with happy end if you will.
Happy to hear you’re feeling better, Susanna. That’s great!
I have some serious issues with both of the PT’s you have seen, but the most important thing is that you are feeling better.
If you require additional PT services in the future, I would continue to recommend our team over the people you have access to. For now, seems like you’re doing well.
Thank you Jordan!
Sure, none of them may have been perfect, the second one much more helpful than the first one though. And a nice change not being offered shock wave therapy once 
I will see how things evolve the next couple of months. Right now it looks ok.
Eh, the second person talking about an inclined hip and shoulder, and a subluxated 1st rib causing your pain, and prescribing specific exercises for them is not something we’d likely agree on. That said, I am happy you’re feeling better and have found relief.
This highlights a common issue when people ask if we think they need to see a PT for an injury. Yes, a good PT can be helpful, but there’s just so much BS and poorly trained clinicians in that space that it’s hard to recommend without reservation.