My wife began getting a tingling/pins & needles sensation in both her hands, along with pain in her elbows, about a year ago. She had been squatting, pressing and DLing for months prior to this without any problems. However she had started a new job that required a lot of typing at the PC, which seemed to bring on the symptoms. Her GP suspected carpal tunnel syndrome and referred her to a specialist.
She finally had her appointment about a month ago. This was with an occupational health specialist at the hospital, who wasn’t sure if it was carpal tunnel or an issue with a different nerve in the arm (I think this was because she has pain in her elbows in addition to tinging in the hands). So, she has been referred to have nerve testing, which we’re still waiting for.
In the months while waiting for the occupational health appointment, my wife found that the symptoms subsided quite a bit. Not completely, but a lot better than when she originally went to the GP. She wasn’t typing so much during this time either, and we were still getting to the gym 2-3 times per week to weight-train and 2 times per week for cardio.
The occupational health specialist did various manipulations on her arms and hands - twisting, tapping, bending etc. These made the symptoms flare up quite significantly and they’ve been quite bad for the last few weeks.
She had a follow-up appointment with the occupational health specialist today. This time she was told that there are probably two issues going on - carpal tunnel causing the tingling hands and tennis elbow causing the elbow pain. The specialist has recommended the following, specifically with regards to the tennis elbow (for the carpal tunnel, she was told to wait for the nerve testing): 1. Stop all weight lifting for a few months to give the elbows a chance to recover
2. Stop rowing and consider stop swimming for a while
3. Apply heat to the elbow
4. Massage the upper forearm
5. Apply some ibuprofen gel to the elbow
6. She was also given some elasticated strappy clasps to wear around her upper forearms I would really appreciate any input you could give regarding this situation. Do you agree with these recommendations? It was quite galling for her to be told to stop training altogether, and that, if it is tennis elbow, then it may never go away, so any weight-bearing arm movements could cause a flare up. I know, from all of the content you provide, that stopping training is a pretty extreme option. But I don’t think I’ve heard you talk about tennis elbow rehab. Do you have any suggestions for us?
The information you’ve given does sound like CTS and potential elbow tendinopathy.
Regarding the recommendations, I don’t agree. Even if we agree the diagnostic labels provided are valid, she can still train; provided we manage loading to the area appropriately while having tolerable symptoms.
Rowing and swimming - likely can be continued provided we are managing loading appropriately. However, in the early stages of rehab I often recommend removing repetitive dynamic loading to the area to help with managing loading and symptom mitigation.
Heat and massage is a net neutral - isn’t aiding healing or impeding. Not necessary.
Ibuprofen - this is on my list to look into. My previous stance - net neutral, but some have been claiming it may be harmful to the healing process and I want to look more into this before weighing-in. My current clinical stance - I don’t recommend it.
The clasps - is this a splint?
Tennis elbow/Golfer’s elbow are terms for medial and lateral elbow tendinopathies - the recommended management is the same for other tendinopathies at this time, manage load.
You all would likely benefit from a consult with us so we can guide this process. Keep us posted!
Thanks for your reply. Sorry it’s taken a while to get back to you, things have been hectic over the holidays!
Thanks for your advice regarding the therapist’s recommendations. I was a little skeptical of some of the suggestions based on what I’ve learnt so far from you and the BBM crew, and it’s a great help to get your input. It’s good to hear that she can still train as that is an important part of her life.
We managed to get to the gym a couple of times over the holidays, in between travelling to family etc. She did some deadlifting followed by some lat pulldowns and shoulder & chest pressing at a fairly light weight. She just did one set of 12 reps to test the waters and see how her arms responded. The workouts didn’t change the level of discomfort in her elbows or wrists, for better or worse, other than setting the bar down during the deadlifts, which gave her some extra elbow pain for about 10 minutes then settled down again.
Is the idea behind ‘load management’ to find a weight you can use that doesn’t make the symptoms worse (or only causes a short term worsening of symptoms like with the deadlifts described above)? Then slowly increasing the load from there?
Should she be doing any specific exercises for the elbow tendinopathy, or just carry on doing the general weight-training that she’s been doing for years, but with a close regard for load management?
She’s going to leave rowing for the time being and do other forms of cardio (probably the stationary bike). She’d like to try swimming again though, so we were thinking of giving it a go and seeing how her symptoms are afterwards - if there’s a flare-up then reduce the distance swam next time and see if that’s better. Do you think that’s a good way to go?
Her CTS is a little worse since my original post, but she thinks that’s because she used her laptop quite a lot over the holidays. We’re still waiting for the nerve tests for it.
We’d love to get a consult, but aren’t in a position to do that right now - my wife isn’t working and I was made redundant before Christmas. But if our fortunes fair a little better down the line, we’ll definitely look at doing that.
Thanks a lot for your help and I hope you had a great Christmas and New Year.
Yes, load management implies finding a “tolerable” load to the area where symptoms will be a part of the process but don’t severely increase to the point she feels debilitated (unable to go on about her day and do the required activities of life or the next day). If symptoms are severely increasing and remaining elevated for 24 hours, then it’s likely modifications in loading need to be made. If we regress the load down as far as possible with say a barbell and symptoms are still severe, then try dummbells at a lower load than the weight of the barbell. If this can’t be accomplished then switch to machines.
I go back and forth on this question dependent on case context. If she’s doing ok with symptoms throughout the day and training doesn’t need to be greatly altered from an exercise selection standpoint, then it’s difficult for me to validate adding exercises in (which contribute to loading of the area). If we were drastically altering training and trying to modify symptoms then I’d likely add-in exercises specific to the region. However, a stance can be taken if the area is a tendiopathic issue and we want to improve loading to the area then perhaps we add in an exercise specific to it. There’s not a black and white answer here…as usual.
[/quote] No. I don’t recommend this and it’s not necessary.
That makes sense. Typically my radar blips with this stuff if 1) we begin noticing obvious atrophy to innervated musculature and 2) muscle weakness becomes apparent and progresses
Sorry to hear this. Hang in there and keep us posted.