♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists on the internet. ♪
- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
Together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- Brad, we've done a video on this before,
but we're gonna do a kind of a comprehensive one.
This is on tennis elbow and these are
the absolute best treatments, stretches,
and exercises you can do in our opinion.
- Sure. Yep.
So, and you've had tennis elbow.
- On both arms.
- So you're a good subject.
- Yeah. It's a very painful when it's in it's, you know it's
- Flared up?
- It's painful and it limits you a lot.
- People I think are shocked how much it hurts.
- And the thing about this is,
is you look perfectly healthy, it looks perfectly fine.
And you can just do the smallest little motion
like opening a door and it just will bite
and it lets you know it right now.
Aye yai yai, yai yai. Yeah, so.
All right, so the first thing is, you know,
normally what it involves it is, you know,
the muscle going into the tendon
and attaching to the bone here.
Nine times outta ten, that's what it is.
- Yep, right about there.
Generally a lot of times it's gonna hurt
when you squeeze your hand or bring your wrist up.
- Yep.
- Or deviate a little bit this way.
- Right.
- That's the indicator 'cause it'll hurt down there.
Those muscles go all the way down the forearm, so.
- Right.
- And catch your elbow. - I know one thing I do when
I have a patient, I'll palpate or feel on that bone
and usually where that bone is that connects,
very tender spot in there.
- Yep. All right.
So you're gonna start off with a ice massage.
I mean, and maybe this is something you've done already.
Brad, you wanna show how that's done?
- Yep. You can just take direct ice, fill a cup up.
It can be styrofoam or paper.
Bob likes the styrofoam.
I like paper ones better, but it doesn't matter.
Fill it about this high, put it in the freezer
so it doesn't tip over, freeze it solid
and then peel away.
- The top.
- So you have some ice exposed.
You can rub the ice to get the sharp edges off
and go right over that area.
I usually rub for five minutes.
The first one or two minutes, it kind of burns
and is a little uncomfortable,
but then it goes numb, skin turns red, and at five minutes,
and I think you even do a little less than that,
don't you, Bob?
- Yeah. I mean, if you're really busy,
you can probably do it in two, three minutes.
- It's gonna help for sure. - So, yeah. It's gonna help.
The second thing that you may wanna go ahead
and invest in a brace, a tennis elbow brace.
- Yeah.
- I like the one by Aircast here.
Just me personally, Brad. - Yep.
- It's worked well with patients.
- It's nice.
They have a bladder on a little air bubble thing there
and usually put that over the sore area
and on the muscle belly, just in front of it.
So if right there was a sore spot,
we're gonna go right in front of it.
And you'll know, 'cause when you're on it
and you tighten this up-
- Yeah, you're not on the sore area.
You're just a little bit off of it, more towards the hands.
- Exactly. I thought I said that.
- It was a little confusing.
- I know, I didn't say it very well, did I?
- But what you're trying to do is take, you know,
the muscle, the stress of the muscle now
is a little bit more right here
instead of where it attaches.
- Right. Kinda spreads it out.
- Do you use a brace Brad or not?
- Yeah, I use one,
and one thing I found within other people,
that some patients of mine is to get it in the right spot,
sometimes when you're working,
if you are working that physical type job
and you bend it, it will get in
the crux of your elbow and it's uncomfortable.
- Oh.
- So then it would kind of bother you.
It all depends on your situation, but they are helpful.
- It was, okay. - You know, it gener-
- It doesn't take away the problem,
but it seems to help.
- At least you can work with it as long
as your elbow's not real flexed a lot.
- Okay. First treatment you may wanna do just to-
- Oh, Bob, just wait.
Right over there. - Oh yeah, by the way.
Before we go any further, we wanna make sure.
A lot of people are new to our channel.
Wanna make sure if you have a minute, just go ahead,
all right, if you have a second,
please hit the subscription button.
We upload videos every day. - Right.
- And they're all on things like this
that can be helpful to you and help you
stay pain free, fit, healthy.
- Et etcetera, et cetera. - All right.
- And we appreciate it.
So let's go on, Bob.
- All right, moving on.
This is a very low level exercise.
But just to start, putting a little bit of stress
on the area without making it worse.
So all you're gonna do is every,
you know throughout the day,
you can do this every hour in fact,
is all you're gonna do is lift your,
make a fist and squeeze.
And you're gonna feel a little bit of pain, but that's okay.
Squeeze.
- You don't wanna get into the sharp pain, but a little bit.
- You do this 10 times.
And like I said, four to five times a day.
- And you notice he's got his wrist up.
We call that extended.
That's the extended position of the wrist.
And that's where you want it.
Not down like this.
- All right.
Now this next one is one that we have found
a lot of people have had a lot of help with.
Lonnie, can you throw me a pillow?
There's one over there.
- He meant to say a lot of success.
- What did I say? - Help.
- Oh. - Well it's kind of true too.
But it is been a nice and it's not real hard to do.
You can do it to yourself. - No.
So what we're gonna do is,
yeah we're cross fiber friction massage.
You're gonna find the spot here,
you know right off the bone.
And you're gonna move a little bit more towards the hand.
- Sure.
- And that's usually the spot where you're gonna do this.
And you're gonna take one finger or two fingers.
You're gonna go across the fibers.
- The fibers of the muscles go this way,
so we're gonna take in the massage and go this way.
- Yep. And what this does,
'cause a lot of times what has happened over time,
is that scar tissue has formed in that tendon,
or even a little bit in the muscle, Brad.
- Yep.
- And that scar tissue is very weak
and it breaks open very easily.
So what happens is it starts to heal
and you think, oh, it's getting better.
And then you use it and it breaks open
and you starts all over again. - Sure.
- So this helps it heal strong.
So like this instead of like a cob web.
- Right. We don't, yeah, that's kind of,
we've got some other things to get into,
but it is definitely a nice technique that's-
- So you're gonna go across like this and you can do this
for a good five minutes if you can tolerate it.
And you can do this every day, if you like.
- Right. - If you can tolerate it.
- You'll know if it's the right technique,
'cause when you start, it'll be a little painful,
but within 30 seconds to a minute,
the pain should start decreasing.
- It might be very painful
to start off with, Brad. - Right.
- But yeah, it should level off at least.
If it's getting worse and worse and worse as you do this,
it may be too soon. - Right.
You may have to ice first.
- Give it a little rest for a day or two,
put the cold packs back on it. - Yep.
All right, what we're gonna do right now, Brad,
is actually, this is a great one to do.
I really want you to focus on this one.
It's probably one of the ones that'll be most helpful.
- Sure.
- But we're also gonna show you some other techniques
that are maybe more for those stubborn types of-
- Tennis elbow? - Tennis elbow
that don't go away 'cause quite often
what we'll see in people who have tennis elbow
is that that particular elbow doesn't
straighten as much as the other elbow.
- Right.
- Now sometimes you can compare the two and you'll see,
it's just slightly bent.
And then these techniques work out really well for this.
So we're gonna show the first one up.
So if you find a doorway,
I'm gonna simulate this that this is a doorway here.
You know, I'm inside the doorway.
What you're gonna do is you're actually trying to move
this lower forearm that way,
while this is supported by the doorway.
- Sure.
- So it's a little mobilization we're calling it.
- So, I don't know if you can see it in the camera.
You know, here's a corner.
You know, it's just a molding of the door.
A door jam perhaps.
- So keep your thumb up.
Okay, and while the thumb is up,
I'm taking you know right here between the thumb
and the first finger here and I'm pushing, pushing.
And while I'm pushing, I'm pushing continuously.
I'm gonna go ahead and squeeze my hand like this.
- Okay.
And while you're doing this, it should feel better.
- Right? No pain with this.
What you can do first, Brad,
is do it this way and that hurts.
- Yep. Okay.
- And you might even squeeze a washcloth.
- Sure.
- Then you do it this way,
and squeeze and it should feel better.
- If it does, you know, you're doing the right thing.
- This is a good technique if it does.
You're doing the right thing.
You can even do it at different bends, Brad.
You can do it straightened. - Okay.
- And do it in a different way.
I had a golfer that she was a semi-pro golfer.
- Okay.
And this actually is what took hers away.
- This technique worked for her?
- Yep. - Good.
- We'll go back.
All right, going back to some of the other techniques.
Now these are different techniques for you to try
and see which ones work for you.
- Right.
- Again, if the elbow's not straightening all the way,
one technique, very simple technique they do
is actually just to have you turn your arm this way
and you just let it drop.
- Sure.
- And you do that 10 times.
And you're doing kind of a little
self-mobilization on the elbow.
- And you know you're doing the right thing
if at each time you do it,
it feels a little bit better.
- Yeah. Yep. Exactly.
- If by some reason it feels worse each time,
then you'll stop.
- The one I liked, the one when
I get a little bit of pain, Brad.
I actually just take my arm and I turn it this way.
The hand is facing me. And then I go this way and I turn it
even a little farther and bend it.
- So, he is rotating the wrist. I'm rotating it this way.
- The palm away in this situation.
- 10 times.
- I did wanna bring up something about this one.
I know with patients I've had and my own experiences.
When you get out of bed, this is really painful.
Obviously you're not gonna do this one early in the morning.
- Right.
- You gotta be up be up and be moving.
- You might try this one. - That might be working.
- And you can also go the other direction
where you turn the palm away from you and turn it.
- This way.
- And again, I'm twisting it
and bending it at the same time.
- And again, if one of these directions
feels better with repetition,
that's the one you're gonna stick with.
'Cause usually one will and one will probably-
- This is the one again that worked for me.
I like this one.
I would do it both directions, actually and it worked out.
- Both ways. All right, okay, good.
- Yep, both worked out for me.
Another one to do, Brad.
This one might be easier than the one
we just showed up against the wall.
You're gonna put your arm down.
Your fingers are pointed toward you.
- Okay. - Like this.
The elbow as straight as you can, tie out of the way.
And now again, I'm doing the same thing.
I'm pushing that way.
- Yeah, let's give 'em a different view here, so.
- Okay.
- And it forces that direction.
- Yep. So pressure on, pressure off.
- Okay.
- Pressure on, pressure off.
- About 10 times, typically. - Pressure on.
Pressure off. Yep, 10 times.
- Again, we're looking for positive results-
- You're right. - As you do more.
- It feels better.
- It feels better as you do more.
- Finally, when the pain is better,
you wanna do some strengthening, Brad.
- Sure. You wanna show these eccentric strengthening?
- You bet.
I like to use stretch band or tubing like this.
You can use like a dumbbell.
I just think this is easier to vary the resistance.
You're gonna go down like this, take the other hand.
You're gonna help it up.
And this is when you're starting,
and then you're gonna let it down slow.
It's called eccentric or negatives,
which is a really good way to strengthen a muscle.
Doo, doo, doo.
And as it gets better,
you know, maybe you can go into the atypical.
- Sure, concentric. - Yep.
- Initially the eccentric really does help healing more.
- Right.
This really gets directly to that.
I can feel these muscles starting to
burn already, just after-
- It looks easy, but it's not.
- Exactly.
- All right.
If there's any other videos you'd like us to make,
make sure you comment below. - Right.
- We always like to hear from you.
- We'll do what we can for you, take care.
- Thanks.