Here I’ll share with you my Golfer’s elbow rehab plan that’s specific to BJJ and Judo.

This was a niggling problem I’d had a few times over the years…

…but then I recently had a big flare up after returning to the mats (too quickly) after the latest lockdown.

So in this article you’ll find how I used the latest evidence about medial epicondylitis to:

Reduce pain.

Improve muscle-tendon strength.

My functional rehab.

And:

My step-by-step plan for returning to full rolling and randori.

Here’s the stages of rehab:

1. Reducing the pain in my Golfer’s Elbow

First we need to clarify something:

Even thought it’s commonly known as medial epicondylitis… and up-to-date physio refers to presentations like Golfer’s Elbow as a ‘tendinopathy’ and not ‘tendonitis’

(because it’s not a typical inflammatory condition)

It’s important to know this because the Rest Ice Compression Elevation (RICE) protocol does not apply to a tendinopathy

(it actually makes it worse)

Even if it was a true inflammatory condition like an ankle sprain… it’s important to note that ice is no longer indicated

(Read here to see that even the original proponent of ice has retracted his position)

And rest?

Rest decreases the load tolerance of a tendon

[after 2 weeks of rest a tendon starts to lose it’s stiffness and strength and which makes the condition worse in the long run]

Tendons are a Goldilocks workload management thing:

  • Not too much load
  • Not complete rest

I would say never rest a tendon, never. You can always do isometrics.

– Dr. Jill Cook, one of the world’s leading experts on tendons.

So the key for reducing pain in my Golfer’s Elbow was 3 key things:

1. Removing high, fast, or unpredictable tendon forces.

  • I took a couple of weeks off any Grappling (by then the resting pain settled)
  • Stopped high force pulling exercises like chins and pull ups

2. Manageing load

Rather than rest completely, I started using Ebonie Rio’s protocol for isometric exercises.

5 sets with a weight that I could just hold for 40-45 second holds with 2 minutes rest between sets

This has been shown to:

  1. Decrease pain
  2. Reduce painful inhibition, while
  3. Maintaining muscle and tendon strength

3. Modifying activity

Now, I could have stopped training BJJ or Judo altogether…

…but instead (once the initial pain settled) I modified my approach.

Here’s some ways I reduced aggravation of Golfer’s Elbow when training BJJ and Judo:

  • Chose No-Gi wherever possible
  • Opted for pulling guard instead of trying to fight my Judo game
  • Stopped any collar-drags
  • Avoided spider guard, collar chokes, etc… and instead aimed for arm-drags, under-hooks, Darces, etc
  • Let go of the fucking Gi!

[I’d still get a little pain the next day, but nothing like it was]

2. Improve strength in the muscle-tendon unit by using heavy slow resistance training

Once the initial flare-up had settled, it was time to introduce a progressive loading program

The key principle here is that you can’t fix the areas of tendon degeneration…

…but with a good progressive loading program you can strengthen the remaining good tissue so that you’re even stronger than when you started

[this research has shown that even if you have tendon degeneration you end up with more good tissue than when you started]

When it comes to tendinopathy you treat the doughnut, not the hole

The goal of this phase is to develop muscle and tendon strength BUT adjusting programming to take into consideration the underlying pathology

But here’s a point I cannot emphasise enough:

It’s not just about the specific exercises… it’s about how they are programmed to achieve specific effects

If you give someone an exercise to do without programming it using the FITT principle it’s like giving them a chair that only has one leg

(or telling someone to take medication without giving any info about the dosage)

So here’s the detail:

1. Frequency

We don’t get stronger when we exercise…

…we get stronger IF we give our body an appropriate dosage of stress AND then allow adequate time for rest and recovery:

It’s in the downtime that we adapt and grow back stronger.

[constant stress damages, intermittent stress strengthens]

For tendons, we need to give them 48-72 hrs between sessions:

Rehabiltation of Tendons in Golfers Elbow in Grapplers - Exercise Effects on Collagen Synthesis and Degradation

This also gives an opportunity to monitor whether our intensity is appropriate…

2. Intensity

You get stronger by lifting heavy weight.

But:

Tendons don’t like change. Our goal here is to back things off and then sneak back up on it.

So here I started at a load that I could just lift for a maximum of 15 repetitions before failure (15RM)

It was then a case of slowly progressing to a 6RM load over the course of a couple of months

[it’s worth noting here that pain during lifting is to be expected]

So how did I know when to progress?

If there’s no big increase in pain 24 hrs after a session that’s generally a sign that the weight is okay…

…and if pain increases 24 hrs afterwards then this should initiate a reduction in weight

(as this is an indication you’re overloading the tendon too much)

But:

It’s important to note that this was done in conjunction with another variable…

3. Time (Amount)

In this context, time relates to the total number of work sets:

I started with 4 work sets per session and built up to 8 sets per session

(that’s around 12 – 18 work sets per week)

Key point:

I never changed both weight and sets in the same session… one variable at a time.

4. Type

The 2 exercises I incorporated into my rehab were:

  1. Deadlifts. I moved these from my ‘leg day’ to ‘pulling day’ purely for the large weights you can move and the big impact they have on grip strength
  2. Bicep curls. This may seem like a strange choice (and it’s not something I normally do). But, these actually create a lot of load on your wrist flexors at the point when your forearm is parallel to the ground

3. Functional rehabilitation incorporating spring-like loading

Strength training creates a good foundation… but rehab should not stop there:

To decrease the risk of re-injury (or a different injury) there needs to be a step-by-step graded exposure and loading program that mimics the demands of the sport you’re trying to get back to.

So now we’re at Step 3 of the graded exposure program for BJJ or Judo: Solo drills that replicate the demands of grappling

Get Back On The Mats - Graded Exposure for Returning to BJJ or Judo After Injury

In the case of tendons it’s all about rebuilding their capacity for energy storage and release

(healthy tendons act like springs)

So this consisted of adding in 3 movements:

  1. Kettlebell swings
  2. Uchi-komi bands
  3. One arm rows (dynamic)

To replicate BJJ and Judo gripping actions I used a set of these Scramble Grip Trainers (affiliate link here)

But it’s important to note:

Overloading dynamic energy storage and release is what usually causes tendon problems in the first place.

So key points for dosage:

  • Started with VERY light initial-level energy storage exercises
  • Small dose with 5 reps each
  • Only minor pain on exercise and no latent increase confirmed load tolerance was okay
  • Built up volume first until 3 sets of 15 reps

Then it was a case of gradually progressing intensity until it replicated the demands of grappling…

Target: Dynamic one arm row with 40 Kg

(dynamometer testing confirms that this replicates the force of a sudden collar drag)

4. Return to sport: Graded exposure for BJJ or Judo

I’d confirmed my tolerance to energy-storage exercises that replicate the demands of BJJ and Judo…

…so now it’s time to progressively add training drills

But in particular:

If your idea of grip fighting is to get hold of some cloth and hold on for dear life… then hand, finger and elbow problems are inevitable

So it was time to revisit grip fighting strategy

One of the best products is Jimmy Pedro’s ‘Grip Like a World Champion

From here, it’s now a case of working grips back into my grappling:

  1. Drill techniques with an unresisting partner
  2. Drill techniques, combos, and counters with a semi-resisting partner
  3. Positional sparring

Again, sneaking up on the tendon in terms of volume and intensity.

Summary: Rehabilitation of my Golfer’s Elbow for BJJ and Judo

I hate to say it, but every time I get an injury I end up a better physio:

My injuries make me take a deep dive into the current evidence for best practice, and truly think of the sport-specific demands of BJJ and Judo.

The reality is that even though I now have no pain, tendinopathies never truly heal; any degeneration will always be there.

So now, it’s up to me to continue with my strengthening program to maintain load tolerance, and avoid any sudden changes in loading:

Treat the doughnut, not the hole.

Hopefully this gives you some insight into Golfer’s Elbow (medial epicondylitis) rehabilitation that’s specific to BJJ and Judo, but remember:

Get assessed by a physio who understands the specific demands of grappling.

Some additional resources you might like to help show that I’m not just making stuff up and using Broscience:

  1. Chronic Medial Epicondylitis Treatment Tips: The Ask Mike Reinold Show
  2. Talking Tendons With Jill Cook: The [P]Rehab Audio Experience
  3. Tendinopathy Rehabilitation: Physiopedia