The Beyond Pain Podcast

Episode 53: Understanding and Working with Elbow Pain

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Summary:
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss various aspects of elbow pain, including common issues like medial and lateral epicondylitis, the importance of grip strength, and the role of cortisone injections in treatment. 

They emphasize the need for a comprehensive approach to managing elbow pain, focusing on long-term solutions and the importance of setting goals for recovery. 

The conversation also touches on the significance of assessing related areas, such as the shoulder and neck, to ensure effective treatment.

Takeaways

  • The Knicks' playoff performance sparks discussion on sports excitement.
  • Elbow pain often stems from overuse in sports, not just specific activities.
  • Common elbow issues include medial and lateral epicondylitis.
  • Treatment for elbow pain should focus on heavy loading and isometrics.
  • Nerve entrapment can mimic elbow pain and should be assessed.
  • Grip strength is crucial for overall arm function and injury prevention.
  • Cortisone injections can be effective but should not be the first option.
  • Long-term management of elbow pain requires patience and consistent effort.
  • Coaching cues can significantly improve movement patterns and reduce pain.
  • Setting clear goals is essential for effective rehabilitation. 



Joe Gambino (00:01)
Welcome back into the Beyond Paint podcast. I am one of your hosts Joe Gambino and I am here with our other host Joe LaVacca You can find us both on Instagram at joegambinodbt for myself at strength and motion underscore PT for LaVacca over there. You can also find this podcast on Instagram cups of Joe, well YouTube cups of Joe underscore PT and Instagram Beyond Paint podcast. there if you'd to work with us, we do have an application form in the show notes. Please feel free to do so.

If have any questions or topics that you would like to hear about, please feel free to DM us, let us know, and we will add them to our queue. Joey Boy, welcome back.

Joe LaVacca (00:39)
is good to be back and it's a special Friday because I'm actually in the city in the gym in the office. So I'm hoping that Riverside does its magic of filtering out any background noise for the listeners this week. If you do catch a little bit, we got a lot of big personalities in the gym. I do apologize, but I will do my best to speak loudly and clearly so no one misses any of these wonderful gems we have to offer Mr. Joe. But I am feeling good, man. The Knicks won last night. They closed out the series.

Joe Gambino (01:02)
Yes

Joe LaVacca (01:07)
I don't like the way they closed it out. I'll just celebrate the win. I'll take it. I'm not going be one of those New Yorkers who's complaining, but they got outplayed that whole series, man. It was not pretty. What'd think? Did you watch it?

Joe Gambino (01:11)
That's I Feel like I didn't get a chance to watch it, but ⁓ I feel like even just from watching last last season they just every win that they had was just just fought out and just

They had to tough out every W they got. So we'll see. Hopefully they make a little bit of a run. It's definitely fun when that with Nick's postseason basketball. So I will start tuning in a little bit more. So ⁓ because this is the only real time that I get the chance to, I really actually even end up watching basketball.

Joe LaVacca (01:50)
Yeah, I would say I don't really watch basketball until the playoffs. I'll follow them. I'll keep in touch. You know, I'll check stat lines and things like that. How's everybody doing? But playoff basketball is really entertaining because I feel like a lot of those games in the regular season when you're doing 82 even baseball, man, when you're doing 162 games, you can't play all out every single game. Not every game matters. I'm sorry. Like there's just some nights that you just take a day off.

Joe Gambino (01:51)
Okay.

Hmm.

Yeah.

Joe LaVacca (02:16)
long

travel, you're going across the country, you know. So I get it, but everyone typically shows up. I love the playoffs because they're really physical. It almost like brings me back to those days of like what basketball used to be just like 24 seven, but it is fun. I do have to laugh at the script though for the Knicks where Jalen Brunson has a career ending ankle injury every seemingly third quarter or fourth quarter.

Joe Gambino (02:31)
Mm-hmm.

Joe LaVacca (02:44)
goes back to the Knicks locker room, just picks up a new ankle or foot, puts it on and then comes back out and scores, you know, 35 points when we need it the most. So hopefully we look, I just want to win a couple games against Celtics, man. They blew us out every game this season. I just want to have it be a respectable series. Like do what the Pistons did to the Celtics, right? What the Pistons did to us, I want us to do that to the Celtics and I will walk away.

Joe Gambino (02:50)
Yeah.

Joe LaVacca (03:12)
Very happy. And then maybe we make a move. Giannis? Giannis might be on the table for next year. So maybe we make a move there.

Joe Gambino (03:20)
Maybe, well I'm with you. I'm hoping for, ⁓ I just, I mean I want them to go as far as possible. Make basketball playoffs a little bit more interesting. I was also rooting for the Lakers but they're not quite there anymore. They're in five so the Knicks are all I got left.

Joe LaVacca (03:40)
Where you rooting for the Lakers because you're just happen to be a Shadow Laker fan or is there a LeBron Luke connection or something?

Joe Gambino (03:45)
Now I'm, uh,

nah, just been kind of always, uh, enjoying LeBron's career. So I just kind of, you know, shadow, shadow rooting for whatever team he's on. So it's always, whenever there's, whenever there's someone who's like a generational talent, it's always fun to watch. Right. I mean, I never really liked Tom Brady, but he was, I mean, probably some of the best football that you would be able to witness in our generation. Right. So, uh, I mean, we have Patrick Mahomes now. mean,

Joe LaVacca (03:58)
Okay, I can respect that, Joe. I can respect that.

Joe Gambino (04:15)
but we'll see how his career stacks up to Brady.

Joe LaVacca (04:18)
Yeah, the problem is none of these players are on our teams. ⁓ You know, I'm waiting for the generational player for the Giants. I'm sure you're waiting for one for the Chargers and you know, I guess hopefully...

Joe Gambino (04:20)
Yeah.

Yeah, well we had one

but it didn't, the Chargers, but it didn't pan out to any Super Bowls. We had LT. ⁓ He was a monster at a running back position. And we had great seasons, but nothing in the playoffs. So, well.

Joe LaVacca (04:35)
That is true. That is true.

I hear you, hear you.

Alright man, what are we talking about today? I feel like we've been floating this one for a little bit.

Joe Gambino (04:48)
.

Yes,

yes we are talking about the elbow and we'll kick it off easy. We don't have to talk about any specific diagnosis today but I may be curious to hear your opinion on what are the more common things that you see around the elbow with the people that you see.

Joe LaVacca (05:10)
Yeah, I was about to say is there any other diagnosis Wait, it says paused on the top. now we're recording again. We're good. All right. I'll edit this. All right anyway So I didn't realize there was any other diagnosis other than medial and lateral epicondylitis or tennis elbow and golfer's elbow and I've still haven't met too many people with tennis elbow who played tennis and golfers elbow who plays golf

Joe Gambino (05:15)
Yeah, yeah, we're good.

Hahaha

Joe LaVacca (05:38)
I'm wondering before we actually really get going, have you actually seen the connection here?

Joe Gambino (05:43)
⁓ maybe more so with...

Not really with golf. I haven't come across too many golfers that are like, yeah, I have medial elbow pain. But I think these elbow issues with racquet sports tend to pop up a lot more.

Joe LaVacca (06:05)
Yeah, and specifically though, I don't see it a lot with on the one side versus the other. Like you mentioned racket sports or overhead sports. I mean, we could even probably throw throwing sports in there. ⁓ You know, the elbow doesn't seem to really play by a particular set of rules, even when it comes to agreement with treatment across the board. And one of the things I've sort of been reading a little bit more of lately is just how long these things actually take to go away. ⁓

Joe Gambino (06:32)
Mm-hmm.

Joe LaVacca (06:34)
And I think even the hint that they might be self-limiting, like, meaning taking care of themselves almost from like an autoimmune perspective. So I don't really see too many elbow issues. So diagnosis wise, it still would fall into the most common of medial and lateral epicondylitis. But what I do try to convey when they do come in through the door is, look, we're going to treat this exactly like we would.

any other tendon in the body. We're to go after it from heavy loading. We're going to go after it from heavy isometrics. We're going to modify maybe grip or certain activities that you have at the gym. And even when we do that, it's still probably going to take a really long time to fully resolve. So we want to make sure that we're not aggravating anything with what we do, keeping those symptoms pretty much baseline.

rather than spiking them. But is that something that you've seen as a pattern too? I don't know if I really see somebody for elbow pain for a year or a year plus, but have these been things that when you get these calls virtually that they nag for quite a while?

Joe Gambino (07:49)
Yeah, it's I think a hit or miss. I mean, I had someone recently that I was working with who had some like lingering elbow stuff for like four months. And then maybe it was just perfect timing because when we started working together after a month, started to resolve pretty well. And he's had a little bit of that lingering issue in the past. I worked with him many, many moons ago, and we were able to successfully kind of build up the elbow and it just kind of recently came back for him. ⁓

And then I have some people where it takes a little bit longer, where three, four, five, six months kind of goes by and it's slow progressing where yeah, we're seeing changes. So they may feel like they can do a little bit more effort or work before that tissue starts to be irritated, but for it to really feel like it's 100%, they're not noticing it anymore, it takes a little bit of time.

Joe LaVacca (08:43)
Yeah, think from the one thing I try to rule out with most people is if we think that there's some sort of like bony pathology. But again, that's typically again, from my understanding, going to happen with a lot of our youth sports clients. So we do want to make sure that the proper channels are being sort of evaluated. We're taking into account the person in front of us. How did they hurt themselves? Was it just the beginning of a season like spring training? They started

Joe Gambino (09:00)
Mm-hmm.

Joe LaVacca (09:13)
growing a lot or they started playing tennis a lot. You know, they're in that, you know, sort of like teenage age frame, maybe even a little bit younger. So we do want to make sure that there's no bone injury. There's no growth plate injuries because I think that would be really important to sort of like keep an eye out for probably when they get to our age or maybe seeing me or maybe even yourself virtually. I would probably say the only things that usually come to mind are any nerve entrapment type issues of the radial nerve or of the ulnar nerve or median nerve. So

Joe Gambino (09:24)
Hmm.

Joe LaVacca (09:42)
screening those out with some nerve testing and tensioners or sliders, however you wanna do it. ⁓ The thing that I always tell people to look out for, clinicians to look out for is that we're not looking for sensitivity with those tests. Because I do a nerve test and it hurts, it stings, it doesn't feel great. So that's not what we're looking for. We're looking for clear asymmetry in that range of motion or a clear reproduction of symptoms.

Joe Gambino (09:47)
Mm-mm.

Mm-hmm.

Joe LaVacca (10:10)
And that's what would make me sort of like say, okay, maybe this is a little bit more nerve related. Maybe that takes me up the route to the cervical spine a little bit more. But if people are just like, yeah, that stretches or that pulls really hard, that's not enough for me to say, yeah, let's take nerve sliders. Let's take a spinal stabilization or mobilization sort of like approach here. Is there anything else that you look for when it comes to the elbow that would take you away from?

the elbow as far as assessment goes, like looking at the neck or looking at the thoracic spine. I've heard a few things even about the scapula. Just wondering if you kind of take that into consideration.

Joe Gambino (10:48)
I certainly do. mean, nerve tension was a big one. I definitely was going to bring that up because I think that one can kind of always pop up in a sense and recreate similar symptoms. So I think that those need to be kind of ruled out or looked at and those nerve tension can definitely give you some issues. And there's a lot of places in and around the elbow and the arm that you can get those entrapments. So it doesn't always bring me to the neck, but might bring me to certain areas to at least ⁓ test and try to rule out to see if those areas need to be worked.

But I always will look above I think the knee and the elbow are kind of similar joints where The things that go on around it, especially for like overuse injuries can can play a part sure if you're constantly throwing or you're constantly playing golf or your I Mean you're using your hands at work for whatever reason. It's a very repetitive fashion. You can you can develop these elbow issues, but It's pretty commonly comes along with either poor scapular motion or spine mobility for shoulder mobility

So making sure that all those things around it I think just kind of helps with the way that the whole arm functions so that you may not be Over utilizing and one thing I actually see which I find interesting is people who have elbow issues Sometimes just like making some like minor coaching cues like if they have pain with Rose ⁓ If you just like have them like try to finish a little bit more a lot by like pulling with your back and just try to like finish with like the back of the arm going up or trying to bring your hands up like little coaching cues like that can like

Like, I don't even feel my elbow anymore. Right? So there's, you know, I think a little bit of being able to make sure movement happens well, more, you know, shoulder, the sky, stuff like that can definitely play an impact in some of these repetitive injuries that end up popping up.

Joe LaVacca (12:33)
Yeah, and I like the coaching cues a lot. And I think that one of the things I read a while ago about some of the ways people grip when they have these types of injuries around the elbow is that it's not like kind of like totally symmetrical, right? So if you make a nice tight fist, you know, my wrist, fist, fingers, forearm kind of like fit into this straight line. Whereas sometimes those people with those elbow injuries will sort of like deviate.

in either direction. that could be where maybe some tape or something comes in. I've done that before where, hey, look, if you feel some stretching or pulling on the tape on one side of the joint versus the other, hey, just correct that, get that wrist back in neutral as we're doing our carries, our rows, our pushes, our presses, and at least temporarily that might help them alleviate some symptoms. Definitely take a look at the shoulder, scapula. I mean, that just kind of gives us maybe more ideas on how to keep loading that arm that's sensitive.

You know, it's very similar to the knee. Hey, I'm going to maybe take a peek at the foot because I want you to load your cap. I want you to load your foot. Hey, I'm going to take a look at your hip because I want you to load your hip. I want you to load your spine, your core, whatever, because I want to keep people training as much as possible. The biggest thing that I've tried doing lately or I've been a little bit more cognizant of even when people are just training and feeling well is that the grip is a big limiting factor for most people.

And a lot of people don't want to do specific grip training. So how do you address that? How are you addressing grip? Do you give any specific exercises for these clients? Because again, if we're comparing things, it sort of seems like the foot, right? Like nobody wants to strengthen their foot and nobody wants to strengthen their freaking hand. So what do do with that?

You're muted.

Joe Gambino (14:28)
always happens to me. Yeah, so there's a couple ways that I work it out.

I don't know what the hell just happened there. We should just keep this shit in. I don't know why my microphone just kept going on mute automatically. Oh my god. Anyway, what I was trying to say is...

Joe LaVacca (14:52)
That was so good, I was like, what the hell is that? Is there like a mouse like rolling across your keyboard? Just like hits mute off, mute off, mute off, mute off, mute off.

Joe Gambino (15:06)
There's a couple of ways that I've tried to work direct other wrist work or grip strengthening stuff in there. So one would be just doing it directly as kind of like an active, active rest in a sense, I guess we could call it. You we're doing some lower body work or maybe we're doing some upper body work. Maybe sort of the end of the session, we do direct wrist work to strengthen the tissue, can use mobility work, whatever that looks like for that person. But you can also, think one way to sprinkle in some like grip work is with arm work.

So, you know, using thicker grips, using a towel, ⁓ farmer's walks, doing like pinch grip stuff. Like you can sneak in some of this little extra grip work ⁓ when people don't really even realize that they're doing like direct arm work at that point. So those are some ways that I kind of like sneaking it in there. then, yeah, you can just like, hey, here's some direct work. I like to put it into their workouts because if you...

Here's some stuff to do I mean they may do it that really depends on the person and like how irritated is how much work they really need to get done But you can always sneak those things in somewhere there throughout a workout to make sure that they're actually gonna done

Joe LaVacca (16:15)
Yeah, mixing that up with the towels and different pinch grips. mean, that's great. ⁓ And I just sort of do that with a lot of my own training, even when I do have Carrie's program. Sometimes I'm at the gym and it's the one in my apartment and the dumbbells only go up to about 50 pounds or so. So I'm like, okay, how can I make this a little bit more challenging? Let me try to grab them on the top. Let me try to use a towel, wrap it around it. Just something that's going to make me work just a little bit harder, given the constraints of what I have.

I think the other thing that ⁓ I try to do too is show people they need to work grip, right? And I kind of make it meaningful. So I have a grip strength ⁓ tester in the office. And you know, when I first got it, it became a novelty, right? Like everyone's walking around like, who's got the strongest grip? Who's got the strongest grip? ⁓ Now what I, what I sort of like about it, and I don't know how valid it is because it just gamifies things for me ⁓ a little bit, but.

Joe Gambino (16:50)
Mm-hmm.

Joe LaVacca (17:12)
The particular one I have, it was not expensive either, which is why I question how valid it is. But I can put in someone's age, if they're male or female, and then based on the reading, it'll actually say weak, normal, or strong, given your age or whatever. Now again, I don't know how it does this, it's analog, but the thing that I just kinda keep going with it is when I plug in someone's information,

and they see their involved side is labeled as weak, they're like, ⁓ I gotta work on this. I didn't realize this was an opportunity or it was that different. The other thing I like about the grip thing is I can change how you hold it with your fingers, right? So sometimes a lot of people can compensate, right? Athletes especially. I can squeeze that grip strength thing, really probably use my Spider-Man muscles, right? Like really kind of get through the midline there. And maybe I overcompensate with the thumb.

So if we see that it's kind of symmetrical, then what I'd like to do with people is say, okay, you know what, I'm gonna have you just squeeze just with these two fingers, your pinky and your ring finger. What's that one look like side to side? And again, not always, but typically when it's on the inside part of the elbow, that grip with the pinky and the ring finger especially, either reproduces their pain pretty quickly or shows a really big deficit side to side. So then it's just like, hey, look, you got a deficit here.

really simple to clean up, let's start working on grip, but let's really think about finding pinky and ring like you just gave your coaching cues. Hey, when you go home, you know, this is why I of want you to do that band work specifically just to fatigue with that side. And this is why we want to think about, you know, different, maybe ways to help our grip so we can keep training. So if you are doing pull-ups and it's aggravating, hey, here's a strap. If you are doing deadlifts and it's aggravating, hey, here's a strap.

Because when that grip is off, the only thing you can do usually from a gym perspective is go lighter. And then you go lighter, then it's gonna take away from your pushes, your pulls, your deadlifts, your squats or anything else. So this is where I always will say, hey, if you're already training and you've developed this pain, get some straps to keep everything else at a high enough signal. And I think that also kind of keeps people motivated that hey, look, I can work around this and then I can work directly on it, whether or not we put it in their programming.

or directly at home. So, but that's me in person. Are you trying to do or how do you assess grip or things like that when you're doing anything virtual? Do you have any go-to tests or scales or anything like that?

Joe Gambino (19:49)
⁓ No, I'm not as specific as you know using a dynamometer or something like that would would go but I would say I mean there's ways you know like you were talking about like someone who's holding something with like their wrist back like that so in those cases right if I'm like seeing like if we're doing like kettlebell work that's like a commonplace where I'll see it you know where someone will like hold it with their wrist and extension to me that's a sign of like poor

a radiation to the shoulder, poor grip, right? Like, so those are things that we'll start to coach through. And I mean, if I'm finding somebody who has wrist pain directly, you know, I'll use isometrics to kind of see, it like painful? Do they feel like one side of the I'll have them like report to me, okay, hey, well, let's do this, ramp it up as hard as you can. And just tell me, does one side feel stronger than the other? So it's a little bit more subjective, but I'm still able to get, think, a good enough data piece. And then,

For someone like that, regardless, I'm probably gonna be sprinkling some of this work to strengthen the area. Regardless, I'm not just gonna be like, well, assume it's strong or not. that's probably where I am with that stuff. But know, like coaching with kettlebells and stuff like that, making sure that the wrist is straight, the knuckles are pointing to the ceiling, all the fingers are there. I've seen people carry kettlebells and like a pinky doesn't wanna grab or something like that, right? So in those cases, the cues will definitely be, okay, how do we start to make sure that we're utilizing all those things and.

and build it up from there.

Joe LaVacca (21:19)
Yeah, sounds perfect. Let me ask you this. Big thought that a lot of people have is I can just get an injection in this. What are your thoughts there?

Joe Gambino (21:22)
perfect. look at that.

Yeah.

Yeah, ⁓

I mean, what I tell people is they're hit or miss. I've seen people get them and it helps and I've seen some people get them and they don't help. And I really think also depends on how stubborn their pain is. If we're going three, four weeks and there's been no change, then we're probably gonna have to have a conversation of, what can we do here to see if we can get over the pain help, right? If nothing that we would expect work, that stuff should start to make at least.

some sort of variable change in my opinion, right? Or we should start to see that you could tolerate more load and if none of that's happening, then I think it's worthwhile to either go explore what a doctor might say or an injection or whatever the next steps would look like for that person. I don't think there's anything wrong with, yeah, think there's a lot of people I've talked to is like, never want a shot. I can't do this, right? Like there's something negative about it, but I think in the right situation is that these can really speed up.

the process for somebody. If it's done and there's a good clinical reason for what we're doing and we're not just jumping to the gun and relying on them, which some people do, is they just rely on shots in their shoulders, their elbows or whatever to keep the pain at bay. And then there's this constant like, oh, I can only have this many shots in this much time. I have to wait, the pain comes back. Having a blend of these two things can be really beneficial for some people.

Joe LaVacca (22:54)
Yeah, I think I've heard two different things, right? I mean, in the smaller studies, it doesn't seem like there is a right or wrong direction necessarily. But in some of the bigger case reports and analysis I've seen, it seems that staying away from elbow injections at all costs is actually probably the better direction for people long term. And that's always the hardest thing, right? Measuring the short term sort of like

gratification of something against the long-term repercussions. And that's that whole delayed gratification thing that like we, I try to teach Avery, I'm sure you try to teach your kids, right? Like it's not everything about right now, because if you get everything you want right now, it's probably not going to set you up for success long-term. So it kind of always goes back around to the same idea for me with all these cortisone injections. It's like, well, how do we know that there's really inflammatory markers

in that tissue. mean, we can take a guess, but when the chronicity of a lot of these things has been lasting, well, it's not like the same as it being like at three days, five days, seven days, 14 days. So is it just a lot of water content? Is it just a lot of edema? Is it just a lot of like imbalance in like this like, you know, watery matrix soup that you have inside of all your body parts, right? Because you dump an anti-inflammatory in there and there's no

not significant amounts of inflammation. think this is where that long-term repercussion happens. So I've only seen a couple of instances of cortisone reaction in my career too, where the skin actually bleaches or turns white. The tissue's actually atrophy in the area. And of the four or five I've seen, three or four of them have just been solely at the medial elbow. So.

Again, that's a small sample size. One was some girl's patella in Colorado, actually. like everyone was like, yeah, we don't know what happened. And I'm like, did you ever get a cortisone injection? She was like, yeah, why? I'm like, well, your skin's bleached. You have atrophy of your fat pad. This is just going to take time for you to come back. I mean, sorry, I don't have any exercise that regrow fat pads. This is going to be bracing, you know, modification. Don't squat too deep. Don't do this too much. And then hopefully that'll come back over time.

So if we can at all costs, I would probably again still go the route of, hey, can we brace this? Can we strap this? Can we give you something like even those those things I see people wear around their forearms, they look like cuffs, right? Like, have we tried every single thing before we go that route of the injection? And then even then, I'm still probably going to educate them and say, look, you know, just like what Dan Pope was saying, right? Like, my job is just give you information. This

has a higher probability of leading to worse outcomes, but it's up to you if you want to do it. And then sort of like giving them that space to make the decision because if they do have something super important to them, you know, they have the PGA tour this weekend and there's their best chance of winning it. Hey, who am I to stand in their way? But if it's something that they can hold off or maybe, you know, wait till next year or something like that, then, you know, that's what I'm gonna try to

Joe Gambino (26:13)
Yeah, no, I mean, that's fair. That's interesting. And I wonder too, first thing I think is, you what happens after people get the shots and they feel better, or do they continue working on it do they just stop? Like, what does that follow up journey look like? So I think there's always questions to why something long-term may or may not work. like I said, I with, when I see, when I, I haven't seen, you know, all this stuff in quite some time where people getting shots and stuff like that, and so that perfect stride. And it's always been just like hit or miss, you know, it's like.

I feel like people go in for shots and you just have like a 50-50 chance of it working. And I don't know if it's because of diagnostic tools or if it's just because they just decide to do, you know, the doctor just decides to do it for everybody and hope it works out or not. But I always just find it interesting with these studies and, you you can't really control the long-term, you know, outcome. So I wonder really what leads to these issues down the line or not.

Joe LaVacca (27:07)
Yeah, it's a good point. that's what I think I kind of opened up like that. Like if this is a self if a lot of these elbow things are self limiting, and they take anywhere between eight to 12 months, you know, with direct treatment or without, then, you know, typically, I don't see people that way. So they could drop out of PT or training or rehab, you know, three months in and being like, Hey, this is bullshit. I don't want to wait another five to nine months to feel better. I'm just gonna go get a shot now.

Joe Gambino (27:12)
and

Thank

Joe LaVacca (27:36)
I don't know what that means. Maybe they get back to training. Maybe they're like, wow, I'm so glad that I didn't listen to Joe and this is great. Or yeah, wow, Joe was right. I never really actually regained the strength there. And now my whole sort of like left side is atrophied on that side. it's harder to grip a racket. It's harder to do pull ups. So now I just don't do those things anymore. And then in so facto, my elbow feels better anyway. So I guess it really is like, what's the goal of your treatment? Is it just to not have elbow pain or?

Joe Gambino (27:37)
Yeah.

Joe LaVacca (28:05)
Is it to continually to maintain function and strength and long term effect? And I guess that also is very individualized to people and some of the stuff we were talking about last week too.

Joe Gambino (28:17)
Yeah, no, mean, it comes back to like every episode that we've probably chatted about. It always comes back to goals and what that person needs and why they're doing it and the risk reward, you know, to everything like that, that can be done and stuff like that. So, ⁓ anything else that we have left to talk in and about Diablo here?

Joe LaVacca (28:37)
No, I think that's a good opening salvo. mean, we can maybe dive into some more of like golf specific stuff in the next couple of weeks. Weather's getting nicer. I know people want to get out and play golf and you want to get out and run and all that other fun stuff. But we just talked a lot about running and had the cash on. So maybe we dive a little bit deeper in the coming weeks and kind of go from there. But I think that was sort of like a lot of my big general ideas. I'm going to approach it like everything else in the body tendon wise.

Joe Gambino (28:42)
Mm-hmm.

Very.

Joe LaVacca (29:04)
See how it does, like we mentioned, the coaching, the isometrics, the modification. Maybe this is just like an orthotic for the foot, maybe where straps and things like that come back for the hand. But we want to kind of keep helping you move forward.

Joe Gambino (29:18)
Perfect. All right, well, that's all I got to you, don't you take us home?

Joe LaVacca (29:22)
All right, well Joe, love you. Thanks for another great episode. Listeners, we love you. And don't forget to come back next week for another exciting episode of the Beyond Pain podcast.

Joe Gambino (29:29)
You