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Get your triceps schmutz gone with DTF ice massage.

DTF tendons that can be reachedAlthough this article was originally written as a response to a person with a painful triceps tendon, the method can be used well on any body part you can palpate for yourself, i.e. tennis elbow, golfers elbow, biceps tendinitis, jumpers knee, groin pull, plantar fascitis. It is not intended to replace a good medical diagnosis or physical therapy rehab, it is simply offered to be of use in those cases where you might have already gotten a diagnosis of soft tissue inflammation and been told to simply rest, take some NSAIDs, ice and stop working out until it heals.

These massage methods might serve to speed up the healing process beyond what simple rest would accomplish and get you back in the gym sooner. I have found DTF (deep transverse friction) to be an effective way of working with adhesions as you work em out. It is always important to get an accurate diagnosis from a doctor when you incur an injury, especially if it is an impact injury. Don’t put it off. There can be stress fractures or small bone splinters that will complicate your healing unless properly diagnosed and addressed.

I am not a doc, chiropractor or physical therapist. I wouldn't presume to speak to your injury diagnostically, nor would it be a real service to ever attempt such on the web, but as a sports massage therapist, I wing it with athletes often, sleuthing thru tissues to try and help root out such stuff as often occurs in the gym and interferes with training and which is largely in the soft tissue. I offer this to you as one possible way of addressing your situation if it lives in the soft tissue and is a form of overtraining injury.

Triceps tendonPalpate the tissue of your triceps in the unaffected arm in the same area where the pain is in the painful elbow. Now palpate just above there in the musculo-tendinous zone and in the muscle belly itself. Get a sense of the texture and look for any strands within these tissues which feel thick or adhered or lumpy, ie not like a good tri-tip steak, which is how it should feel in that muscle belly when it’s healthy. The uninjured triceps should feel relatively healthy and will provide you with a tactile base of information on the feel of healthy tissue when you palpate it.

The premise is that healthy tissue doesn't hurt when touched, in general, unless it has delayed onset muscle soreness (DOMS) after heavy training, but that’s a different kind of pain than an injured state. If you’ve been in the gym a few times I’m assuming you know that dull achy feeling that constitutes DOMS. If the non painful triceps have strands of gristle in them, feel ropey and painful upon palpation as well, perhaps that arm is not entirely clear of the wake of past micro-macro traumatic offenses to it either. It’s just not acting out acutely for you to notice. ‘Pro-dromal’ is a term I like to use when that is the case. There's schmutz (yiddish for dirt) in the tissues but it hasn't become a noticeable problem yet, just interferes imperceptibly with the muscle’s ability to adequately adapt to the training stimulus.

Now feel thru the painful triceps starting at the elbow tendon where it hurts. If you can find areas within the muscle or strands within the tendon which are ropey or fibrous or feel like glued fetuccini noodles stuck together in there, or even spaghetti or cappellini noodles, and they are painful when you run your fingers or thumb across them, can be plucked like bass strings, snapping back and forth, then it indicates that you have had a micro trauma or macro which has adhered and, in the process of healing, has left some schmutz in that muscle. The adhered tissue is fixated by the crosslinking in the adhesions and prone to tearing further at the edges of the crosslinked area. It's unable to lengthen and contract fully under load, thus weakening the muscle by whatever percentage of that muscle is bound up by the schmutz and also keeping it prone to re-injury. It can be as small as a lentil or as thick as a couple of hot dogs stuck together and running thru the entire length of a muscle, which might be more the case in the hamstrings or quads, for example.

If you find some of that kind of stuff or if the tendon is painful as you run across it with your finger or thumb, (don't rub over the ulnar nerve, nerves don't like that, they buzz or cause numbness or feel like a sharp screaming pain when irritated), then getting the schmutz out of that tendon right where it hurts will encourage it to heal more quickly and completely in a flexible and resilient way. This allows you to proceed with training in a rehab style for a bit to engage the fibers you've just freed up, and bring em back up to snuff ASAP.

Perhaps an experiment would help your situation and put these methods to the test in the trenches. Get an ice cube or fill a dixie cup with water and freeze it. Wrap the back side with a paper towel so you can hold on to it without freezing your fingers. Use the edge of it as a tool, rub across the painful spot, moving the skin and underlying tissue as one, to and fro across the width of the lesion for 15-30 seconds or reps. Then move your ice cube on up the tendon into the
musculo-tendinous tissue and on in to the muscle back and forth across the ropey part for the entire length of the adhered and painful strand. Do as many sets of these strokes as you can stand up to 4 or 5 sets on each painful spot.

If you are successfully breaking up the promiscuous fibers which have gotten attached where they're not supposed to be, the feeling is a bit fiery and painful, but not fierce like if you irritate the nerve. Difficult to describe kinds of pain. Don't let it get beyond 8 on a scale of 10 in the fiery shearing "it's being torn apart with dry ice that feels like glass cutting thru it" pain scale, but when you are being effective on adhered tendon there will definitely be some discomfort right on that spot where you are purposefully releasing the inappropriately aligned fibers in the collagen. Myofascia releasing from adhered states does have a slightly burning feeling as it frees up, like you're cutting thru it with a sharp piece of dry ice perhaps.

The idea is that this breaks apart the restricting fibers, causing a specifically applied trauma to the tendon and thereby invoking the body's healing mechanism into an area which is low on blood flow. If tendon or musculo-tendinous then it's low on capillaries therefore nutrients for healing. This method works like a wake up call specifically applied to the tissue in trouble. Ice the area generally after you finish cross fibering it. Leave the ice pack on for 5-15 minutes several (5) times the day you give yourself the treatment, and a couple of times on the next day. You can take anti-inflammatories, (NSAIDs) to good effect if your body tolerates those medicines and there are no contra-indications for them that your doc has discovered.

Since you have intentionally irritated the area, you want to have some immediate histamine response, the redness you’ll see after the passes over it with the ice cube, but not too much inflammation, just enough to kick it into healing gear, bring in the macrophages et al. I've heard good reports about MSM and Sam-e as well, perhaps one of those could be a good addition to your anti-inflammatory medicine chest, especially if your stomach or filter organs don’t tolerate NSAIDs very well or you don’t like the side effect that they dry out the connective tissue they are de-flaming, so to speak. Omega 3 fatty acids are reputed to improve connective tissue recovery. Adequate hydration is important for connective tissue integrity as well.

Glucosamine/Chondroitin w/manganese ascorbate is helpful in rebuilding connective tissue of all kinds, not just ligaments or bursa but it is not an anti-inflammatory in the sense that you will not feel it immediately diminish the inflammation and pain. It is still a very useful supplement to take while you are in repair mode as it provides just the right raw materials for rebuilding this injured connective tissue. Dr.Steadman, a very skillful orthopedic surgeon who innovatively healed Bode Miller’s ACL just before the 2002 Olympics used to recommend Cosamin-DS brand as a highly absorbable source of glucosamine/chondroitin. I've known several folks who got that recommendation from him post surgery. They used to carry that brand at my local Costco, haven’t checked recently.

Triceps db extensions, eccentric emphasis for rehabbing triceps tendonNow here's the tricky part. How to re-introduce the right amount of training without re-injuring the overtrained tendon. Next day move the muscle thru FULL ROM. Possibly some gentle contract/relax movements without much load on the contract part. The following day or the day after that you can train it under load but use positioning and weight loads which do NOT cause you to feel any pain there. If you feel pain, try another exercise until you find one which does not cause ANY discomfort while it is in this repair phase of rehab. Keep the reps high, 10-15, the load low, body weight only to start, the tempo slightly slow so you strengthen the tendon and musculo-tendinous areas without risking re-injury. Modify positioning on lifts which involve this muscle synergistically so that its stress is minimized, IE: bench press arm position, use an arm angle which throws the load more to the pecs and anterior deltoid. Don’t load it in the gym until 2 or 3 days subsequent to the deep transverse friction treatment you’ve just given it.

The idea is to avoid that which might overload it and invoke re-injury, i.e. protect it from pain while you systematically increase its strength. It is vulnerable after you have cross-fibered it because it is repairing itself, if it is used well, taken thru full ROM and strengthened without loading it beyond it's capacity you can bring it back to a schmutz
free texture poste haste.

It will be necessary to repeat this complete paradigm twice a week until it is cleared out. If your tissue recovers quickly from the treatment and is noticeably less painful upon palpation by the following afternoon then try the protocol twice weekly. If not, do it once weekly, but it will take longer to get back to fully functioning tissue. You should do the DTF treatment after you train it on the day you train it, if you are trying to do it 2 times per week, so it has a rest day, then a body weight only day, before you train it under load again. Ice packs several times per day on the day of DTF and the following day, then once per day till next training day.

It should take anywhere from 3 to 12 treatments to clear it out of there depending on how much schmutz is in the tissues, how long it's been in there, becoming like chewing gum on the bedpost overnight, how quickly you recover, how well you engage it in training stresses without re-injury. If you stay on it and there's not alot of tissue entangled in the adhesion, it will feel better 2 days after the first session and proceed from there, if done twice weekly, you should feel some strength returning by the second week and be able to increase its load carefully in very small increments.

To train and treat effectively on a twice weekly rhythm one should do those exercises which most directly utilize it and synergistically use it under higher load on the day you treat it before the treatment, then ice it, hit the anti-inflammatories, next day ROM primarily, no heavy loads for 2 days then train it with a heavier load but skillfully on that 3rd day and give it another treatment later that same day. Keep taking glucosamine/chondroitin, Essential Fatty Acids, anti oxidants, plenty of protein and water. Proper hydration is important for connective tissue integrity and repair. Repeat this pattern till the painful spot becomes smaller and smaller with less tissue involved in the stringy texture and more malleable as you work thru it until it is down to just one little spot, then gone. At least that is usually how it goes as I work that stuff out of tendons.

A solid noodle of schmutz then an intermittent line of softening glue then a spot usually in the tendon itself nearer the bony attachment then that last lentil erases and behold a healthy tendon. Now you can start training it with heavier intensity and it will be able to respond to the training stresses and grow stronger without a re injury.

If yours has been lingering in and out of pain in that tendon, interfering with the muscle's capacity to advance under load, therefore undermining the training effect in the triceps, you should see the muscle's strength improve and in a few weeks progress beyond what it could do before. Do not use those positions which stretch it under load until you feel it is free and clear of schmutz. Perhaps by then if you are happy with your results but unsure if you are ready for a bigger test of its flexibility and resilience, have someone who knows how to palpate tissue for adhesions or to do DTF to tendons, a PT or massage therapist with those skills, look through it and get the remnants out which you might have missed. Once it is cleared of the adhered strands, if that is in fact the problem in that tendon, you should be able to progress in training without recurrences.




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