MitchellDButler

I've heard you talk about the superiority of training for treatment over physical therapy, and was wondering if you (or anyone) can help me where months of PT has failed.

I've had a chronic tightness/inflammation in the lateral head of both of my triceps for over a year now. (It may also extend to the other heads, but I feel it most acutely in the lateral head.) It gets tight in training any part of my upper body, and sometimes reaches painful levels. It flares up into pain under heavy bench presses, curls, etc. It even used to be really bad squatting, but I improved my shoulder mobility and no longer support weight with my triceps. It also occurs whether I do heavy weight/low reps (2-3) or lighter weight/high reps (8-10).

The pain feels like tightness in that part of my triceps and culminates at the elbow. It starts mild but can reach stabbing levels, and makes it so that I can't even raise my water bottle to drink. The pain can be mitigated somewhat by massaging the lateral head with my hand or on a bar, but continuing to lift heavy makes it unbearable. It subsides within 1-2 hours after I stop training, and I rarely feel the tightness during the day until I go to bed and think about my workout the next morning.

The physical therapist I was seeing for a few months thought it was due to muscle imbalances between my front and back, and had me doing daily work with a light band on my rotator cuffs and rear deltoids. I did face pulls, internal and external rotation, etc. These have helped a bit, but I've been doing them for about 6 months and the problem persists. He also massaged my triceps regularly, but that didn't help much until he did dry needling on them (a delightful form of torture) which seemed to make every thing better for about 3 months. But now it's back.

I think that's pretty much all there is to say about it. It's stunted progress on my presses so I'm very eager to figure this out.

Brodie Butland

I actually can speak to this from experience, since I had a similar problem a few years ago. My pain was primarily in the elbow, with some shoulder as well. Very debilitating...to the point where, like you, I couldn't even do basic movements with the arm like drive a car or lift a glass. The MDs and PTs misdiagnosed it as something in the shoulder or elbow. I had an MRI done (no abnormalities found) and six sessions of those stupid physical therapy exercises (high five for insurance hoop-jumping). Didn't do shit.

In desperation since I had a meet coming up in two and a half months, I then went to see a masseuse who knew what he was doing. He was formerly the team massage therapist for the Cleveland Browns and the Cleveland Cavs, and has a lot of strongman and competitive lifting clients...so he knew a thing or two about how to work out sports injuries. (Had some interesting stories about working on Shaq during his brief stint with the Cavs.) After poking around for a little he figured out that it was actually a severely strained and inflamed tricep and had nothing to do with the shoulder or elbow. I did four one-hour sessions of basically Medieval torture methods* with him, along with using a moist heat pad at least twice a day for 15-20 minutes (the ones that pull moisture from the air and act as damp heat...not the dry heat stuff you can buy for $10 at any pharmacy). Problem was completely gone after about 5 weeks.

So my suggestion is to find someone who actually is knowledgeable about soft tissue injuries and let him/her work you hard. You'll probably have to research for a while to find the right person. In my experience MDs are good at orthopedic stuff but generally aren't very good with soft tissue injuries, and PTs are basically useless for everything (the Petrizzos, Will Morris, and a few others I'm blanking on now excepted). You'll pay a premium for the good ones, but they're at a premium because they're good...kind of like how you'll rarely find a Starting Strength Coach at "market" personal training prices.

Brodie Butland

When it comes to sports masseuses, I think one of the most differentiating questions is "what types of athletes do you treat, and how often?" A lot of people may offer "sports massage" therapy but don't actually have experience doing it on serious weight trainers. The guy I found specifically advertised that he treated high caliber athletes including Olympic lifters and competitive Strongmen – and his office had signed pictures from many of them.

If you get a nondescript answer like "all kinds of athletes," you're probably getting played – a few follow up questions may be worth it just in case they suck at selling their services, but usually if someone doesn't have a good "elevator speech" on a simple question like that, they don't know a lot about it.

Another helpful follow up may be to describe your injury and say how you think you got it, and ask them to explain how they would approach solving the issue. If they say "you shouldn't be lifting heavy," that's an easy strike. If they can't give an answer that sounds intelligible, that's probably an issue. One person I talked to told me when I described my weight training regimen said that I should lift high reps so I could "age gracefully." I didn't need to know client lists after hearing that one.

At a certain point though, you'll just have to make a decision based on the best information. And then the question becomes whether you're getting a result. I actually saw someone else before seeing the masseuse that eventually fixed the problem (I initially went elsewhere based on price). They didn't fix the problem at all, so I went with plan B.

Internet is a useful starting point but should not be an end point for this type of stuff.

GesD

I'm a senior at Montclair State University studying Physical Education. I will graduate with my degree in teaching, but with the way the job market is right now jobs are few and far between. I'm interested in pursuing a career in the medical field because of my love for science. Specifically in physical therapy and even though many are completely ignorant when it comes to strength training, I want to see what I can contribute to rehabbing patients with the barbell. What really struck the cord with me was when you mentioned that when you can teach an older person how to squat, you really give them their life back. I was wondering if you could give me any advice?

Mark Rippetoe

What specific mechanism would you suggest? Just telling them to do it our way probably won't work.

stef

The most useful thing would be for you guys to stop equating education with credentials. Credentials do not reliably signify education, intelligence, the ability to think logically or anything much of real, actual value. I think the most useful aspect of credentials is that when you find someone throwing them around to establish their authority it lets you know an awful lot about that person.

Learning/education is like physical training – you get out what you put into it, it requires real effort and time, and it is not something that can be "borrowed" or "transferred" without that work. Anything you can learn you can learn on your own (and really, you have to learn everything on your own since it is far more than saying/doing the right thing at the right time) just as well as from any class taught by Lon or anyone else. Credentials require a whole lot less.

stef

Learning is an active process. The essential part is you and how you interact with information and use it in the real world The trouble with so much "education" is that it is a passive process, focused on repetition and all sorts of things that are convenient to grade. Real learning is never passive.