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Discussion Starter · #1 ·
It's taken years and countless physical therapy sessions for me to realize the intense tennis elbow/golfers elbow is a result of my mountain bike setup.

Custom steel hardtail so fit is right. Nice components so no fault there. Been put on a trainer at a reputable bike shop with basic measurements and they said everything looks good and no idea of what could be causing the pain. They suggested possibly moving the controls toward the center more which I did but did not find any relief.

Pain is most prevalent on the inside of my elbows but if I start to really pick up mileage and ride hard it can creep into the outside of my arms and down my forearm.

Advice on what to start evaluating or changing to see if it helps? My next plan was to possibly buy some bars with 15ish degree sweep (currently have 8 degree sweep) to see if wrist and hand positioning will help. Maybe there is a step prior or a way to definitively determine the problem instead of messing with a bunch of variables.

Thanks for any guidance!
 

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You 100% sure it is tendonitis?
Have you had an MD diagnosis it?
Have you ruled out nerve compression?
Lots of nerve issues can present and be incorrectly diagnosed as tendonitis/tennis elbow/golfer's elbow etc.
 

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Deroymac
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My similar issue turned out to be nerve compression. Hand surgeon recommended EMG and MRI and afterward told me I needed to see a neck surgeon. I told her my neck felt fine but I needed her to fix my thumb! After seeing neck surgeon I went back and apologized to her and had C-4,C-5,C-6 fusion surgery done a year ago and thumb is now about 75% better and was told to give it another year and it may get completely better. Neck surgeon told me morning after surgery I was very lucky I had it fixed as I "was one fall from a very bad outcome". Good luck!
 

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Discussion Starter · #5 ·
Thanks all and appreciate that this may be more complex than just "don't beast grip the bars the entire ride!" kind of advice.

Would just a general MD be able to give guidance on if it's just tendonitis or if I should get checked for nerve compression?

I can say that I've been to two different PTs over the course of 3 years with a total of about 25 sessions each year - most including intense needling. I have also been to a specialist recommended by one of my PTs where he removed blood, spun it to remove just the white blood cells, and then injected the white blood cells back to the pain points to possibly heal the injury. During this process he did a sonogram I could see on his monitor and he could point out the areas of inflammation.

I only get pain in my arms riding my mountain bike with plenty of miles on a touring bike as well.

Thanks again!
 

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Norðwegr
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www.thefixcharlotte.com

Who you want to see or talk to is someone like that in addition to specialist docs, GDs aren't going to be specialized enough; atleast not if you've already confirmed inflammation at a specialist.

You should also consider watching youtube videos on forearm/elbow pain, there's alot on the topic.

Are you doing any exercises to strengthen your arms? It'll help with bloodflow which helps the healing process. Light resistance bands, thera-band flexbar etc are good cheap ways to do it.

Needling/acupuncture isn't worth wasting money on, there's no scientific evidence for it.
 

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Deroymac
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My general MD recommended PT. My Dr. of PT recommended PT for at least a year before seeking a surgical solution. I feel the EMG Dr. was of the most help, being he was able to point out that I not only had multiple nerve impingements but the worst one was in my neck. I had two 45 minute, MRI sessions which helped surgical staff pin point the fact that one of my disks had slipped over another and had self-fused, pinching my spinal cord. The morning after surgery when the Dr. told me how lucky I was he also told me the surgery took longer than scheduled as he had to remove the bone spurs which were holding my neck together. Having a very active lifestyle, which got me into this trouble, may have killed or paralyzed me if I hadn't taken it upon myself to see hand surgeon and find the root cause of my condition. You are your best advocate for your health. I hope your solution doesn't require surgery but I wish I had used the modern medical diagnostic tools available, sooner.
 

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Once bars went wide, I couldnt handle 8 or 9 degree bars. On a whim, I tried salsa rustlers at 11 degrees back. It feels hugely different, and even looks like significantly more backsweep than 2 degrees would suggest. Cured all my hand and thumb pain.

I liked them so much I bought the carbon set. If you want to try the aluminum set on the cheap, id be glad to send them your way. Took my riding from unpleasant, to a hobby I love again.
 

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Once bars went wide, I couldnt handle 8 or 9 degree bars. On a whim, I tried salsa rustlers at 11 degrees back. It feels hugely different, and even looks like significantly more backsweep than 2 degrees would suggest. Cured all my hand and thumb pain.

I liked them so much I bought the carbon set. If you want to try the aluminum set on the cheap, id be glad to send them your way. Took my riding from unpleasant, to a hobby I love again.
To all the folks that are saying it could be a nerve issue - +1. The easy way to see if it's tennis elbow is to do PT for tennis elbow. If it resolves more or less normally great. If doing loads of tennis elbow PT does nothing you'll want to look at nerve related causes. Unfortunately that'll require a specialist and advanced diagnostics.

Following up on One Pivot's point bars/fit can make a lot of difference. I have been dealing with intense tennis elbow symptoms and done enough PT for 3 people! No change in over a year. I've been through a few bars/grips, but mostly smaller changes. I finally decided to try a 17 deg backsweep bar, bringing the bars back towards me and up. That added up to a major position change. Had the first trouble free ride in as long as I can remember. :thumbsup:

This may not be the full solution and other treatment may be required [going through the specialist process now], but it feels like a step in the right direction.

To the OP if you keep doing the same thing and getting the same result time to change the bike setup and see what happens. I would also pursue the PT/specialist option, but you can change bars/stems in a day or two while you wait for the next step in the long medical process.
 

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I know this is old, but did the OP find resolve? What was the issue?

I have mild nerve pain/burning/etc. in both arms. Mostly around inside of elbow, but some minor symptoms in my armpits and forearms almost, light tingling in pinky ring on left. I had a compression “mild” fracture of T6 in my back from a descent crash roughly 9 weeks ago. It did not require surgery and seems heeling without issue. The hand/arm stuff started about 2 weeks ago, at least that’s when I noticed it I guess. My spine surgeon took several xrays and an MRI of my neck but no issues really showed up. He gave diagnoses of ulner nerve syndrome. He said he was confident the issues weren’t from my neck. It’s possible I suppose since I basically slept on my back for almost 2 months straight and often crossed my arms across my chest when I slept like this. However, I’m not sure what to think. I still can’t shake the feeling it’s a disc issue like others mentioned here. Doctor and my friends/ family say give it time and see if it clears on it’s own, but it feels wrong to go on without knowing or believing. Next diagnostic test would be EMG, but I’m holding off deciding what to do.
Any advice here?

Thanks.
 

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Discussion Starter · #12 ·
Hi Crillz. OP here. Not sure we have the same source of pain but I'm getting closer to finding the cause. Due to some reasons out of my control, I was off the mountain and road bike for 6 months. Prior to that break I was in the best biking shape of my life after getting into gravel races. At that time my inner elbows were on fire and incredibly weak. I was not on my mountain bike much and my gravel bike was custom built and professionally fit so I could rule that out. I went to a new PT and the felt I needed to strengthen interior stabilizer muscles in my arm. Tried for a bit but not much help.

After taking 6 months off the pain was completely gone and I could do push ups and any other arm based workout with zero pain.

After the 6 months I got back in the bike and really tried to pay attention to my arms keeping as little weight as possible on them. I started to notice, despite very little weight when riding, my triceps felt like they were getting tired quickly. I'm now trying to really foam role my triceps and back of arms out and stretching them. This helped leg issues I had when running so hoping a good stretch routing will mitigate the pain since riding as much as I want has me in pretty severe pain both on and off the bike.

Best wishes in your hunt to figure this out and please keep us posted.
 

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crux19 - I feel for you and really hope you can figure this out. Nerve stuff seems to be a mystery sometimes, and it's a very unique kind of pain(s). I had never really experienced it before this. Have you had xrays of your elbows? Sometimes people can be pre-disposed and seemingly insignificant bumps or trauma events (crashes) can cause minor damage that can maybe mess up someone who was right on the edge anyway - according to the neurologist anyway. Also, I guess in an unlucky few, the stuff never really goes away either he said.

If it helps anyone ever, I ended up going to see a Neurologist, did an exam and nerve conduction test in both arms, and he said at that point it wasn't worth doing and EMG. Basically, my nerves were not injured or inflamed as far as he could tell at that point - they were "irritated". The cause was almost certainly from sustained unnatural sleeping position with prolonged bent arms - again from being doped up on opiates. The diagnosis was ulner neuropathy and not necessarily ulner nerve syndrome. It can take anywhere from weeks, to months to go away according to the neurologist - that was about a week and a half ago, and my symptoms are almost gone thankfully, so they hung around for about a month, slowly getting better and then suddenly getting better much faster. I have been sleeping with a hand towel wrapped around my left elbow at night, since that was the arm most impacted it seemed. The towel helps keep the arm from bending too much to allow the nerve to rest without much force. Anyway, it seems simple enough.

Edit to add: The neurologist did confirm that the neuropathy can travel "upstream" too, which I guess makes sense. Ulner nerve stuff online never mentions pain above the elbow but he said it does happen.
 
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