Is collagen good for golfers elbow?

The mirror: what golfer's elbow is, why it is a lifter's injury, and how a tendinopathy of the flexor origin is treated

Is collagen good for golfers elbow is a question whose answer depends on two structures that sit a finger's width apart on the inside of the elbow, and the honest page places both before it answers, because the first decides what collagen could do and the second decides whether the reader has golfer's elbow at all. Golfer's elbow is tennis elbow's mirror. The forearm's muscles attach to the elbow in two groups: the extensors, which lift the wrist and fingers, converge on a tendon that attaches to the bony knob on the outside of the elbow, and their tendinopathy is tennis elbow, lateral epicondylalgia, the commoner of the two by a wide margin; the flexors and the pronators, which bend the wrist and fingers and turn the palm downward, converge on a tendon that attaches to the bony knob on the inside, and their tendinopathy is golfer's elbow, medial epicondylalgia, around five times less common than its mirror and otherwise the same condition on the other side of the joint, a tendon whose load has exceeded its capacity for long enough that its matrix has disorganised, its cells have changed and it hurts when the muscles that pull on it are used. The movements that load the flexor-pronator origin are gripping, bending the wrist against resistance and turning the palm down under load, which is the golf swing's trailing arm and which is also, more often in a gym, the pull-up and the chin-up, the heavy row, the curl, the farmer's carry, the deadlift held in the fingers, the climbing hold and the racket's forehand, so that golfer's elbow is a lifter's injury as much as a golfer's, arriving as a dull ache on the inside of the elbow that sharpens with grip and wrist flexion, is tender to a single finger over the inner knob and stiffens after use, with the twelve-week look-back for the load change that nearly always precedes it. As a tendinopathy it is treated exactly as every tendinopathy is treated, and the honest page gives the programme in its order. The load is brought under the tendon's capacity first, not to zero: the provoking movements are paused or reduced, the grip is changed with a thicker bar that spreads the load, a neutral or reverse grip that shifts it, and straps for the heavy pulls so that the fingers stop doing the holding, and the daily life load, the lifting of bags and children and the gripping of tools, is modified for the weeks the tendon is reactive. The tendon's capacity is then raised by progressive loading of the muscles that pull on it, which is the wrist flexors and the pronators: isometric holds first, a wrist curl held at mid-range for around forty-five seconds for pain relief that lasts about forty-five minutes and lets the session begin, then slow heavy wrist curls and pronation against a weighted hammer or band, three slow repetitions at loads near the heaviest manageable, every second or third day to match the seventy-two hour synthesis curve, through the months that remodelling takes, with grip strength work as the tendon tolerates it and the heavy pulls reintroduced by tests rather than by date; the hand's three columns, today, the weeks and the months, on the hand tendonitis page run the same order one joint down. A corticosteroid injection into the origin gives weeks of relief and worse outcomes at six and twelve months in the trials that followed people, which is the twelve-month column on the what really works page, and surgery to release or debride the origin is for the few who have failed a year of the programme.

The neighbour: the ulnar nerve, how it announces itself, why it changes the plan, where collagen sits beside the flexor loading, and the worked example

The neighbour is the ulnar nerve, and the honest page gives it its own section because a reader who has it and treats their elbow as a tendon alone has treated the wrong structure. The ulnar nerve, the funny bone's nerve, runs down the inside of the arm and passes behind the inner knob of the elbow in a shallow groove, a finger's width behind the flexor-pronator origin, before entering the forearm between the two heads of one of the flexor muscles, so that it lies against the tendon that golfer's elbow inflames and is squeezed by the same muscles the condition involves; in a sizeable minority of people with golfer's elbow, a fifth or more in some series, the nerve is irritated alongside the tendinopathy, and in some it is the nerve rather than the tendon that is the problem from the start. It announces itself differently from a tendon: numbness or tingling in the ring and little fingers, the two fingers the ulnar nerve supplies, especially with the elbow bent for long periods, at night or on the phone; an ache that runs down the inside of the forearm into those fingers rather than staying at the elbow; and, if it has gone on, weakness of the hand's small muscles, a clumsy grip, difficulty spreading the fingers, wasting of the muscle between thumb and index finger. None of those is a tendon symptom, since a tendon has no sensory territory in the fingers and does not produce numbness, and a reader with ring and little finger tingling beside their inner elbow pain has an elbow that needs a clinician's examination, with the nerve tested for sensation, strength and the tap over the groove that reproduces the tingling, rather than a tendon programme alone; the plan changes, with the elbow kept straighter at night, the pressure on the groove avoided, the nerve's glide worked and, if the nerve is being compressed, a surgeon's opinion about releasing it, while the tendon programme continues beside. Nothing in a tendon protocol touches the nerve, and collagen least of all, so the first thing a reader with inner elbow pain does is ask which structure, which the fingers answer. Where collagen sits is beside the flexor loading, exactly where it sits for every tendinopathy, with the honest statement of what it has: the pre-loading protocol, 15g of gelatin or collagen with vitamin C about an hour before a loading session, raised a marker of collagen synthesis in healthy men in a trial that loaded nothing near an elbow, and one small six-month trial of 2.5g beside calf strengthening improved Achilles tendinopathy more than placebo beside the same exercise, a tendon at the other end of the body; there is no trial of collagen in golfer's elbow, tennis elbow or any elbow condition, and the adjunct's place is beside the wrist flexor session on the strength of the mechanism and the Achilles result alone, taken before the session and not after, with the capacity gap that the loading closes from both sides on the get rid of tendonitis page. Under the programme runs the floor, protein, vitamin C, sleep and no smoking, which removes brakes and shortens nothing. The worked example is the adjunct at habit scale, stated on its true terms: two capsules, 1200mg hydrolysed type 1 marine collagen with 12mg vitamin C at 15% of its reference value plus zinc, 120 for £16.99 at 28p a day, lab tested and UK made, below the 15g protocol dose, carrying vitamin C's collagen formation sentence for cartilage and bones and no tendon claim. Is collagen good for golfers elbow: as for any tendinopathy, an adjunct beside the loading that treats it, with no elbow trial, and nothing at all for the nerve a finger's width behind.

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