Tennis Elbow

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    May 08, 2007 12:00 PM GMT
    I'd like to hear guys personal experiences about tendonitis in the elbow.What has worked,what hasn't.I've had the problem for a few years on and off.The last few months have been hell.I'm going to get another shot of cortisone (depo-medrol)tomorrow.The thing that pisses me off the most,is that I can't do a full shoulder workout.Lateral rasies are my main problem,as I can't lift anything over 10kg-22lbs.The pain is just too much or if I can get away with heavier weights the pain later almost makes me cry and if I bump my elbow on anything I sometimes do cry.Looking forward to hearing from you all.Maybe we can set up a support group.haha.Thanks boys.
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    May 08, 2007 9:52 PM GMT
    Tennis elbow (lateral epicondylitis) can be a real bugger. Most times it's related to lifting form and using weights that are too heavy, too fast. It's typically aggravated by motions such as reverse (palm toward the floor) curls. As a temporizer, you can use a forearm strap, and there are stretches you can do that help relieve the pain. Repeated injections of corticosteroids aren't a good idea, because ultimately that can actually weaken the connective tissue in the area. You have fantastic physiotherapists in Brisbane who could help you with the problem. I can even recommend one in particular if you'd be interested.
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    May 08, 2007 11:31 PM GMT
    lateral epicondylitis is very prone to become chronic if not treated early. it is one of the most common conditions i see in my patietns.

    Youneed to understand the following factors will exacerbate your symptons:

    1. Tigh squeez of the hand, especially bars with thin diameters. The reasons is because when you squeez yuor hand and fingers around an object such as a weight bar, both the wrist/finger flexors and the extensors (the muscles on the palmar side and dorsum sides of your forearm) have to CO-CONTRACT, otherwise the wrist would collape into a completely flexed or extended position such as what you would see in a patient with stroke or spinal cord injury. ANY contraction of the wrist extensors ANS supinantor would aggrevate your symtons.

    2. Mentioned above, forearm supination, or the motion of turning your palm upwards, will aggrevat your sympton.

    3. Of course, wrist extension will aggrevate the sx as well. This also happens EVERY time your hand is facing down, because the wrist extensors will have to fight gravity, and unless you have a neurological problem, your body will unconsicously fight the force of gravity by muscualr contraction.

    The most sucessful treatment I have come to seen and used is ART, or Active Release Technique. It is used by many PT, chiropractors, and some MDs (I ma certified with all body parts.) Try this technique in conjunction of using a band onthe site of pain with a bulge, this would unloed the tendon site a bit. if conditions do not improve, you may need a cutom made wrist splint to prevent any motin of the wrist even when you sleep...

    And in the gym, war up, do not grab bars taht is thin and heavy. Avoid straight bars in place of cruved bars as the stright ones forces your forearm to go into supination. Avoid any exercises witht he palm facing down. And use ice after wards.

    There 4 paramters you cannot over load; even just overloading one would exacerbate your sx:
    1. Load, or force, weight, resistance.
    2. Range of motion, every joint has its open pack and close pack positions. Some are more stressful to the jpint and some to the musculature, some to the capsule/ligaments, etc.
    3. Duration. How long you do an activity without a break. How long is the break you take inbetween activities.
    4. Velocity. How fast you do a certain acitivty.

    Carpal Tunnel Syndron only loads the velocity and duration, and look at what damage it can do...
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    May 08, 2007 11:36 PM GMT
    And yes depo medrol is a catabolic steroid, youreally should not have it more than twice a year. It can break down all tissues including bone.

    AND stretchign for lateral epicondylitis usualy do NOT help becasue you are stretching the wrist, and the site of the tendonitis is on the other end of the attachment of the muscle, to proximal.

    You need manual therapy and compliance with modified weight training instructions as I have listed above.

    Dont let it turn into a chronic condition.
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    May 10, 2007 7:23 AM GMT
    Thanks for your time on the subject guys.I had the Depo yesterday and it worked like magic.I will stay away from the weights for a little while.I saw a Physio a few months ago and she told me the pain was caused from too much muscle in my forearm???.I paid my $85 and never went back.Another Physio told me it was refered pain from my neck???Paid my money and didn't go back.I know you need to put a little trust in doctors and the like,but even I knew the problem was the tendon in my elbow!No one made any metion to an overuse injury the way you guys did.I just kind of expect it to get better,to work through the pain.I will go and see an experienced PT to learn the excercises to stay away from and what to do instead.NYCmusc thanks for letting me know this can turn chronic,that scared the shit out of me.Once again boys thanks for your time and giving me some simple stuff to work with.
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    May 10, 2007 11:30 AM GMT
    As I mentioned in my posts above, glucocorticoid steroid shots does work and works fast. But it does not prevent the condition from returning if you do not do your part not exacerbating it.

    The first PT must ahve not expresses his or her words correctly. It is not TOO much muscles in the forearm but over use, poor mechanics, and irrtation of hte forearm muscles tendons that causes the condition.

    The 2nd PT may or may not be correct as well. All the nerve supplying our uper extemety comes from the neck, so you may have pain from both the tennis elbow and also a neck condition. But the way you described your symptons, and the periperal nerve patterns also not usualy for this to happen. This PT maybe syaing thigs to you without careful examination..

    Just do this, if you turn your neck to one side then backwards, and you feel some pain on taht side of the arm, or you just side be your neck and y ou feel some symtons on the opposite side of the arm, some thing is going on in your neck. You would need and EMG, xray, and if warrented, MRI.

    ANd do this again: Make a tight fist, do a reverse arm curl with the palms facing down, turn a door knob so your palm is turning towards the ceiling. If any of the above hurts at your elbow and the neck stuff didnt, the 2nd PT was just talking before he could support his claims with objective exams...
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    May 11, 2007 3:30 PM GMT
    The first thing you should do is STOP the cortisone injections! They can cause tissue and even skeletal damage. NYCMusc had some great advice. I would also recommend taking Enzymatic Therapy. A tablespoon of omega 3 oil a day on an empty stomach (even if you don't have tennis elbow). Nordic Naturals makes the best and is even flavored in orange or lemon...tastes great. I would take Bromelain to reduce inflammation. It is a natural anti-inflammatory made from pineapple extract so you can take it for a long period of time without doing damage. For those times when the pain is harsh, take 3 Ibuprofin to keep the inflamamtion down. Ice it whenever you can. To make icing more convenient, wet a dish towel with water and fold it into a long, narrow shape. Put it in the freezer flat. When you need to ice you can just wrap it around your arm and put it back in the freezer when you're done. Oh, and switch to a dumbbell only routine until you heal completely.

    Tanner
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    May 12, 2007 11:58 PM GMT
    Dumbell routine would actually in theory be WORSE for teenis elbow!

    Dumbells require a lot of stabilization of the wrist, so all the wrist flexors and extensor have to co-contract to keep the weights balanced individually. The more co-contraction of the wrist flexors and extensors, the more you aggrevate your tennis elbow!
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    May 13, 2007 12:01 AM GMT
    Then again most people cannot do as heavy a weight when using dumbelss (for the exact reason I mentioned, but not just co-contraction and stabilization in the wrist but also elbows and shoulders.)

    So lighter weight is the key to go.

    Again, dumbells in theory would be worse for the condition.
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    May 17, 2007 3:29 PM GMT
    By far, the best therapeutic exercise for any sort of "tendinitis" are eccentric muscle contractions. This is different from most exercises in the gym that involve shortening the muscle, concentric contractions. For eccentric contractions, you need to slowly lengthen the muscle, by, for example, lower a weight slowly.

    These exercises will make you sore, but as long as its not incredibly uncomfortable and you stick with it (2-3 sets of 15 reps, with gradually increasing weights), you should start to see some improvements. Just remember the most important thing with rehab is to be able to do today what you could yesterday, meaning if you are too sore from yesterdays exercises, you did too much and it was probably detrimental.
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    May 17, 2007 3:35 PM GMT
    Sorry. I have to correct you..

    Such an advice will only make a patient much worse.

    No contractions at all. Rest, ice, and spot compression on the local area of tenderness (complete wrap around of the forearm runs intot he risk of neurovascula compression of various bundles.)

    Sorry, I am specialized ortho Pt and I teach PT interns on ortho rotations. Eccentric contractions is a GOOD rehab protocal for SOME conditions but not for this one. As a matter of fact, almost all musculotendonous injuries occurs during ecentric or reboundconcentric from eccentric contractions. You rarely get acute injuries frm isometric or concentric contractions.
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    May 19, 2007 2:23 PM GMT
    Mate, your physio may have been onto something. Is the pain most intense on the inside (soft side) of you elbow rather than on the outside (dony side?) If so, the problem isn't too much muscle in your forearm per se, but too little antagonist muscle development on the TOP of your forearm (extensors.) This is a very common form of tendonitis developed among motocross riders and rock climbers aggravated by selective development of the flexors. The only physiotherapy that I or any of my friends have found successful is absolute rest from exercise that aggravates the tendonitis combined with daily wrist curls. After stabilising the wrist, we hold a weight in each hand and twist my wrist upwards to target the extensors until they burn. While perhaps the least satisfying training you'll ever do, be diligent. If, however, the pain is in the outside side of your elbow (peripheral side? distal side? I'm having a hard time communicating here!), it is likely due to weakness in a different set of antagonist muscles, requiring another set of exercises
  • bigguysf

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    May 19, 2007 2:58 PM GMT
    I'll let the guys who know about lifting routines handle those questions on what's best to do on that front.

    While you are in the 'rehab' process, I would like to suggest seeing a chiropractor who practices ART (Active Release Technique...a method of tissue manipulation that helps to break up scar tissue for better muscle function).

    I am an avid tennis player (3-4 times a week) who developed tennis elbow a few years ago while working on a one-handed backhand stroke. I thought it would go away with reduced activity, stretching, and ice. It didn't. I went to my doctor and was prescribed ultrasound and physical rehab through Kaiser. Both helped only a little.

    Finally after over a year of pain so bad that I couldn't lift a soda can, I went to a chiropractor versed in ART. 4 visits later (with continued stretching, reduced activity, and icing) the pain was greatly diminished, and eventually was gone completely within two months.

    I'm not big on chiropractors, but I am a firm believer in ART with respect to tennis elbow! Check it out.
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    May 19, 2007 4:29 PM GMT
    I am also an ART practioner, fully certified in all body parts. A lot of PTs like me do it as well.

    I have already recommended it. It has been the ONLY soft tissue management system that I find work well...
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    May 19, 2007 4:34 PM GMT
    BuolderBum, your PT was not correct taht is an old myth...

    Both lateral and medial epicondylitis are results of 2 things:

    1. Repeatitive over use.

    2. Poor tensite quality unevenly distributed along the path of the muscle fiber.

    I am certain the tennis player cantell youtaht when it hurts, it is only a spot. The long muscle, instead of distributing load evenely along the entire path of the muscle length, is over used and you canfeel one spot getting very hard and the contractile quality changes. This concnetrates the load at both ends of the spot, and it is usually a musculotendonis junction that gets irritated, as this portion is not contractile and load poorly all by itself.

    That is why, with ART, the pathological portion of the tissue, when being worked on, is painful. When it starts to feel like a massage, you do not need treatment anymore.


    Am I correct (to the tennis player)?
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    May 19, 2007 4:39 PM GMT
    I just wanted to point out that ART is not a chiropractic only practice.

    The type of chiropractors who practice this type of treatment are more recognized inthe traditional eveidence based medicine and this same group does NOT get along witht he old fashioned chrios who has very litel knowledg of the extremities and beleives an adjustment cures all illness...

    ART is practiced by many newer chiros, PTs, OTs, LMT's, and MD's.
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    May 19, 2007 4:42 PM GMT
    Oh I already mentioned ART with my 1st reply to this thread...
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    May 20, 2007 2:34 PM GMT
    Hmmmmmmm... I may have to check out ART, because my left elbow on the inside of my arm has started giving me a lot of trouble during workouts. Fortunately, there's an ART practitioner only an hour away from me, near Iowa City.
  • bigguysf

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    May 23, 2007 4:19 PM GMT
    This is for Paradox:
    Give it (ART) a good honest try. I am very certain that I'm playing pain-free tennis these days ONLY because of the ART work done on my injury. Nothing else worked.
    Good luck with it.