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Old 02-25-2009, 12:58 PM   #1
Dan Ricciardi
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My Sports Med Dr Advice on Tennis elbow

I'm happy to be posting for the first time on the forum but unfortunately about an injury which will keep me from CFing for awhile. Started the WODs last week but had been doing Tabata and pullups for a couple of months. I had had a soreness over my lateral elbow 1-2/10 in intensity which got worse when I started DLs. Anyway after 2 days of markedly increased pain even with trivial motions such as shaking hands or opening jars I came to the unwelcome realization that I had full blown case of tennis elbow. What a bummer! just got my rings and oly weight set and well on my way to creating my garage gym when this happens.
Luckily one of my friends is sports med doc. Went to see him today and wanted to share his recs in case anyone else has a similar problem.
1. No pushing pulling with a bar for 4 weeks
2. Tennis elbow band to be worn at all times except when sleeping. Amazing but this little piece of neoprene and velcro really helps so far. Don't know if it matters what brand.
3. Ibuprofen 3 times a day.
$. Ice massage to the sore area 4-5 times a day or as often as life allows. Basically freeze a Dixie cup full of water and massage the sore area for 10-15 minutes.
5. I have read about golf ball massages from other posters but he prefers the ice massage because of anitinflammatory properties.
Just thought I'd share and would like to hear from anyone with a history of tennis elbow and your experience with how long it took to heal, ability to lift heavy and do rings.
Cheers
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Old 02-25-2009, 07:03 PM   #2
Steven Low
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Re: My Sports Med Dr Advice on Tennis elbow

Good stuff. Here's my list that has a couple things your guy didn't include:

1. Rest. Especially if it's overuse.
2. Ice after any use & when sore. 15-30 mins per sessions for couple times a day.
3. Stretch flexors, strengthen extensors *until* pain subsides (medial epicondylitis). Then strengthen everything (my pref = rice bucket)
4. Self massage... cross friction and myofascial release the whole forearm & upper arm
5. Anti-inflammatories/NSAIDs. Fish oil is a good one.
6. Stay away from painful exercises. Period. It hurts, you're done.
7. Light eccentric exercises tend to help
8. + joint/cartilage health supplements like glucosamine & chondroin sulfate, MSM, shark, etc. Might be a good idea to start eating the cartilage and tendons off your meat too.
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Old 02-26-2009, 08:42 AM   #3
Dan Ricciardi
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Re: My Sports Med Dr Advice on Tennis elbow

[quote=Steven Low;527245]Good stuff. Here's my list that has a couple things your guy didn't include:

3. Stretch flexors, strengthen extensors *until* pain subsides (medial epicondylitis). Then strengthen everything (my pref = rice bucket)
.
6. Stay away from painful exercises. Period. It hurts, you're done.
7. Light eccentric exercises tend to help



Regarding the above, what is "rice bucket"?
Regarding #6 does that mean I never do pullups again? I find it difficult to believe that I should never do a painful exercise again. It seems thatthe whole purpose of rehab is to return the athlete to whatever activities they were doing before, albeit in such a way to protect against further injury.
Also, what sort of eccentric exercises are helpful for the forearm.
thanks for the advice
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Old 02-26-2009, 08:56 AM   #4
Jake Thompson
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Re: My Sports Med Dr Advice on Tennis elbow

Find yourself a good Manual Physical Therapist,

75% of the "tennis elbow" lateral epicondylitis I see can be fixed in a week. The Ulna has a tendency to shift (abducted Ulna) and this misalignes all of the carpals putting undu stress on the extensors due to change in length.

A quick "pop" back in place and symptoms subside, still need to correct the Inflammation you caused "all the stuff listed above" but should only take a couple weeks at most, let pain be your guide on what you can and can't do.

I struggled with this for 4 months, pushed through it. Finally decided to teach another PT the technique so I could get it fixed, he manipulated it and bam, no pain.

Just a suggestion, most chiros have not been trained in this so???
Look for NAIOMT trained manual therapist.

Good luck.
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Old 02-26-2009, 11:22 AM   #5
Steven Low
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Re: My Sports Med Dr Advice on Tennis elbow

Quote:
Regarding the above, what is "rice bucket"?
Regarding #6 does that mean I never do pullups again? I find it difficult to believe that I should never do a painful exercise again. It seems thatthe whole purpose of rehab is to return the athlete to whatever activities they were doing before, albeit in such a way to protect against further injury.
Also, what sort of eccentric exercises are helpful for the forearm.
thanks for the advice
1. put some rice in a bucket then stick your hand down in it and hold your elbow still with your other hand. Then move your fist counterclockwise and clockwise to exercise all of the muscles in the forearm. 50 times each way. Get too easy then stick the hand in deeper or open it up some.

2. No, it means you shouldn't do exercises if you are experiencing pain. When you can do a pullup without pain by all means go for it.

That would be dumb to exclude exercises that previously caused you pain when you don't experience it anymore. You misread my statement.

3. Stick a dumbbell in your hand and do 3-5s eccentrics. Most tendonitis injuries respond well to eccentrics...
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Old 02-26-2009, 11:25 AM   #6
Dan Ricciardi
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Re: My Sports Med Dr Advice on Tennis elbow

Jake,
I tkake it from your post that you are a physical therapist ( don't worry I'm an ER doc so not looking for free forum care) Any references on above technique in journals? I am s/w of a science based guy and steer clear of anecdotal evidence for treatments. Can't anatomically think how the elbow could work normally if the ulna is abducted. Does this mean it's displaced off the trochlea? I have certainly seen this before but that's called a dislocation. Thanks for the help just seeking any and all advice to get er fixed.
Dan
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Old 02-26-2009, 11:42 AM   #7
Christian Lemburg
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Re: My Sports Med Dr Advice on Tennis elbow

Dan,

have you already included regular self-massage (with hand, tennis ball, golf ball, ice bucket, other implement, I don't care) in your scheme?

What are the results?

For many people on the board, self-massage has helped significantly to reduce their problems. Just do a search on "trigger points" in the forums if you need more evidence. The other thing that really seems to help is the icing part. Just rest will usually not cut it.

Good luck, and fast recovery,

Christian
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Old 02-26-2009, 12:26 PM   #8
Mark Martinez
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Re: My Sports Med Dr Advice on Tennis elbow

Quote:
Originally Posted by Steven Low View Post
Good stuff. Here's my list that has a couple things your guy didn't include:

1. Rest. Especially if it's overuse.
2. Ice after any use & when sore. 15-30 mins per sessions for couple times a day.
3. Stretch flexors, strengthen extensors *until* pain subsides (medial epicondylitis). Then strengthen everything (my pref = rice bucket)
4. Self massage... cross friction and myofascial release the whole forearm & upper arm
5. Anti-inflammatories/NSAIDs. Fish oil is a good one.
6. Stay away from painful exercises. Period. It hurts, you're done.
7. Light eccentric exercises tend to help
8. + joint/cartilage health supplements like glucosamine & chondroin sulfate, MSM, shark, etc. Might be a good idea to start eating the cartilage and tendons off your meat too.
Our PT here gave me a recipe for a nice cold pack that stays malleable versus solid.
I haven't actually tried it. So, I don't know how well it works.

- 50/50 water & isopropyl alcohol mixture placed in a freezer bag
- Freeze a couple of hours and presto!
- Refreeze, as needed
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Old 02-26-2009, 12:38 PM   #9
Camille Lore
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Re: My Sports Med Dr Advice on Tennis elbow

Fwiw, the two things I found that helped most were like Steven said:
Ice cube massage directly on skin. There's something about this specific method that really helped versus ice packs.
The golf/tennis ball massage. I had so many sore spots I didn't know about.
I also did just about everything else he mentioned. Until I added the last two items, it wouldn't go away.
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Old 02-26-2009, 03:56 PM   #10
Dan Ricciardi
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Re: My Sports Med Dr Advice on Tennis elbow

Camille, Yes I have started ice massage today and it really seems to help... the only hard part is slowing down for long enough to sit there and do it ( 2 little kids and FT job)

Mark- I have seen a similar recipe elsewhere but haven't actually used it. I will give it a try when the kids go to bed.
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