January 28, 2009

Tennis Elbow

R

eader Adam points us to this article in Newsweek about Tennis Elbow. Two things to note:

  1. The futile tone of the writer.
  2. How he developed the problem.
  3. The diagnosis of tendonitis.
  4. The standard treatment options of rest, ice, and medications (and hope).

The American Academy of Orthopedic Surgeons now considers Tennis Elbow to be a degenerative condition of the tendon and not a tendonitis.

An article you might enjoy:

DK

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July 17, 2005

Put the Squeeze on Tennis Elbow

What is the name of the condition for pain on the outside of your elbow when you shake hands, pick up a six pack of soda, or swing a tennis racket? If you're thinking Tennis Elbow, you're right.

Tennis Elbow is also known as Lateral Epicondylitis (EPEE-CONDALL-LIE-TIS) which means "inflammation of the epicondyle". The epicondyle is the end of the upper arm bone that forms part of the elbow joint and "itis" means inflammation. Your bone is inflamed.

But, there is some confusion about Tennis Elbow. While the term means "bone inflammation", the actual tissue injury in most cases is tendon. Tennis Elbow is an example of labeling gone awry just like another condition: Plantar Fasciitis. The main causes of Tennis Elbow, or perhaps more aptly named, Lateral Elbow Pain, are:

  • Inflammation of the epicondyle.
  • Inflammation of the common extensor tendon (that connects to the elbow).
  • Weakness of the common extensor tendon (also known as tendonosis - (TEN-DIN-OH-SIS).
  • Osteoarthritis of the elbow joint.
  • Entrapment of the radial nerve.

In most cases, the cause of lateral elbow pain in an active, athletic population is tendonosis of the common extensor tendon. Tendonosis is a focal weakness of the tendon similar to the worn spots on the knees of an old pair of blue jeans. The fabric is thin and weak. The pain from tendonosis is more from the stress applied to the tissue than from an active inflammatory process. But, since the most common term used to describe the symptoms has an "itis" in it, the conventional approach is to use non-steroidal anti-inflammatory drugs (Advil, Motrin, Aleve), ice, stretching and then...hope.

The symptoms of common extensor tendonosis (and the technical term would be extensor carpi radialis brevis and longus tendonosis,   - see why I use the term "common extensor"?) include pain on the outside of the elbow area especially with gripping, squeezing or lifting. Your grip may seem weak. You will typically not hurt until you perform some type of activity and then may hurt for 24-48 hours. The pain seems to come and go but never goes completely away.

To beat tennis elbow due to tendonosis, you need at least the following:

  1. An accurate assessment of your grip strength and wrist extension strength. You need to know how much force you can produce and NOT hurt while gripping and then extending your wrist. Remember, pain is all or none and shows up when you greatly exceed your physical capability. If you do not know what your physical ability is (in this case, grip and wrist extension force), how will you know if you are any better or if you are doing the right things?
  2. An exercise regimen designed to purposely fatigue and stress the common extensor tendon. The exercises should produce some mild discomfort and should take place under the supervision of a physical therapist or athletic trainer familiar with tendonosis. And, since the hand serves at the pleasure of the shoulder, the exercises must include movement of the shoulder girdle not just the wrist. The shoulder sets the platform upon which the rest of the arm functions. If your shoulder is weak, you may overload the wrist and hand.

How long will it take to rebuild the strength of your tendon? Months not weeks. Tendonitis resolves in weeks, but remodeling a tissue like tendon is much slower. Persistence is a must.

The take home point is that most cases of Tennis Elbow are:

  1. Due to tendonosis.
  2. Treated like tendonitis.
  3. A source of great frustration.

To put the squeeze on your Tennis Elbow, think tendonosis, establish your baseline strength levels, stress the common extensor tendon and avoid tendonitis treatments.

Make today count.

Doug Kelsey
Author. Speaker. Therapist.

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January 05, 2005

Elbow Pain and Injuries

The Injury
Elbow problems are divided into two groups: those that can be tied to a specific event or activity and those that cannot. Unexplained pain the elbow that is not relieved with rest, has worsened over time and has an irregular pattern of symptoms needs assessment by your family physician. Although conditions. for example, as a bone tumor or ankylosing spondylitis are uncommon, you would be wise to have your condition screened. If you do not have a family physician and need a referral, we will be happy to help you locate a sports medicine or family physician.

The most common causes of elbow pain in active, athletic people are Tennis Elbow and Golfer's Elbow. These two conditions share a common tissue problem: tendonitis. Direct blows to or falls on the the elbow typically cause a sprain of the ligaments. Overhead athletes (baseball, tennis, volleyball) may also sprain the ligaments from repetitive over use. We will help you identify the nature of your tissue injury if you do not know and explain in detail what it means to you and what to do about it.

Biomechanics
We first need to know if your elbow is stable.
A stable elbow coordinates all of its three connections or joints into smooth, quick motion. An injury (a fall, blow to the arm or sudden jerking of the arm) or repetitive use of the arm overhead (baseball, swimming, tennis) often causes instability. Signs of elbow instability include pain with specific movements especially straightening your arm quickly, pain when you throw or move suddenly and / or pain when you lift heavy objects. Instability can provoke or prolong tissue damage. It is important that you address both your tissue injury and your biomechanics. We will tell you if your elbow is stable or not from our biomechanical examination. Instability can often be corrected using Sports Center's exclusive upper extremity stabilizing drills to improve muscular support and timing.

Attitude
Beating an elbow injury or surgery requires a winning frame of mind. But to win, you first need to know what's wrong and what to do about it. Until you do, your mind will be filled with wonder and worry. Will I always hurt? Will I ever be able to throw? Can I lift weights again? You have to have a game plan and you must focus on what's important today. We'll help you formulate a plan, execute the plan and celebrate your successes along the way.

Sports Center uses a consistent approach, Target Tissue Training, to solve all musculoskeletal problems. Target Tissue Training involves three primary components: tissue injury, biomechanics and attitude. If you are ready to learn more about your injury, call 512-206-0433 today to schedule your Sports Center consult.

Make today count.

Doug Kelsey
Author. Teacher. Therapist

February 08, 2004

Helpers in Disguise

The pain in his elbow wouldn't go away. With every pitch off the mound, Tommy felt the electrical zing run down the inside of his left arm. As he delivered a sinking fastball, he felt a pop and a wave of nauseating pain. His left hand and fingers were numb. He tried one more pitch but could barely get the ball to home plate.

The doctor told Tommy he had completely torn the medial collateral ligament of his left elbow and that he would never pitch again. Tommy disagreed. He wanted to talk about options. He was told he could try some rehabilitation but that was about all he could do. So, Tommy spent two months trying to regain the use of his left arm. It didn't work.

Tommy then went to see an orthopedic surgeon, Dr. Frank Jobe, who offered him an experimental surgery. He would take a tendon from Tommy's right arm and transplant it into his left elbow. The doctor could make no promises but it was Tommy's only option. Tommy said yes. The year was 1974 and the surgery is now known as the Tommy John Surgery.

Tommy spent several weeks in a cast followed by two months of rehabilitation. But, he noticed his hand and fingers tingled and were weaker than they should be. He went back to surgery to remove scar adhesions on the ulnar nerve in his left elbow. He had to start over. The rehabilitation was painstakingly slow. At first, he had to tape his fingers together just to hold the ball. When he tried to throw, he looked like a little leaguer on his first day. But, Tommy loved baseball and desperately wanted to pitch again.

A little over one year after the surgery, Tommy pitched three innings in an instructional league game. He would have to earn a spot on a big league's team roster. Not an easy thing to do without having had surgery. By spring training of 1976, Tommy pitched well enough to earn his spot on the team. He went on to pitch thirteen more years with the Los Angeles Dodgers and New York Yankees.

In speaking about his recovery, Tommy believes he was blessed by the second surgery because it forced him to slow down and allow his body the time it needed to completely heal. As a result of his second surgery, the rehabilitation timelines following the Tommy John Surgery were altered and the success rate is now nearly 85%.

Discouragement is around every corner in life. Just when you think you have overcome one obstacle, another one shows up. But sometimes, the obstacles are not really obstacles at all. Sometimes they are helpers in disguise. Whether Tommy made it back to the big leagues is not the most important part of his story. What’s important is the transformation that takes place when you give something everything you have to give. You win and are forever changed.

When you feel overwhelmed and discouraged by unexpected downturns, take out a piece of paper and write down your answers to these questions I call the Barrier Breakers:

1. How could this situation / problem help me?

2. What do I need to keep going?

3. What will I miss if I give up?

Writing forces you to exit the emotional, worry loop scurrying around in your head. Your mind can only hold one thought at a time (Try it. Try thinking a happy and a sad thought at the same time). By focusing on these questions, you force your mind to find answers that it might otherwise miss.

Tommy John discovered his own answers. His second surgery slowed him down and gave his body a chance to heal. He needed to feel the ball in his hand so he taped his fingers together. If he held the ball, he could keep going. If he gave up, he would never play baseball again; never throw anything again and maybe never even be able to write his name. Because Tommy John found answers to the Barrier Breakers, I am now sharing his story with you. Maybe it will inspire you to find your own answers and you, in turn, may share it with someone you know. This is how we change the world.

Make today count.

Doug Kelsey
Author. Teacher. Therapist.

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