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Elbow tendonitis
Rip,
I have read some the past posts on tendonitis but have to ask if you have any further experience with dealing with tendonitis. I have been dealing with golfer's elbow on and off for over a year. I had physical therapy which did not make any good progress. I had used naproxyn and ice for a good period of time with no considerable improvement. My orthopedic surgeon had administered a cortisone shot which returned my elbow to normal function and strength without pain. However as time wore on, it seems that my elbow would regress. I had a second shot and the experience was similar.
The pain is prevenlant during pulling motions such as pullups. When I deadlift heavy or do cleans, the elbow doesn't not hurt during the exercise but does the next day. I am making progress but I have pain on days off and it does affect recovery. I thought about the Starr protocol but the sticky mentions that the protocol is for muscle belly injuries.
I am going back to the orthepedic surgeon on Monday. We had both agreed that if the pain returned, we were not going to use another cortisone shot but perhaps surgery.
Have you ever had athletes with this type of tendonitis? If so, what was their disposition to resolve the injury.
TMPHBITEU
I have had tendinitis in every tendon in my body at one time or another. Cortisone shots do not work long-term. Surgery may work, may not: it helped my knee for about 2 years, then it came back. But that seems like a rather radical approach to golfer's elbow, which I have myself right now. I'm going to train through mine, just like I did my tennis elbow which was not supposed to heal, and it will go away, just like it has several times in the past.
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In that other thread about tendinitis, you mentioned how they treat tendinitis in horses, by scalding the site of injury. You advised that in order to mimic the effect of this, one should perform exercises that irritate the tendinitis, to the point where it is very painful and severe. For example with golfer's elbow, one should do chins/curls to increase the irritation. Supposedly this should create the same effect as the horse treatment. I was wondering how you know that this creates the same effect, since there are fundamental differences between the two methods.
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I'm coming off what I would call a medium sized bout of elbow issues on my right elbow. I upped vitamin C and fish oil. Probably twice my normal dosage and had a liter of water each dosing.
I actually find like Mark said already stuff that works it helps push through it. Here's one I haven't heard mentioned though, but it is probably more good for only issues just below the elbow, but it seems to have help my elbows overall too. Take a light gripper and with arm extended perfectly straight do RAPID opening and closing and time it like a Tabata. 20 seconds work 10 seconds rest. You won't be able to do 8 rounds first time through, it's amazing how tiny resistances can kick your ass when put to effective use. Once I can't complete 20 seconds work I time work sets shorter. These days I time 10 seconds work 5 seconds rest switch hands 10 seconds work 5 rest switch hands etc etc. Keep the arm straight out not bent, rotating your hand on the clock back and forth will change the pull angle on the tendons too, and whichever ones are sore will be quite obvious. Don't do more than one series of sets a day. And maybe initially every other day. I now do them at least once a week whether elbows are painful or not. This process helped me a ton whether psychosomatic or not I don't care, elbows feel and work better. Caveat emptor, YMMV...
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Tendonits is an acute inflammatory condition affecting the tendons and the soft tissues surrounding them. The key work is "acute." There are 4 components of inflammation - pain, redness, swelling and heat. In the acute condition, things that will help bring the inflammation under control are ice, anti-inflammatories (natural and synthetics), therapeutic modalities such as e-stim, ultrasound, etc.
However, this will not address the cause of the inflammatory process. These methods will only help in driving the inflammation away from the tendon, resulting in less pain, swelling, heat and redness. If the cause of the tendonitis is not addressed, then the pain will return. Thus, the reason why cortisone shots do not work long term (plus the fact that it is a catabolic steroid which will destroy the soft tissue surrounding the injection site, creating a weaker overall joint structure).
In chronic conditions involving the tendon, it is not actually a "tendonitis," rather a "tendonosis." This is a condition of the tendon which involves quite a bit of degeneration and destruction of the connective tissue that generates pain. However, there is not usually the accompanying swelling, redness and heat that is associated with tendonits - the acute condition. Which is why anti-inflammatory treatment methods have diminished effects in the long term.
Since I practice as a Chiropractor, my belief is that if the structure is not balanced and functioning properly, then the soft tissue surrounding the joints will be operating at a disadvantage. This state of deficient function, over the long term, will produce repetitive stress injuries such as a tendonsis. If the structure is not corrected, then the soft tissue will never heal completely. The pain can be controlled, but without correcting the underlying cause of correction, the pain will return and will usually be accompanied by a further state of degeneration of the connective tissue.
I've got a great paper on pdf that was written by a PT, which explains the difference very well. And he explains why traditional therapies aimed at reuding inflammation do not work. His treatment protocols are aimed at improving function of the joint by improving functional strength of the muscles surrounding the joint. My only complaint is that he does not address the underlying dysfunction of the joint. Without addressing the underlying dysfunction of the joint, the musculature will never be 100% functional and is operating at a higher chance of repetitive injury.
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how long did your elbow take to become pain free when you trained through the pain? Did you experieince some loss of strength due to the pain?
Member
I feel for you guys. I'm at 11 months now on my case and it's still there. I thought it was gone, so I added pullups to my SS program, but it came back after 6 pullup workouts when I'd progressed to 8,8,7 for my three sets.
I'm similar in that it doesn't hurt during DL or PCs. Hurts some the next day, but now it's hard to say if that was because of pullups.
GE is, by far, the crappiest injury I've ever had.
TMPHBITEU
Please show me where I said all this shit. I never said I KNEW any such thing.Originally Posted by zephed56
TMPHBITEU
What do you mean specifically by "underlying dysfunction"?
I prefer not to merely believe things whenever it is possible to know them. Sometimes it is necessary to trust your hunch if the data are not available, but Chiropractic often strays into belief when it should be either quiet or looking stuff up. I have the greatest respect for Chiropractic's ability to help with many injuries that should never be taken to an MD, but lots of you guys have a tendency to pull explanations out of your ass, and this provides hours of entertainment for physicians who would otherwise have to accept the usefulness of the Chiropractic art since it so often works.
So I'll go out on your limb with you and say that it is my opinion that tendinitis in general and elbow tendinitis (which may in fact lead to tendinosis) is a function of a general weakness in the muscles and connective tissue of the affected area, one that shows up when a volume of work above the ability of the structure's ability to recover is performed, and inflammation is the result. That workload which for a stronger forearm would not cause inflammation causes it in a weaker forearm. This is why so many doses of tendinitis have been fixed with training, and grip training in the specific instance of elbow tendinitis. But I don't know this for sure, it merely comports with my experience.
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I'll give an example of an "underlying dysfuction," and probably the easiest would be tendonits/tendonosis of the supraspinatus tendon. First of all, if the musculoskeletal structure is in correct balance, it is very difficult to damage this tendon. But if an imbalance is present, the injury not only becomes very easy, but often very likely. However, it is also possible that a muscular imbalance can produce structural imbalance as well, since the muscles are connected to the bony skeleton. A good example of this is a lost cervical curve noted in heavy bench pressers who do not perform the required neck and back exercise to promote balance. They spend way too much time putting on their bench shirts to perform proper preventative exercise to offset the fact that they are bench pressing in cervical flexion because it gives them a shorter range of motion. But I digress.
In all of the x-rays I've taken of patients' cervical spines, I would say that 95% or more of them show evidence of a whiplash injury. Those who do not show evidence are usually young children, but I digress yet again. Anyway, the normal compensation of a lost cervical lordosis includes extension of the lower thoracics, anterior/posterior rotation of the pelvis (unilaterally or bilaterally), and some degree of rotation with lateral bending of the lumbar vertebrae. With this compensation pattern, what almost always happens is there is segmental extension in the middle thoracics, usually around T4-T6, which affects the rhomboids either unilaterally or bilaterally. The scapulae protract which jams up the AC joints, but most importantly sets up the stage for a supraspinatus injury. Since the scapulae are protracted, the underlying structure which comprises the origin and insertion of the rotator cuff muscles are compromised. There are odd forces of pull being acted upon these very small muscles and eventually a soft tissue dysfunction will become present.
Some may argue that proper strength training of the scapular retractors, the rhomboids, mid/lower traps, etc. will prevent the soft tissue damage to the rotator cuff. However, those muscles are also at a great disadvantage because they are constantly fighting a structural imbalance that exists elsewhere. And these muscles are prone to fatigue from constantly fighting this imbalance, which also sets the stage for soft tissue injury. It's all a part of the normal compensation patterns of the spine, of which we have a database of thousands upon thousands of xrays demonstrating these patterns.
Now, a lot of PTs state that they can correct the problem with functional training alone. And a lot of Chiropractors believe that they can correct the problem with the restoration of structural balance alone. And the success rates of both fields are approximately the same, which is just "pretty good."
However, it is my belief that in order to fix the problem the fastest, and have the greatest chance of preventing it from returning, or preventing it in the first place, is to utilize a combination of both functional training with restoration of the underlying skeletal structure. The problem is, there is really no great amount of outcome measurement utilizing the combination of these two fields in combination. That is something that I will be working on over the next few years. The problem right now is that most of the research out there is heavily flawed. I'll take years of experience and practical knowledge over research studies done in a lab, under conditions that cannot be satisfied in the real world.
I also believe that about 50% of all PTs and Chiropractors either need to be thrown away or need to seriously rethink their practice philosphies. Too many of them embrace the old school ways of thinking and are too closed minded to accept that no single discipline works for every patient, and that the best method may be a combination of several disciplines. But, to do that would mean giving up market share in patient care.
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