Is this tennis/golf elbow?

Discussion in 'Health & Fitness' started by Alejandro Lanza, Jan 16, 2012.

  1. Alejandro Lanza

    Alejandro Lanza Rookie

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    Hey everyone,

    I've had some discomfort for a good 5 weeks on my elbows, but much more noticeable in the right one. I play tennis about once week and go to the gym 2-3 times a week since last July and never had any issues. However starting december i weighted lifts (biceps, upper back and shoulders) right after a yoga class, which i had never done before, additionally i stupidly increased the weight and overall intensity in an effort to compensate for not having done much exercise wise on that particular week. Next day i played tennis and was demoing a racquet which had kevlar on the mains and i think nylon on the crosses, previously i had only ever used nylon i think.
    Next day after that i started to feel some pain on both elbows but much more noticeable on the right one. I'm right handed and use a OHBH. So i was thinking that maybe increasing the weight training all of a sudden on what were perhaps very stretched joints due to the yoga class may have been the problem, and being right handed that was the arm that would suffer most.
    However time has passed and the discomfort is still there. Initially the pain was really only noticeable when i rotated my forearm with a 90 degree bent arm, after some time that went away and now i mainly feel it when i stretch my right arm to its max. While playing tennis i haven't felt issues, except a sporadic small amount of pain on the OHBH. However i've only played maybe 3-4 times since the issues began.
    Left elbow is ok, but if i carry say a lot of groceries with it for an extended time i'll also feel some discomfort when i stretch it out afterwards.
    It seems clear to me that tennis didn't cause this, but obviously it may not help the issue, so i wanted to hear your thoughts. Another thing to note is that after the first week of rest i did a workout session at the gym (with less weight, being real careful) and the pain completely went away for the next 2-3 days of that session, but eventually returned. I haven't done any weights or yoga since then. The pain is located on the outer part of the arm, just above the elbow itself. Final thing to note is my work involves using a mouse all day long, so just in case i've started to use the mouse with my left arm for about 3 days to see if that helps a little.
    In this forum i've read about the flexbar and may try it if i find it locally .
    Thoughts? thanks!
     
    #1
  2. Ramon

    Ramon Hall of Fame

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    It sounds like tennis elbow, and it could be due to your form on your backhand. You might want to have a teaching pro look at it. The Kevlar strings definitely didn't help. Stay away from Kevlar and Polyester.

    I use the green flexbar, and I like it. If you can't find it locally, you can get it on Amazon.
     
    #2
  3. rufusbgood

    rufusbgood Semi-Pro

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    If you had said the pain is located on the outer part of the arm just below the elbow itself I would say, yes you've got tennis elbow. Not sure about your English in general though. So here's a picture. The red dot is where it should hurt if you have tennis elbow. And this is a right arm with the bicep being in the top of the picture and the forearm at the bottom.

    [​IMG]
     
    Last edited: Jan 16, 2012
    #3
  4. jatnut

    jatnut Rookie

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    You should also make sure that your workplace ergonomics are correct.
    My TE was brought on by poor computer posture and then I blamed it
    on tennis because I was trying out a 1 handed backhand. Its only when
    adjustments to my neck and shoulder alleviated the pain that I made
    the connection.

    Hope u get better soon.
     
    #4
  5. Alejandro Lanza

    Alejandro Lanza Rookie

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    Understood. Yes my instructor told me to try and use a slightly bent elbow, not sure if that'll help but i may give that a try. Or simply start with a 2hbh, it's not like my ohbh is that great to begin with hehe. I'll get that fbar from amazon. Thx

    It's definitely on the biceps side, and i only feel it when i try to stretch my arm really straight. I know little to nothing about anathomy but it feels close to where one of the triceps goes into the elbow, more or less around that soft spot that if you get hit sends a shock down your arm

    Thanks and yes that's why i got started with using the mouse with the other hand, i think the table top is too high, i'll see if they can get it fixed.

    Cheers!
     
    #5
  6. Chas Tennis

    Chas Tennis Hall of Fame

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    Tennis Elbow, Golfer's Elbow, A picture of tendon healing

    I am not educated in this subject so double check each point.

    Tennis elbow refers to injuries where the tendons from the lower arm connect at the elbow.

    Tennis Elbow. 90 % cases are injuries to the upper outside of the elbow (as shown in reply #3 by rufusgood). Known as Tennis Elbow or Lateral Epicondylitis (search terms). Backhand technique is often mentioned as a cause. The book by D. Knudsen, Biomechanical Principles of Tennis Technique, describes the angle of the wrist as being very important for preventing injury. When I bend my wrist as recommended I get a stronger 1hbh backhand. I give credence to the wrist angle as being important.

    Golfer's Elbow also called Tennis Elbow. 10 % of cases are injuries to the inner side of the elbow on the bony prominence, medial epcondyle. Know as Golfer's Elbow or medial epcondylitis. I have assumed the term "golfer's elbow" comes about because when golfer's swing and accidentally hit the ground it can injury the tendon at the medial epicondyle. Forehand technique can cause and serving maybe also, other motions? I got golfer's elbow suddenly trying to add pace to my volley with very poor technique.

    My version of what is likely to be going on for tendon injuries in general based on what I have read.

    I have read that tendon injuries usually occur at the tendon-bone connection or at the tendon-muscle connection rather than within the tendon itself. The tendons for both above injuries attach at the elbow bone over some small area, known as the "origin" of the muscle. These injuries on the epicondyles are therefore probably the tendon-bone type injury. Let's say that the tendon connects to the bone over a small area, say, for discussion an area of 3 square centimeters. Pain probably indicates some part of this area is injured, let's say 0.5 square centimeters is injured. Let's say the tendon is peeling off the bone in the 0.5 square centimeters where the strain was too great (during a tennis stroke). 0.5 square centimeters of the 3 square centimeter connection is involved in the injury and gives pain. Immediately healing starts. Now the injured person must decide what to do.

    I read in the Repetitive Strain Injury Handbook, pg 141, a brief description by Dr John Cianca. He said that playing on a new acute tennis elbow injury for more than a few weeks may cause the injury to heal with permanently weakened tendon tissue on the microscopic level. I would like to find more references on this subject as it may be very important in helping some people avoid chronic tendon injuries. I believe that my golfer's elbow healed because I stopped playing tennis completely after reading Dr Cianca's comments. In the meantime please don't play with tennis elbow and especially with a new tennis elbow or golfer's elbow tendon injury.

    See also reply # 29 in http://tt.tennis-warehouse.com/showthread.php?t=406699

    And Charliefedererer #4 in http://tt.tennis-warehouse.com/showthread.php?t=408660
    for a tendon healing description.
     
    Last edited: Jan 17, 2012
    #6
  7. Chas Tennis

    Chas Tennis Hall of Fame

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    Info on pinched nerves

    Since you have the pain in both elbows.

    My son gets some numbness in his fingers and arms after working out for a few months. He researched it and found that pinched nerves were one possibility. The various nerves that travels down the arm can get pinched, perhaps at the shoulder. Pain & numbness can result.

    Some information:

    http://emedicine.medscape.com/article/1285531-overview#a1

    Obviously there are many possibilities so you need to see a qualified doctor to get a proper diagnosis.
     
    Last edited: Jan 17, 2012
    #7
  8. mikeler

    mikeler G.O.A.T.

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    That is likely TE. If you don't have a backhand preference, definitely go with a 2 hander. That will take a lot of stress off your elbow.
     
    #8
  9. Alejandro Lanza

    Alejandro Lanza Rookie

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    Chas, thanks so much for your detailed answers and great links. What's harder is that i feel that even though i've been playing sporadically, i'm doing things i couldn't do before with the ball so it's frustrating having to accept that i may be better off giving it some rest. Regarding pinched nerve, i don't really feel numbness.
    Mikeler, i think i'll give the 2hbh a try before deciding to give tennis a rest for a few months.
     
    #9
  10. charliefedererer

    charliefedererer Legend

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    Tennis elbow is incredibly frustrating.

    But if you go back through several pages of the Health & Fitness Forum here on Talk Tennis, you'll see so many suffering from tennis elbow that it will seem like an epidemic.


    The most common link in all is that they all thought they could "play through it" initially, without taking a rest.


    But continuing to play means the inflammation continues.

    I just can't see your tennis elbow improving continuing to play, even if you do switch to a 2HBH.


    Normal tendons look a lot like a cable or rope in cross section, composed of many long fibers wound together and very organized to withstand the tremendous forces making our bones move by attaching muscle to bone.

    [​IMG]



    What tennis elbow represents is a tear, or multiple small tears in the tendon:

    [​IMG]


    White blood cells are attracted to the site of the tear.

    The white blood cells release chemicals [cytokines] to attract the type of cells [fibroblasts] that will make the tiny protein strands that will repair the tears.

    The protein strands are just like a spider's web - potentially as strong as steel - but not until the strands are all cross linked together.

    [​IMG]

    It takes many weeks for the strands to cross link and get their full strength.

    Bashing a tennis ball too soon means that the strands will be broken again and again.

    The result is a weakened tendon that never seems to heal, and yet remains inflamed and painful because the body is desperately attempting to repair it all the while you are destroying the progess made over the previous few days.



    The result can be a disarrayed jumble of scar tissue and tendon at your arm that is never going to be normal (degenerated tendon or "tendonosis"):

    [​IMG]


    Try to spare yourself from all the misery by resting now.


    [Even "rest" for most is not total rest, as we give our elbow a workout just in our activities of daily living. But at least we are not anywhere close to developing the forces to disrupt the tendon repair that we incur from bashing a tennis ball.]

    [Hold off from using the Flexbar green until pain has gone away. The red Flexbar can be used earlier to begin some range of motion movements (NOT strengthening exercise) and the Flexbar green can be used later for the actual strengthening.]

    [Also later after all the pain has gone away, dumbell wrist curls, reverse wrist curls and pronation/supination wrist excises can strengthen the forearm muscles and help prevent a recurrence. These are the last 4 exercises of the thrower's ten: http://www.muhlenberg.edu/pdf/main/athletics/athletic_training/throwers10.pdf But why not do all the exercises and help avoid a shoulder injury, the other bain of tennis players?]

    [Don't return to tennis until you have strengthened the forearm muscles with the flexbar green and those dumbell exercises above.
    When you do return, use a flexible frame and soft (multilfilament or natural gut strings.)
    Start with short hitting sessions and lengthen them slowly over time, as recurrences of tennis elbow are all too common.
    If pain recurs, you should put off your return until the pain again resolves.
    Hold off serving until you clearly can do hitting sessions without pain occuring.]
     
    Last edited: Jan 17, 2012
    #10
  11. Chas Tennis

    Chas Tennis Hall of Fame

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    You don't know what your injury is

    You described the pain as in both arms and "on the biceps side". Where exactly is the pain? TE?

    You don't know if you have tennis elbow. Maybe you gave yourself some muscle or similar tendon tears at the gym and have not let them heal? Tendon injuries take a long time to heal (see the Charliefedererer reply referenced my earlier reply). You take a risk diagnosing and treating yourself. Playing tennis with a tendon injury is one of the worst treatments. Resting a tendon injury for two weeks when tendons take 2-6 months to heal............ You would have to see a Dr for a diagnosis.

    I take TE very seriously as I believe that it was nearly a tennis show- stopper for me 2-3 years ago. I had one tennis friend, about 40, with chronic tennis elbow. A few times he would take off tennis completely for 6 months and it would be right back as soon as he started playing again. He quit tennis. A pathetic thing as he was an excellent player who loved tennis. I have another friend with TE who is now in the chronic/not chronic stage, he took off for 2 months, it came right back and he has stopped again. ? When I got golfer's elbow I bought one of those elbow straps. I subbed in a match with 3 other players that I did not know. All 4 of us had TE elbow straps! I'm glad that I stopped tennis in time.
     
    #11
  12. ChipNCharge

    ChipNCharge Professional

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    I had golfer's elbow for about a year. I tried all kinds of stretches, exercises, bands, braces, equipment changes, etc, but ultimately what worked was just not playing tennis for a few months and allowing my elbow to heal.
     
    #12
  13. Chas Tennis

    Chas Tennis Hall of Fame

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    #13
  14. Alejandro Lanza

    Alejandro Lanza Rookie

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    @Charliefedererer, thanks for the excellent and very informative post, what you're saying makes sense and i'll be very careful about my next move, i'll definitely follow your advice.
    @Chas and everyone else, going from above images/descriptions i can say for sure the pain is not what is known as TE. It's hard for me to tell you exactly where it is but it's definitely not where those images show it. I've googled a bit and the best description i have is that if i'm standing straight, arm in resting position, and then i stretch the elbow really hard, i feel pain around or just above the cubital tunnel. This is true of both arms but the right one will cause more pain with less effort. Regardless, i guess rest is in order, but i'll follow yours and other's advice once i get back to tennis.

    I'll go the the therapist that helped me some months ago with my knees (i'm now using orthotics, worked great) and see what his take is on my issue.

    So what do you people think in terms of rest/other sports? I like table tennis quite a bit and the other thing i like doing is basketball but sounds like elbows get a work out there too. Running is fine but can't really replace tennis as a sport. How about cycling? i guess a good deal of impact goes into the elbow but i haven't climbed onto a bike since i was in school. I see nowadays they have front suspension so that may help?

    Oh and those are great links Chas, i'll be checking them out too, thanks!
     
    #14
  15. mikeler

    mikeler G.O.A.T.

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    I played table tennis with my other arm for awhile.
     
    #15
  16. charliefedererer

    charliefedererer Legend

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    It's great to hear you have no intention of slowing down even if you have to take some time off from bashing that fuzzy yellow ball.

    While you have to swing your arms running and there is some jarring riding a bike, the forces are no where near those involved in firing a forehand/backhand winner or service ace.


    Agility drills http://assets.usta.com/assets/1/USTA_Import/USTA/dps/doc_437_269.pdf or High Intensity Interval Training http://www.intervaltraining.net/hiit.html may not initially seem your cup of tea, but if you try them, they seem more exhilarating if you time yourself, and track your progress. There is something about competition - with someone else - or even just against your best time - that somehow can make all the difference.

    I ran my sprints Monday as usual on a football field next to the tennis courts. While I am hardly a kid, I can feel like one as the 50 yard line suddenly appears in just a few seconds, then actually enjoy the struggle to finish the next 50 strong even with only a short interval from the last sprint.

    Are there playing fields, parks, woods, hills or neighborhoods that would be worth a run or bike ride through near you. You can start out in a slower mode, but you can also "attack" them more aggressively in a HIIT like pattern of maximal effort alternating with a stretch to "catch your breath".

    If your knees are not great for running, a lot of gyms are running "specials" right now for a couple of months, catering to those with a "New Year's Resolution" to "get fit". Some of stair climbers, cross country skiiers, and other equipment can be easier on your knees. Some of the electronics on these may seem glitzy, but again can be motivational.
    Kudos for checking with you therapist on what would be advisable.


    For many tennis players, the thought has gone through their head - if I got into better shape, would it really help my tennis?

    This may just be your opportunity to find out.
     
    Last edited: Jan 18, 2012
    #16
  17. Alejandro Lanza

    Alejandro Lanza Rookie

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    Not sure my left arm is good enough ffor that :) . So i guess you're saying i should try ping pong with my right arm correct? bummer...

    Thanks Charliefederer, that does lift my spirits. And yes i go to a university campus where i run a 4 km circuit and they also have a sand voleyball court that i like to use barefooted, i find it to be good for my knees (i'm flat footed). There's also a gym at work but I get really bored with the stationary machines, though i'll continue to do lifts for things not involving my arms.
    Anyways i have an appointment with a therapist tomorrow (not my previous one as he's out of the country at the moment), so i hope he'll be good.
    Thanks again!
     
    #17
  18. mikeler

    mikeler G.O.A.T.

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    Give it a whirl. Don't knock it without trying it. :)
     
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  19. jwbarrientos

    jwbarrientos Hall of Fame

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    Hi ChipNCharge, could you very kind of elaborating a little more your approach to the injury?

    I mean how long it takes to heal? 2/3/4 months?
    Have you changed your racquet? what brand/model?
    String setup?

    Finally Age/level? just to compare.

    I've been out for a month or so, doing some therapy tried to go back changing my frame to PK Ki5 295 and 315.
     
    #19
  20. Wildman

    Wildman New User

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    Tennis elbow?

    Hi to all,
    I've had pain in my elbow and wrist for months now. The doctor said the wrist is just sore (attempting to return a deep ball with my backhand), but my elbow pain remains a mystery. It is on the inside of the elbow (facing my body). I use an elbow band but to no avail: the pressure is not on the sore spot. I play every day, about two hours and have tennis lessons once a week. I use a babolat aero pro with polyurethane strings. Has anyone had something similar?
     
    #20
  21. Cindysphinx

    Cindysphinx G.O.A.T.

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    My goodness.

    Do some searches about using poly and continuing to play through elbow troubles.

    Spoiler alert: You need to address this.
     
    #21
  22. Chas Tennis

    Chas Tennis Hall of Fame

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    Golfer's elbow is on the inside. Search that and see if it is one possibility. Any sports medicine Dr should be familiar with golfer's elbow. Did the Dr examine you for your elbow injury?
     
    #22
  23. Wildman

    Wildman New User

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    The doctor and I spoke briefly about the pain, but at the time of my visit I didn't feel anything-just the wrist.
    Now, the last time I restrung my racquet, the pro at the shop did tell me that the strings I had were for string breakers, that needed to be restrung every two weeks or so, and if not the elbow would suffer.
    I may consider saving myself a visit to the doctor and see if new strings solve the issue. Who knows.
     
    #23
  24. Chas Tennis

    Chas Tennis Hall of Fame

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    I wish I could find this information referenced somewhere else as it is very important. In Repetitive Strain Injury Handbook (not in all Editions?) - Dr John Cianca described what can happen with an acute tennis elbow injury.

    If the injury is stressed while it is trying to heal for 'more that a few weeks' the tendon tissue can heal is a permanently weakened state on the microscopic level. That is, the fibers of the tendon become disordered. See Charliefedererer discussion & illustrations earlier this thread.

    I would take tennis elbow or golfer's elbow, similar tendon injuries of the elbow, very seriously.

    A tennis player from our blocktime had tennis elbow. More than once he would take off for 6 months and when he started playing the pain would be right back.

    I believe that most players who have developed serious chronic tennis elbow are probably no longer reading this tennis forum. The ones who have less extensive chronic injuries and are still able to play or the lucky ones who have recovered are the ones represented in the forum replies. Some have on going injuries with healing under very unfavorable stresses from playing tennis.

    I got an acute golfer's injury from stupid volleying technique using excessive internal shoulder rotation to increase pace. Instant ping & pain. Other stressing strokes, I believe, are the forehand with certain grips & topspin stroke patterns and serving with very poor technique. But who knows?

    I have not seen scientific evidence showing how certain strings and rackets effect tennis elbow. References?

    I have seen some discussion in D. Knudson's biomechanics book on tennis that says wrist angle is important for the one hand backhand. He notes that pros use their wrists in extension and not neutral or flexed as many amateurs do. When I use an extended wrist angle my one hand backhand feels like a better stroke.

    Search tennis elbow, golfer's elbow in the Health & Fitness Forum for more information.
     
    Last edited: Feb 23, 2012
    #24
  25. Wildman

    Wildman New User

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    Thank you chas tennis. It's true that it'd be safer to see that looked over by a doctor
     
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