PRP injection for tennis elbow - successful or not?

Discussion in 'Health & Fitness' started by aussie, Jun 16, 2013.

  1. aussie

    aussie Professional

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    I'd like to hear from anyone who has undergone a Platelet Rich Plasma (PRP) injection for tennis elbow (lateral epicondylitis) and if it firstly relieved the pain and then secondly healed the tendon. Basically, did the PRP injection work?

    I don't normally post in the Health and Fitness forum, but a 4 month long severe case of tennis elbow has sent me here. I have played tennis for over 40 years and never had so much as an elbow twinge in all that time. On February 7th this year, I lifted a fallen branch, felt a slight bit of elbow pain and thought nothing of it. Played tennis that night, and from the first hit was in severe discomfit. Have not played since that time and have spent time with 2 physiotherapists, 2 acupuncturists, a sports massage therapist and had an ultrasound guided cortisone injection. I have spent plenty of time doing eccentric exercises both with weights and the red Flexbar all to no avail. If anything, the elbow is much more painful now than it was 3 months ago. I have had the diagnosis confirmed by both ultrasound and MRI - degeneration of the common extensor tendon, or tendonosis.

    The pain is very debilitating - I cannot shake hands, squeeze anything, pick up the lightest objects without pain, shave, floss teeth etc let alone even grip a tennis racquet. I can stand a lot of pain and have undergone plenty of rehab in the past following surgeries - my left knee has been reconstructed twice plus 6 arthroscopies to repair meniscus tears or debride the joint, 2 arthroscopies on the right knee and a reconstructed right ankle to get back on the tennis court so I am no stranger to pain and painful rehab. But this consistent, nagging ache and pain is something again Just want to get rid of it and am hoping that PRP will start the healing process - at least have me moving in the right direction.

    I'm happy to undergo surgery to fix the problem, but have been told that surgeons will not touch it until I've tried absolutely everything and 1 year has elapsed. So PRP it will be and maybe some ART if that doesn't work. To that end, I am booked in to have a PRP injection here in Brisbane on Monday 24th and am hoping for the best.

    Your comments and advice would be most welcome and I'll post some updates on the PRP process and progress as time goes by.
     
    #1
  2. newpball

    newpball Legend

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    Medical advice on a forum, not a good idea

    Just my opinion but I absolutely think you should not take any medical advice from anyone on this forum. Please leave it up to the medical specialists and get a second opinion if you have doubts.
     
    #2
  3. aussie

    aussie Professional

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    I'm not seeking medical advice as such, just opinions, thoughts and perhaps anecdotal evidence as to the effectiveness of PRP injections for tennis elbow. Even so called expert medical opinion regarding this condition is laced with inconsistencies as we all know, so all and any opinions are welcome.

    To the above list of things I have tried I can add both oral and topical NSAIDS. I had high hopes for Penetrex cream, but for me it gave no relief but caused skin irritation. I also had some hope for Nitric Oxide patches but could only wear a patch for 4 hours before severe headaches set in and I had to remove it.

    So the PRP injection is my next big hope and does seem to work for many sufferers, but not all. My injection is now Thurs June27 and the cost in Australia is under $300 so it is not prohibitive.
     
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  4. kid-tennis-1980

    kid-tennis-1980 New User

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    Have you tried exercises for tennis elbow? IMO, I would not spend $300 on the PRP treatments until you have tried exercises. I just found a killer list of 10 exercises you can try:

    http://www.tenniselbowsecretsrevealed.com/top-10-most-effective-exercises-for-tennis-elbow-of-all-time/

    I found this study on PRP:

    http://www.foxnews.com/health/2013/01/23/platelets-steroids-may-not-aid-tennis-elbow/

    which in short says that more time is needed to see if they work in the long term. The study also confirms that cortisone injections are only effective in the short term.

    Good luck.
     
    #4
  5. RogueFLIP

    RogueFLIP Semi-Pro

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    First, sorry to hear about your symptoms....always a shame when we can't do what we love, and here on this forum, obviously tennis.

    Perhaps something to consider: what if the CAUSE of your pain wasn't at your elbow?

    Could all these doctors and therapists who are just treating your symptoms be missing something?

    Because if all they're doing is treating your elbow, treating your elbow, but you're worse off now than ever, is it possible that your pain isn't only coming from your elbow?

    Think about it like a rope, you pull on one end but you can feel the tug on the other end. Now if all you're doing is treating the one end where you feel the tug, but aren't doing something at the other end where the force is being applied, you'll never resolve things completely.

    Unresolved soft tissue restrictions and postural misalignments due to compensations for pain, all can still be a major factor to why things have not been able to resolve and have only gotten worse.

    Oh, to sort of not really answer your question, we just had a thread on PRP and stem cell injections on knees. Of course, not the body part you wanted and just because one person seemed to have some success doesn't mean it'll translate to everyone, but an interesting read.

    http://tt.tennis-warehouse.com/showthread.php?t=461985&page=5

    I hope everything works out for you.
     
    #5
  6. charliefedererer

    charliefedererer Legend

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    I'm sorry to hear you are having such a tough time with tennis elbow, and had such a tough time with your knee and ankle.


    It sounds like the PRP injection is very reasonable, as nothing else is working and your surgeon is unwilling to do any other procedure until you have the PRP.


    One of the big problems with "tennis elbow" is that it encompasses such a broad range of severity.

    Some have acute tendon tears and persistent inflammation because they keep returning to tennis too soon.

    [​IMG]


    Others have had such severe inflammation that the tendon has fibrosed (turned to scar tissue) and the inflammation has caused tendons, muscles and other tissue all around the area to become all "glued together" by scar tissue, so any movement involves pulling on adjacent structures causing pain.

    [​IMG]


    Since there is variable reaction at the tissue level among different individuals from PRP, and there is such a wide spectrum of tennis elbow pathology, it is not surprising that clinical trials have resulted in different findings.
    [By clicking on the following URL, you can read about the 7 published trial results from randomized trials: http://www.ncbi.nlm.nih.gov/pubmed/?term=prp+tennis+elbow ]


    But I give you best wishes for recovery with your injection.

    And while not scientific, I hope others that see this thread and have had
    PRP injections can give you their experience.
     
    #6
  7. aussie

    aussie Professional

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    Thanks guys for the input - all comments and views are appreciated.

    Reading the results of the trials of PRP injection reveals that even clinical trials do not agree. Some show no benefit over placebo injections, some show limited benefits and I guess that none show that PRP injections actually heal the degenerative tendon attachment, at least in an expeditious manner.

    The list of 10 exercises is very good. Some I have done and others not. But certainly I believe that they all have merit from both a rehabilitation aspect and as a preventative program. Many, if not all the exercises really depend on the severity of the injury. Certainly the light eccentric weight exercise really aggravates my elbow - not while doing it, but immediately after, my elbow is so sore, I can't flex or extend the elbow without pain.

    I'm often bemused when reading this and other forums about treating tennis elbow, that some tennis players claim that their elbows were so sore that they had to cut the amount of time they were playing down from say 4 times a week to just 2! IMO, when you get proper lateral epicondylitis, you can't even grip the racquet handle without pain so any tennis at all is impossible.

    My understanding of the PRP injection I'll be undertaking is that it allows the tendon to heal enough and reduce the pain to a level where I can begin a structured strengthening program. I know that the PRP injection by itself will not allow me to return to tennis etc - it will be the strength and function building program that will do this.

    I'm fortunate that in Australia we have health rebates that reduce the PRP injection cost to under $300 so it is worth the try. There appears to be little risk with this procedure, and hopefully, there will be substantial benefits.

    With evidence that almost 50% of recreational tennis players will suffer tennis elbow, we are all looking for a definitive treatment and way back from this insidious condition.

    I'll keep you all posted on how the PRP injection and following rehabilitation goes - it may be of some comfort and benefit to us all.
     
    #7
  8. Raul_SJ

    Raul_SJ Professional

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    How about cortisone injections.

    Some guys I know take cortisone injections along with some time off from tennis.
     
    #8
  9. charliefedererer

    charliefedererer Legend

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    Cortisone is a very powerful anti-inflammatory.

    Stopping the inflammation stops the pain.

    But since inflammation is the first step in healing, cortisone also turns off the healing.

    Therefore there is an increased risk of tendon disruption:

    "Posterolateral rotatory instability from multiple steroids injections for tennis elbow: a case report.
    - This article reports the complication (lateral collateral ligament rupture) arising from improper numbers of steroids injections for the chronic lateral elbow pain (tennis elbow)."
    - http://www.ncbi.nlm.nih.gov/pubmed/23724465


    "Corticosteroid injections are a poor treatment for tennis elbow

    - British Medical Journal

    Expert opinion is already turning away from corticosteroids for tennis elbow in response to mounting evidence that the injections don’t work for long and encourage recurrences. The latest trial compared corticosteroid injections, multimodal physiotherapy, both, or neither in 165 …"
    - http://www.bmj.com/content/346/bmj.f748



    "Corticosteroid injection for tennis elbow or lateral epicondylitis: a review of the literature
    Bernardino Saccomanni

    Treatment: corticosteroid injections
    Corticosteroid injection has been historically the most common intervention for lateral epicondylitis. This intervention must be compared to the efficacy of a “wait-and-see” policy because the disorder is most often self-limited.

    Smidt et al. [10] reviewed 13 randomized, controlled trials that evaluated the effects of corticosteroid injections compared to placebo injection, injection with local anesthetic and injection with dexamethasone and triamcinolone. Although the evaluated evidence showed superior short-term effects of corticosteroid injections for lateral epicondylitis in terms of pain relief and grip strength, no beneficial effects were found for intermediate- or long-term follow-up [10].

    Among prospective, randomized trials controlled with a placebo injection, none showed a difference at final evaluation.

    Altay et al. [11] compared 60 patients treated with 2 ml lidocaine to 60 patients treated with 1 ml lidocaine combined with 1 ml triamcinolone, with all injections performed with a peppering technique of 40–50 injections. Another trial compared disabilities of the arm, shoulder, and hand score, grip, and pain in 31 patients injected with lidocaine and dexamethasone and 33 patients injected with lidocaine only [12]. A third trial randomized 19 subjects to receive rehabilitation and a sham injection, and 20 to receive rehabilitation and a corticosteroid injection [13]. There was no significant difference between the two groups on a pain questionnaire, a visual analog pain scale, and a grip measurement at 4, 8, and 24 weeks (P < 0.05). Both groups improved significantly over time, with more than 80% of subjects reporting improvements from baseline to 6 months (P < 0.5) [13].

    Bisset et al. [14] in Australia and Smidt et al. [15] in the Netherlands randomized patients with tennis elbow to physiotherapy, corticosteroid injection, or a “wait-and-see” approach. In both studies, corticosteroid injection showed significantly better effects at 6 weeks (P < 0.01) but paradoxically high recurrence rates and significantly poorer outcomes at 1 year (P = 0.0001) [15]. In a randomized trial comparing steroid injection to naproxen and placebo tablets, injections were better at 4 weeks, but over 80% of patients were better by 52 weeks in all groups with no significant differences (P < 0.05) [16].

    In another double-blinded study comparing different kinds of steroid injections to lidocaine alone, Price et al. [17] found that the early response to steroid preparations was significantly better than for lidocaine (P < 0.5), but at 24 weeks, the degrees of improvement were similar. Of interest was the discovery that post-injection worsening of pain occurred in approximately half of all steroid-treated patients [17].

    Conclusions
    Corticosteroid injection is the corner store of care for lateral epicondylitis. The objective of such conservative care is to relieve pain and reduce inflammation, allowing sufficient rehabilitation and return to activities. Although this treatment has been described as highly successful, there remains a lack of information concerning the long-term outcome of steroid treatment. In conclusion, I believe that a corticosteroid injection runs the risk of delaying resolution of symptoms in the long run."
    - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941575/
     
    #9
  10. aussie

    aussie Professional

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    Certainly after I had an ultrasound guided cortisone injection there seemed to be some relief. Was this the anti-inflammatory properties of the cortisone (celestone I believe) or was it because I totally rested the elbow for 3 weeks? The relief I had at the 3 week mark disappeared very quickly after I commenced some light eccentric exercise.

    Interestingly, tendonosis of the tendon due to degenerative changes and the accumulation of repeated micro-trauma to the tendon (as all long time tennis players will have) is reputed to have very little inflammation - no swelling, no redness etc. Yet the ultrasound preceeding my cortisone injection at 1 month following the onset of the tennis elbow, showed quite an amount of inflammation present where the degenerative change to the tendon attachment was located. Which is possibly why cortisone injections which are powerfully anti-inflammatory, do give a quick relief from pain. However, it would seem that the very anti-inflammatory properties of cortisone which reduce pain also strongly hinder the inflammation necessary to supply the nutrients to stimulate healing. Therein lies the delicious dilemma which would almost amuse me if I wasn't the one suffering!!
     
    #10
  11. charliefedererer

    charliefedererer Legend

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    Cortisone is such a powerful anti-inflammatory that it can decrease inflammmation even in the presence of continued use.
    Hence the danger in an athlete continuing to play with a damaged tendon - leading to rupture.



    I believe tendonosis is the end stage of the inflammatory process of tendonitis.

    As your case illustrates, surgeons are cautious about operating on "tennis elbow". When they finally do, they often find abnormal fibrosed tendon segments that they remove.

    [​IMG]

    When that abnormal tissue is examined under the microscope by the pathologist, there usually is little inflammation [manifested by few white blood cells in the tissue].

    For some reason, this seems to be a great surprise to many - and a great mystery that tendonosis does not have inflammation.

    But orthopedic surgeons are going to be conservative and just remove the most abnormal tendon segments.

    The finding of "tendonosis" as a diagnosis from the densely scarred tissue that is removed is not a surprise to me.


    I agree.

    Cortisone acutely relieves inflammation, and hence pain.

    But cortisone also turns off healing, because inflammation is the first stage of healing.

    Millions of years of evolution resulted in inflammation precisely as the initiation of healing.
     
    #11
  12. Tamiya

    Tamiya Semi-Pro

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    perchance when you drive, do you hoik your arm on the door sill?
     
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  13. aussie

    aussie Professional

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    Yes, being Australian with the steering wheel on the right side of the car and having tennis elbow in the right arm I do have to be careful not to knock the lateral epicondyle on the door arm rest. It's not agony when I do, but not pleasant. It wouldn't prolong the tendonosis but still to be avoided.
     
    #13
  14. dannysul

    dannysul Rookie

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    PRP is a crap shoot, you'll never know unless you try it yourself. A good surgeon should be able to determine if your past all stages of properly healing without going under the knife though.
     
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  15. sadowsk2

    sadowsk2 Rookie

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    hi there. I to have been battling CHRONIC tendinosis of the lateral epicndyl brought on from overuse of playing too much tennis as I've gotten older and I had a PRP injection done to no avail IMO... A bit of my history for what its worth for you to put everything in context...

    I began feeling that dull ache of tennis elbow tendinosis in early April 2012. I didn't take it serious and continued to play (DUMB DUMB DUMB ME).. I proceeded to play until the beginning of July 2012 until the pain was so unbearable I had to stop. Like you, I couldn't so much as turn a door nob, and it hurt even if the arm was idle. I proceeded to rest it followed by a vigorous PT regiment (flex bar, wrist curls, resisted wrist pronation/supination, etc)... By September I was asymptomatic. My orthopedic doc suggested I try hitting- going real easy at first and slowly building it up. My first hitting session was roughly 30mins with predominantly light hitting- 48 hours after that the pain was back with vengenance. My ortho doc then suggested a PRP to try and kickstart further healing of the tendon... I had a PRP done on Thursday, November 1st 2012. As I'm sure you've read, its very painful for the first 24-48 hours. I then proceeded to begin PT once again... I had an ultrasound done in March 2013 that showed the tendon improved some in terms of collagen sythesis, however I still had a high degree of neovascularization. I continued with my therapy and was asymptomatic in May. I tried to hit again and made it through 2-3 light hitting sessions... I dialed it up a little more and the pain came back- not as bad as before (I would say I was a 3.5 on the Nirchl tennis elbow pain scale). I took another ultrasound on early June and it showed SLIGHT collagen degeneration with no change to the neovascularization. Soooooo, here I am, again doing PT and fortunately I am now, about one month since hitting almost pain-free, however the tendon isnt looking like a healthy one when viewed under an ulstrasound. At this point I am going to continue to rest it and not play tennis for a few months. Hopefully aroud September-October I will try and hit again (presumable being ~2-3 pain-free)... if pain returns I need to do something...

    Soooooo, to answer your question, I don't believe the PRP did much of anything for me. However, as crazy as this sounds, I am actually considering getting another one done if my next ultrasound in September doesnt show any improvement. Either that or a prolotherapy (did I spell that wrong?) shot. Why do it again? I absolutely don't wanna do surgery unless I feel I've exhausted every available option. I believe at a minimum the PRP will agitate the tenocytes in the tendon and spur an inflammatory healing response from the damage the needle makes... Furthermore, as you said its relatively low-risk though about ~$700 here where I live in the US. I'd be willing to give it another try before considering the knife. I am slowly beginning to think I might be one of those folks who fall in the "15%" group: those who can live pain-free of tendinosis for daily activities, but simply reinvite injury/pain when playing tennis... So I may not be able to play tennis again, however it won't be from a lack of doing everything possible to play again.

    FWIW- I'm 37 years old, *WAS* a high 4.0 player, used a 1hbh for years... my racquet was a Babolat Pure Storm Tour and I used babolat VS Touch natural Gut at 50lbs
     
    Last edited: Jun 21, 2013
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  16. sadowsk2

    sadowsk2 Rookie

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    BTW- If you do proceed to get the procedure done, please do post your progress here for future folks considering the treatment! Best of luck!
     
    #16
  17. EP1998

    EP1998 Semi-Pro

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    Wow, you're the fourth person I've heard of having arm problems with that racquet. I would get rid of it. I played with it and developed problems. I never thought it was the racquet because it isnt known for arm problems. I've never had arm problems previously, even when I'd practice serves for two hours a day when I was in my 20s (not with that racquet).

    I switched racquets when I was playing with a coach/friend who politely said "your racquet isnt good, try mine" which I did and I liked his racquet better so I bought one. I was reluctant to switch racquets even though I was struggling with arm problems because i dont like change. But I did change to a Wilson Blade and have not had an arm problem since. The light really went on when I went to a tennis event and ran into a player with the exact same kinieso arm/shoulder tape job I'd had a year earlier, and that's the racquet she was using (the pure storm)! Her symptoms started the exact same way as mine.
     
    Last edited: Jun 21, 2013
    #17
  18. mikeler

    mikeler G.O.A.T.

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    The PST got to my shoulder as well which is why I dumped it.
     
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  19. sureshs

    sureshs Bionic Poster

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    There are doctors and physios who post here. Not everything should be left to one or even two people. They are also humans, and could be wrong, not to mention they may be the unscrupulous types prescribing unnecessary procedures.
     
    #19
  20. RogueFLIP

    RogueFLIP Semi-Pro

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    Sadowsk2,

    First, you have my sympathy to your current condition.

    If you didn't see my Reply #5, I'd suggest you look that over for questions to ask yourself.

    Supplementing my response that soft tissue restrictions can reach down to the cellular level. Meaning that if there is a significant restriction in the area, it will not allow for proper "flow" in the area, disrupting the normal healing process. Medicine will not be able to reach into the region, it'd be like pouring water over a stone.

    I wish you luck in your current course of action. Just make sure you question yourself that if your previous actions didn't result in a satisfactory result, and you repeat those same actions expecting a different result....hmmm? Third time's a charm maybe?
     
    #20
  21. sadowsk2

    sadowsk2 Rookie

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    Funny you mention this, I had been using an AeroStorm Tour for quite some time, and really liked it.... I figured two years ago I should consider switching to a racquet that might be a little more arm friendly as I was getting older and simply can't let go of my 1hbh... So I opted for the PSTour as it was still heavy enough for me, but notably less stiff... I really like the racquet but I noticed the other day while I was gripping both of them that the AST actually felt lighter as the racquet is 10pts head light versus 6 for the PST.. So it got me wondering if the racquet played into this some of my ailment as it felt like the PST was a bit harder to wield... At this point I've been analyzing every possibility no matter how remote
     
    #21
  22. Texas Scrambler

    Texas Scrambler New User

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    PRP Reply for Tennis Elbow

    I talked to a sports physician about PRP and he replied no documented medical evidence yet but seems to be working best for tennis elbow and achilles injuries. I was asking about knees and he did not recommend for that part of the body. I have a tennis lady friend with severe tennis elbow and PRP is the only thing that appears to be working for her.

    As a side note, it helps to be a guy. The extra testosterone assists in the healing process. Most ladies will elect out of this option for the obvious reasons but think about ways to increase testosterone while healing such as lifting weights in a slow controlled manner.

    Good luck and when you do get healed do the following: (1) identify with a tennis pro the technique/equipment that lead to the injury and retrain/requip and (2) lift weights. Your tendons can take a lot more abuse when they are bigger and stronger from lifting weights.
     
    #22
  23. aussie

    aussie Professional

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    Thanks for all the contributions thus far. Good to have as many opinions and thoughts as possible.

    I'm booked in to have the PRP injection on Thursday June 27 and for me, it can't come too soon. My elbow pain seems to be increasing with every passing week even though I have basically rested it with no strenthening exercises other than regular stretching (which seems to aggravate the elbow anyway).

    I'll keep everyone updated on the procedure and the results (hopefully positive) as time goes by. I've missed more than 4 months of tennis and other activity and I really do not want to rush my return to tennis. I'm prepared to follow whatever rehab protocol is required and my aim is to have the elbow "tennis fit" by Janaury next year.

    If anyone else has anything to add, please do so as all comments are welcome.

    Actually 1 further comment to make - my referring doctor says he has seen some excellent results with tennis elbow following PRP injections and will not recommend cortisone injections again because of the success of PRP. I'm obviously hoping he is spot on!!
     
    #23
  24. aussie

    aussie Professional

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    One thing I failed to mention is that I gave Nitric Oxide patches a try. Some people have had success with them and clinical trials have generally positive results. The recommended dosage is a 1/4 patch applied every 24 hours - that is the patch remains on over the tender elbow area for 24 hours and then you remove that one and replace with another. This is supposed to continue for 6 - 8 weeks.

    I tried the patches 3 times but could not last more than 6 hours before the onset of very severe headaches. Headaches are listed as one of the major contraindications of Nitric Oxide patches and I certainly suffered. So unfortunately, another treatment with potential eluded me.

    Anyone else have any success with the patches?
     
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  25. aussie

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    Thanks for your import sadowsk2. It seemed that the PRP injection may have partially improved the health of the tendon attachment but not enough to withstand the constant trauma from hitting tennis balls. It may well have needed another PRP injection to fully heal the tendon and that in conjuction with the correct range of exercises may have resulted in a better outcome. Also, the tendon even with the possible "hurry up" healing urgency of the PRP injection, still can take considerable time to be completely healthy.

    For what it's worth, and this is for my benefit as well as yours, my mother was a very good tennis player back in the fifties. She tells me she suffered severe tennis elbow when she changed racquets and it was 18 months before she could play again. Once she did, the tennis elbow never cam back. Hope for us all!!
     
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  26. newpball

    newpball Legend

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    Aussie, how long have you been using polyester?
    I assume that if you pickup tennis after treatment you get something else?
     
    #26
  27. aussie

    aussie Professional

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    Haven't used poly for a couple of years. Use syn gut or multi. Nice soft syn gut is Forten Sweet which I'll stick to if and when I get back to tennis. I string my own racquets so will experiment with lower tensions than I've used in the past. Problem is I cannot even grip the racquet let alone swing and make contact with a ball.
     
    #27
  28. aussie

    aussie Professional

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    Okay had the PRP injection some 7 hours ago. Under ultrasound guidance, the physician injected the platelets directly into the site of the tendonosis. He observed that there was no major tear to the extensor tendon and that the collagen fibres were totally disrupted with calcium deposits spread throughout the site. Relatively painless although the needle made contact with the bone twice which was pleasant (not). He inserted the needle through the tendon twice which will also assist in the inflammatory response.

    From here, I wait for the pain of the injection to settle in around 5 days and then commence stretching and eccentric strengthening exercises.

    The elbow right now is somewhat swollen and fairly painful, but not excruciating. I'll update as time progresses and hopefully the outcome will be positive.
     
    #28
  29. sadowsk2

    sadowsk2 Rookie

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    Best of luck... Please keep us posted as to how you are progressing!
     
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  30. aussie

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    4 days post injection and the elbow is still slightly swollen with some associated pain. There is a degree of stiffness there as well. The physican said to use the elbow for daily activities following the injection but nothing too heavy or strenuous. Pain permitting, he wants me to commence eccentric exercises from about 5 days post injection.

    To me, 5 days post injection seems a little early. When researching the many sites on PRP, many say to wait for 2 weeks until commencing any exercises. Some even recommend immobilizing the wrist/elbow for 3 days after the injection.

    sadowsk2 and others, what rehab protocols did you follow post PRP injection?
     
    #30
  31. sadowsk2

    sadowsk2 Rookie

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    I started light stretching, splaying the fingers against light resistance, amd squeezing a real mushy stressball 4 days after the procedure. i started the eccentrics 7 days post-operation. On a side I visited a highly regarded orthopedic doc local to my home, and he seemed to indicate I should wait 3-4 months once I'm a-symptomatic... I'm almost at that point which means hopefully I can start playing come October... He also inidcated what we both already know: PRP is really hit or miss, but with low risk of side effects... hope youmhave better luck than i did with it. also, I also picked up a few Aerostorm Tour racquets, which he suggested I switch back to if I'd been using them for quite some time with no elbow problems... I find when using that racquet feed balls to my 5yr old daughter, the elbow feels strong.... Keep us posted on your progress! I'm eagerly following your progress as I've been there and no exactly how you're feeling
     
    #31
  32. aussie

    aussie Professional

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    Sadowsk2, when you started your eccentrics 7 days after the injection, had you noticed any lessening of your tennis elbow pain at that time? Or did you commence the exercises with the same amount of pain you had before the injection?

    It's just that I don't want to start the post injection exercises while I have the same degree of pain I had before the injection. I guess I would feel that I would just worsen the pain and make the whole point of having the PRP injection pointless.

    I read that it takes between 2 - 6 weeks before the elbow starts having a reduction in pain so I deduce that the rehab protocol is to commence the eccentrics a week after the injection - while still with tennis elbow pain, and then the pain subsides over the next month or so. Is this your experience?
     
    #32
  33. sadowsk2

    sadowsk2 Rookie

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    When I started my eccentrics I was in pain obviously... The key I've learned and believe, is that you do not want to ESCALATE your pain level. So, I started out going back to the red flex bar (was using blue right up to the procedure), doing wrist flexor and extensor curls with a 1lb weight and my arm/elbow supported by a table and gradually built it up from there. Starting at that point was good as I my elbow was in pain but it didn't get worse, converesely it's gotten stronger and more pain free over a long period of time. The biggest improvement in pain youll see will happen around the 4-6 week mark. Today I'm at the point where I can do 50 reps of the following: blue flexbar, 8lb weight wrist flexor and extensor curls with the arm fully extended and UNsupported from the body. Pronation and supination loading with a big hammer, pronated and supinated bicep curl with a 10lb weight, and elastic band work as well. Itss about 1 hour of therapy most every day. My ADLs are great, my problem is when I try and play tennis.... So I've agreed to shut it down until the end of the year and hope by then I can resume playing.
    One of the world's leading orthopedic doctors on tendinosis, Robert Nirschl, has a pretty good report on his orthopedic website about what pain level you're at and what you should be doing. You can check it out here: http://www.nirschl.com/elbowten.asp. I highly suggest you try it out. He's published several major medical reports on tendinosis and also has had his surgical procedure for tennis elbow named after him... I found his pain scale to be helpful as it provides some descriptive characteristics to each pain level... Best of luck with the rehab and keep me posted!
     
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  34. charliefedererer

    charliefedererer Legend

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    Thanks for posting this source.

    It is one of the most succinct and reasonable explanations of the goals of rehab I have seen.

    Hopefully by posting some of this report, it may promt those suffering from tennis elbow to read the rest, and benefit from treatment.

    "While rest is appropriate in the acute elbow, the Virginia Sportsmedicine clinic advocates an alternate definition of rest. Rest is defined as the absence of abusive activity, not absence of activity. All tissues, particularly injured tendons, require tension and motion to maintain health. Total immobilization is obviously contra-indicated as it results in muscle atrophy, weakness, and decreased vascular demands. More specifically, immobilization at the elbow results in limited capsular extensibility, joint stiffness, fibrous fatty tissue adhesions and random alignment of collagen fibers. Changes at the muscular level include loss of myofibrils, decrease in the number of mitochondria, and decreased tension-generating capabilities.

    Because individuals with tendinosis experience some degree of discomfort, Nirschl and Sobel devised a classification system to help delineate the significance of the pain. This allows the therapist to better assess the injured elbow and offers guidelines for where to start the individual on the necessary rehabilitation portion of the program.

    PHASES OF PAIN
    Benign Pain
    Phase 0: No pain or soreness
    Phase 1: Stiffness or mild soreness after exercise activity. Pain is usually gone in 24 hours.
    Phase 2: Mild stiffness and soreness before activity which disappears with warm up. No pain during activity, but mild soreness after activity that disappears within 24 hours.
    Phase 3: Same as above with mild pain during activity which does not alter activity, disappearing in 24-48 hours. Counterforce bracing may be considered here as well as mild anti-inflammatory medication.
    Phase 4: Mild to moderate pain before, during, and after exercise which alters the exercise or activity. ADLs are affected. Phase 4 is indicative of some level of tendon damage.
    Phase 5: Moderate or greater pain before, during, and after exercise or activity, forcing the patient to discontinue the exercise. Pain is experienced with ADLs. Usually reflects permanent tendon damage
    Phase 6: Phase 5 pain that persists with complete rest. Pain disrupts ADLs, many activities have to be eliminated.
    Phase 7: Phase 6 pain with disruption of sleep on a consistent basis. Pain is aching in nature and intensifies with activity.

    Pain phases 5, 6, and 7 indicate increasing percentages of permanent tendon damage.

    Rehabilitative Exercise Program and Promotion of Healing

    The goal of rehabilitation is to promote optimal healing of the injured tissue. Rest and pain relief offer no stimulation to the injured tissue. Injured tendons must increase vascular supply, synthesize new protein, and ensure the collagen matures into healthy tissue.18 Rehabilitation promotes strength, flexibility, and endurance in the injured and adjacent tissue. The S.A.I.D. principle (specific adaptations to imposed demands) is followed whereby demands are placed on the body in order to force the body to make adaptations. These adaptations include neural adaptations such as increased motor unit activation with increased motor unit coordination, recruitment, and firing, as well as intrinsic muscle adaptations including increases in the number and size of myofibrils, in the number of mitochondria and in enzymatic content of the muscle cells. Studies have demonstrated that training increases the tensile strength of tendons as well as promotes invasion of vascular elements in tissue. 25,27

    The objective of elbow rehabilitation is total arm strength. Trained muscle is able to absorb more energy prior to failure, and the incidence of injury increases with fatigue. This is because as a muscle fatigues, greater stresses are absorbed by the tendons. A concept the clinic emphasizes is that you cannot play your way into shape. You get in shape to play a sport, not play a sport to get in shape. Consequently, it is the duty of the therapist to better prepare the individual for return to participation in work, recreational activities, and sports. "
    - http://www.nirschl.com/elbowten.asp
     
    #34
  35. sadowsk2

    sadowsk2 Rookie

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    Anytime... Like you said I like the rehab layout... Characterizing the pain levels was also very important to me as it attempts to mitigate the subjectivity of it all... There are a few more noteworthy websites ill try and post which may prove useful to some folks. Believe me, I've spent ALOT of time researching this terrible condition.. It's really impacted my life and others as well
     
    #35
  36. EP1998

    EP1998 Semi-Pro

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    IMO, I wouldnt touch any Babolat racquet. I hate to say that because its a great company....
     
    #36
  37. aussie

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    Thanks sadowsk2 and charliefed for your continuing input both here and elsewhere. Tennis elbow is indeed a terrible condition - one I had given little thought to until I succumbed to it back on Feb 7. I'll check out the websites you list above as one cannot get enough information about this condition and how to prevent, treat and recover from it.

    sadowsk2 from what you describe you have certainly faithfully followed the correct rehab protocol with the range of execrices you have performed. All the literature and information I have found detailing the correct rehab protocols for lateral epicondylitis have been performed by you to a tee. And yet even with your seemingly full recovery from the condition demonstrated by your pain free execution of the exercises, when you return to tennis the condition flares again. It may well be, and you mentioned this earlier, that there is a small percentage of people who recover from tennis elbow well enough for pain free daily activity, but the resumption of tennis induces the condition again. Unfortunately, you and possibly me, may fall into this category.

    I can offer you one piece of hope however. I have a friend who is a coach at a tennis center here in Brisbane. The manager is a keen tennis player who suffered dreadful tennis elbow for a year, and like us tried everything possible to get rid of the condition. After a year, he finally saw an orthopedic surgeon who operated on the elbow. 8 weeks later, he was back on the court, no pain and full function of the elbow. He has experienced no further problems.

    So, even though we would all rather avoid surgery, it is comforting to know that surgery is an option. It aint over till it's over!

    Thanks for your advice thus far and I'll keep posting updates on my "progress".
     
    #37
  38. mikeler

    mikeler G.O.A.T.

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    I don't agree with the conclusions at the end under "Techniques and Racquet Design"
     
    #38
  39. sadowsk2

    sadowsk2 Rookie

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    I tend to agree with you... I don't think his site should have tennis-specific information so I wouldn't put too much credence to that... The medical protocol though is of tremendous insight... Another important note from his site is as follows:

    "2. Continue the full rehabilitation exercise program for a minimum of 1 month following return to full sport or activity. If no pain is present, the program may be reduced to 2 x a week thereafter on a permanent basis."
     
    #39
  40. mikeler

    mikeler G.O.A.T.

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    Yes, the rest of the info is very helpful.
     
    #40
  41. aussie

    aussie Professional

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    Thanks for posting the link sadowsk2. Well worth a read by anyone suffering or recovering from elbow tendonosis. Interesting that the authors mention the type of exercises involved in the rehabilitation, but do not specify that the wrist extension exercises should be eccentric only (arm supported, palm down, uninjured hand lifting the weight and lowering slowly with the injured limb).

    I like that the authors have devised the rehab exercises around the Phases of Pain which gives very clear guidance to patients at home. I also like that the stage 1 exercises are to be performed with the elbow bent to 90 degrees and supported on the patients leg etc. This is important as my early eccentrics were done with my arm straight and I now know that this is incorrect.
     
    Last edited: Jul 4, 2013
    #41
  42. aussie

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    Well 2 weeks have elapsed since my PRP injection and no good news to report at this stage. At 8 days after injection I commenced light stretching and light eccentric strengthening exercises (120 gram weight), but elbow did not like it. Basically feels like nothing has changed since before the injection - same pain when gripping, squeezing, lifting and holding.

    Many people report that there is no noticeable pain relief until around 3 - 6 weeks following injection so I'll cling to that glimmer of hope. I have ceased all stretching and eccentric strengthening for the time being to give the platelets maximum time to encourage healing without being irritated by the tendon being stressed.

    I'm hoping that in a few weeks the pain will have died down enough to recommence the exercises.
     
    #42
  43. Talker

    Talker Hall of Fame

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    I was wondering if they mentioned to not use anything to control inflammation?
     
    #43
  44. aussie

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    Only ice and paracetamol (acetaminophen in the US) if neccesary - no anti-inflammatory med such as ibuprofen, voltaren etc. I did not take any pain relief meds or use ice at all after the PRP injection as I want the full inflammatory benefits of the injection to occur. So far the pain part has occurred, but not the healing. Time will tell.
     
    #44
  45. Talker

    Talker Hall of Fame

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    Very good to let the inflammation do it's job.
    The pain will also help you to be aware of when there is too much stress in the area.
     
    #45
  46. comeback

    comeback Professional

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    I had the worse case of tennis elbow and couldn't wash my hair or lift a cup into the microwave. But I am playing now pain free. It took 4-6 weeks but worked. Don't squeeze anything like the flexbar or a tennis ball. it will only make it worse
    As i have advised in several other threads, the flextend glove www.flextend.com works
    Flextend is a proven medical device COVERED BY INSURANCE and actually has an insurance code# so you will get reimbursed. Used by professional golfers guitar players etc that really works and then will strengthen your entire finger, wrist, forearm, and both sides of the elbow. Here is the video for tennis elbow but there are many other videos next to it on Utube that cover the fingers,wrist, forearm etc..it's also GREAT for carpal tunnel..send me an email at comeback@safe-mail.net if you need further details
    https://www.youtube.com/watch?v=AVhlgBDy_F8
     
    #46
  47. Arthuro

    Arthuro Semi-Pro

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    Inflammation causes the healing response. If you stop the inflamation the body will not know what or where to heal.
     
    #47
  48. john blackman

    john blackman New User

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    Another glimmer of hope!

    After reading this stuff it might justify not going under the knife. Been out of tennis for a year with a attenuated scapholunate rupture(tear in wrist). Had 2 wrist surgeons look at xrays and mri with confirmation. Surgery then a year before playing. You guys think PRP could help before going under the knife. What I can tell there is only a slight chance the surgery will work anyway, so what the hell, might as well try. Anyone think this is worth looking into?
     
    #48
  49. aussie

    aussie Professional

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    Certainly worth a consultation with a PRP physician. Be aware that there is no hard, clinical evidence that a platelet injection does actually promote healing. My physician says his best success with PRP has been with hips and then tennis elbow. Theoretically, it can accelerate healing in tendon, ligament, bone etc so may be a reasonable option for you.
     
    #49
  50. superdave3

    superdave3 Rookie

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    I am one of the few guys responding to you that was diagnosed with tendenosis. I can tell you that the exercises, stretching, and rest alone do not cure it, as I tried all of those. Also, forget cortisone injections, as they can weaken the tendon where it attaches to the bone, and then if it tears you could have major problems. After 6 months of both TE and GE which came out of nowhere, I went to a PT, who diagnosed it and also found I had weakness in my shoulder called external rotation, which had put more stress on my arm. With tendenosis, you have a build up of scar tissue that becomes so large your body shuts down trying to heal it. Unfortunately, you still feel pain, however. There was an excellent article a few months back in of all things AARP magazine about it, and how it mostly affects folks over 50 (I am 64). To heal it the therapist has to massage the scar tissue over several sessions, and in my case gave me exercises to strengthen my shoulder. It takes about 6 weeks to heal it and form new tissue and 8 weeks for the strengthening. She said this is the only therapy where you have to cause pain to heal, and said if this didn't work to have the PRP injection, but mine healed ok to where I did not need it. Hope this helps.
     
    #50

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