TE Relief: Racket+Strings+Tension+Rest

Discussion in 'Health & Fitness' started by DaveInBradenton, Jul 24, 2013.

  1. DaveInBradenton

    DaveInBradenton Rookie

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    If you're reading this, you've probably had Tennis Elbow. (Those players who haven't had TE yet, are thinking they will never get it)

    Last year when returning to tennis after a 15 year hiatus and being 68 years old, I soon got Tennis Elbow. So, I got online and discovered that the cure was some combination of the following:

    Rest or cease playing

    A flexible racket

    Low string tension

    Natural gut strings (probably 17 gauge)

    Throw in some rehab exercises and you're probably on the road to recovery.

    I did the above and I have been pain free for six months or so. I practice three sessions a week and never feel my elbow. A great feeling!

    Today my elbow hurt and I want to pass along to you what I think the cause is so you can be forewarned.

    One week ago I got three demo rackets from TW, all ProKennex. PK is noted for it's arm friendly rackets, the Kinetic System. For the last 4 months (2-3 times a week) I have played with a PK Kinetic 7G model, 17 gauge VS Natural gut at 50 pounds tension. No elbow problems, period.

    The past week I hit three sessions with the demos, the last two with the Q5 295 and the Q Tour 295. They are both strung with Wilson NXT 16, presumably at the middle of the recommended tension range which is 57 or 58 pounds.

    Today my elbow hurts. I last played the day before yesterday so a two day delay in pain (DOMS ?). The elbow hurt enough that I took Tylenol.

    I strongly suspect that the pain is due to the strings and the tension. IF this is the case, it again suggests that natural gut with low tension is the way to go to prevent Tennis Elbow.

    I know the cause & effect is speculative on my part, but I have a new PK Q Tour 295 arriving today from TW, strung with 17g Wilson natural gut. I will play test it and evaluate it's effect on my elbow.

    Have fun,
    Dave
     
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  2. Chas Tennis

    Chas Tennis Hall of Fame

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    I don't know about the equipment and especially the strings. I wish people would post more research on the effects of equipment.

    If some part of your tendon has just been injured I believe that playing and stressing it as it starts to heal is very risky. You have an opportunity now to just not play and optimize the healing and perhaps avoid chronic tendinosis (defective healing).

    my reply from another forum

    "I have been trying to understand the nature of tendon injuries and, in particular, the nature of tendinitis (with inflammation) and tendinosis (with defective healed tissue).

    This British Medical Journal article seems the most reasonable view that I have found.
    Time to abandon the “tendinitis” myth
    www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

    Another, more detailed paper,
    Tendinosis
    www.ncbi.nlm.nih.gov/pmc/articles/PMC3445129/

    Review paper-
    Current Concepts in Examination and Treatment of Elbow Tendon Injury
    sph.sagepub.com/content/early/2012/10/29/1941738112464761.full
    -----Excellent review paper - but no magic bullet - no longer available free. ----

    Since many injuries are probably a mixture of the two conditions, what to do and especially when to do it seems very important and complicated.

    Research on early tendon healing is important.

    The first publication states briefly that tendinitis is usually gone in 2-3 weeks and then injured tissue looks more like tendinosis.

    "Animal studies show that within two to three weeks of tendon insult tendinosis is present and inflammatory cells are absent."

    Stressing an injured tendon especially with an activity similar to what caused the injury is more likely to produce tendinosis, the more chronic condition discussed above.

    Read more: http://asmiforum.proboards.com/sear...ast_one=tendinosis&display_as=0#ixzz2ZyxpzIBg
    "

    In a risk-to-benefit analysis,

    1) the risk is - of getting some unknown degree of tendinosis
    2) the benefit is hitting tennis balls in the next weeks.
     
    Last edited: Jul 24, 2013
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  3. newpball

    newpball Legend

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    Listen to your body, if there is pain don't don't continue to play. The pain is there for a reason, it's to wake up the brain to say: "hey, stop what you are doing because this is not good for you".

    I believe gut is by far the best string for your arms.
     
    #3
  4. mikeler

    mikeler G.O.A.T.

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    I cut out NXT 16. It was too hard on my elbow.
     
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  5. DaveInBradenton

    DaveInBradenton Rookie

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    Mike, thanks for your input. As usual, you are a fountain of knowledge.

    This lends credence to my theory that the NXT (at mid tension) caused my slightly sore elbow, even when using an arm-friendly ProKennex.

    My new PK Q Tour 295 (Wilson 17g N-gut) arrived yesterday. I will rest my arm today and test the Q tour tomorrow.

    Based on the radar, I don't think you'll be playing tennis in Orlando this morning. BTW, I occasionally go motorcycling west of Orlando on the scenic roads near Polk City and Groveland.

    Best wishes,
    Dave
     
    #5
  6. mikeler

    mikeler G.O.A.T.

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    I used NXT in the PK 7G if I recall correctly. I'm in Germany where it is sunny and warm but no humidity. Lining up tennis on the red stuff next week.
     
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  7. RogueFLIP

    RogueFLIP Semi-Pro

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    In addition, IMO:

    Correcting any postural issues
    Reducing any soft tissue restrictions
    Identifying and correcting technique

    Honestly I think those are more important than the racket and strings. You can have the softest racket and strings, low tensions, but if you don't address the above, all it could take is one wrong swing, one wrong hit, and all your troubles will come back to haunt you.

    There's been plenty of threads here about oh I've got TE/GE whatever....I rested, flexbar'ed, switched rackets/strings.....but it came back....help! what do I do??

    OP, hey though, I'm glad you are feeling better.
     
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  8. Posture Guy

    Posture Guy Professional

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    Amen.

    In EVERY case of tennis elbow I've ever seen in my clinic, the shoulder and upper back position was compromised, which pushed the elbow out of position. The problem isn't inflammation. It's what is CAUSING the inflammation. A player with sound technique and reasonably good postural and soft tissue health can play with just about anything and be ok. If the elbow is positionally or functionally compromised, softer racquets and strings can help by reducing the demand on the compromised joint that is already close to threshold. But that's addressing symptom, not cause.
     
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  9. RogueFLIP

    RogueFLIP Semi-Pro

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    http://www.youtube.com/watch?v=i92rtcbWqcM

    Well, I might suggest a racket/string change in this instance if they were complaining. :)
     
    #9
  10. Chas Tennis

    Chas Tennis Hall of Fame

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    If there are any research references available that discuss this cause of tennis elbow, please post?

    Knudson indicated that tennis elbow for the one hand back hand might result from a technique issue where the wrist joint is held in a flexed instead of an extended orientation as most pros do. I looked at pro 1 hbhs and they do hit with the wrist extended. It would be great to find other research papers that describe other causes.

     
    Last edited: Jul 25, 2013
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  11. bertrevert

    bertrevert Hall of Fame

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    See what I did find interesting in what you wrote here, and relevant for my mild case of TE - after rest, and not playing for 2-4 weeks, my elbow feels better - but the material you draw upon advises that that is NOT time to play.

    It's tempting to go and play as soon as the pain subsides but would I be wrong if the advice says there's still 2 or 3 weeks where it's vulnerable?

    Absence of pain doesn't mean it's ready, nor is it smart to provoke a secondary condition.
     
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  12. Chas Tennis

    Chas Tennis Hall of Fame

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    please excuse the rambling -

    Few weeks ??? My interpretation came from a Dr's description in a book. He said that if you play on an acute tennis elbow injury for 'more than a few weeks' ??? you risk developing defective healing. I believe what he said. I found the information while dealing with an acute and very painful case of GE. I stopped immediately after reading it and credit that advice for possibly preventing my getting chronic GE. Of course, who knows what is going on inside the the tendon tear itself.

    The British report on tendinosis fits well with what I see myself. Chronic TE is prevalent. At one time, I wore an elbow brace for a short time. On one court, all 4 not-so-young players were wearing elbow braces. Both the best man and best woman player in our club have TE that does not heal. Another player took off 6 months - on more than one occasion - only to have the TE come right back as soon as he played again. Last year another enthusiast had to quit because of TE, out now for about 1 1/2 years.

    People who have quit tennis are probably not reading this forum and writing replies on how they were cured. Their experiences are under-represented in the replies. They are not on the courts either.

    Of course, the average case of TE is not so simple as a fresh, acute tendon tear. People usually play on TE for months to see how it will do.

    In my opinion, many players, including me, have some percentage of their tendons that have not properly healed. That portion of the tendon could be classified as having tendinosis. Probably some tendon tissue is still healthy tissue. ?? Maybe the tendon tissue has stabilized. But any tissue with tendinosis is weaker so probably the chronic condition will get worse with the strain of tennis. For example, I believe that my GE tendon is 90-95% healthy tissue and 5-10% characterized by tendinosis. That's why I get a little mild GS's pain a few times a month after I hit certain shots.

    Let's picture what must be happening if you get a tendon tear - some percentage of the tendon's cross section has been separated or structurally seriously damaged. The body immediately begins to clean up the blood and damaged tissue. If the player stresses the tendon again with the same forces that just tore the tissue, what does that do to the healing process?

    A few weeks is not enough.

    3-4 Months ??? With my acute GE injury, there was a sudden very distinct pain, there was also a second sudden reinjury maybe 1 or 2 weeks later. I screwed around for about 3 weeks before finding the above description of tendon injury by the Dr. I then stopped for about 2-3 months. When I started back there was a little pain that lessened as I played. Please don't take this as a way to deal with a tendon injury. I did not see a Dr.

    One Year???
    At the time of my GE injury I was asking around about GE & TE injuries. A woman had a story for her TE. She got a painful TE injury when she first started tennis. The Dr told her to put her racket in the closet for one year and not to touch it. She did as he told her. After the year, she played for 40+/- years and her elbow was OK.

    Search tendon healing times in replies by CharlieFedererer in many recent GE & TE threads.

    I am not qualified to give instructions on how to heal unknown tendon injuries, how long to avoid strain, etc. But from what I've read it's bad - risking chronic tendinosis - to play on a fresh acute tendon injury and that the earliest healing is important.

    See a Dr.
     
    Last edited: Aug 2, 2013
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  13. newpball

    newpball Legend

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    I think one of the problems is people having the wrong expectations. Hope is the last thing left in Pandora's jar and it is not benign.

    I think that people getting those problems in the elbows, shoulder, knees, ankles or feet too often think that the doctor will do some magic and it is all in the past be it rest, stretching or taping or even injections or operations.

    I am sure there are cases where someone wakes up from the operation and is like a new person but hearing from people who actually got those issues they more often go from bad to worse only to be interrupted by the latest piece of $$$$ costing hope.

    The moral I think is be careful with what you have, play safe and sane and prevent these things.

    Pain is the a messenger of truth, your body is telling you what you are doing is not good. Listen to it.
     
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  14. vantageboy

    vantageboy Rookie

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    I Had Tendinosis......

    all above is what u need to do--what worked for me was.
    prolotherapy(6-8 visits)
    dry needling acupuncture(8 visits)
    5 months no tennis
    deep tissue massage
    flex bar
    at night i used a combination of tcm, vitm. e oil, 99.9 dsmo rubbed on my elbow/right shoulder every 2 days(after play as well)-none of this while u do the top 2.
    compression sleeve at work/bed.
    3 days rest between play.
    54 years young while not 100% i have no pain only slight soreness after i play.
    PATIENCE IS YOUR FRIEND.GOOD LUCK
     
    #14
  15. Shroud

    Shroud Hall of Fame

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    Interesting. So how does one treat the cause?
     
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  16. Posture Guy

    Posture Guy Professional

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    To pursue the path I outlined, you need someone who is trained to assess the body as a functional unit, and treat it as such. Sadly, there are fewer of these types of practitioners than there should be.

    There are some PTs who are very good, and the best typically don't take insurance and have a pretty good wait list. Most physical therapy focuses on the afflicted body part, but from my clinical experience, the problem is rarely where the pain is.

    For example, I had a client once with wrist and elbow issues. Upon assessment, as expected the same shoulder was significantly mispositioned, which then pushes the elbow and wrist joints out of position. So, the answer here is to fix the shoulder position, right? Well, yeah, but why is the shoulder out of position? Sometimes, it's a shoulder issue (for example, someone who uses that side of their body consistently differently than the other side, could be someone spending a lot of time at a computer doing drafting work doing fine manipulation with a mouse, or a dentist or surgeon who leads with their right hand). In this case, the left hip was so mispositioned that the person was having great difficulty initiating the swing phase of gait with the left leg, the part of walking where you pick the leg up and advance it forward. We're designed to move using opposite arms and legs in tandem, and they started throwing their right shoulder forward to help leverage the left leg into swing. We could've given them shoulder, elbow and wrist exercises from now 'til eternity and they wouldn't have gotten better. We had to use corrective exercise to restore position and function to the left hip so they didn't have to use their right shoulder in a compensated fashion just to walk.

    A good place to start with these concepts is the book I usually recommend, "Pain Free" by Pete Egoscue. Read the first 3 chapters, then do the exercises for elbow pain. Feel free to email me with any questions.
     
    #16
  17. bertrevert

    bertrevert Hall of Fame

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    Good advice.

    Re-visiting this because I had played through the TE for already a month or two before I wrote in this thread.

    Now after two months off... went back to two sets of doubles today... pain straightaway returned. Immediate.

    Seriously, pain is a... pain.

    Of the four on court three off us had elbow braces on. Pathetic.

    Okay will go up a grip size.

    Multi strings only.

    Playing thru pain drains the experience as well. I have healed from TE quicker than this before but I accept age plus fairly stiff racq is not a recipe for success cheers...
     
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  18. DaveInBradenton

    DaveInBradenton Rookie

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    Are you using a flexible racket?

    Are you using natural gut?

    Do you you have your rackets strung at manufacturer's recommended minimum?

    These three things, along with giving your body time to recover between playing sessions, allow me to play without elbow pain.

    Best wishes,
    Dave

    DOB: 12/27/43.
     
    #18
  19. bertrevert

    bertrevert Hall of Fame

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    Good stuff Dave - are you over yours?

    66 flex racq according to TW - I don't think of that as too bad?

    Just Forten Sweet syn gut.

    Not down to the minimum... yet! But ok will try that as well. I hate that slingshot-y mess that can be too loose ... but I have to give anything a try. Thanks.

    Btw I blame this current dose on having some of the black poly string (RPM?) for a month or so - I started feeling twinges which developed into full-blown problems - and in this non-flexible-beamed racquet I really felt it travel down into my arm.

    Cramps today as well, argh the triumphs of age. :p
     
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  20. DaveInBradenton

    DaveInBradenton Rookie

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    Bert,

    My TE is gone. My arm brace is stored in a drawer; I don't wear it any longer.

    Good news, the more flexible rackets have thin beams and are low powered. That means they work well with low string tension.

    More good news: natural gut is the best string for TE; it adds power and control while it cushions impact. Yes, it costs more, but it's durable and retains tension.

    Are you a string-breaker? If so, go with 15L or 16 gauge. I actually started with 15L, then 16, and now 17 gauge. Remember, the low tension prolongs string life too.

    IMO, your 66 stiffness rated racket is probably too stiff. I suggest the 22mm and thinner beams would be kinder to your elbow.

    I'm a big fan of the ProKennex rackets with Kinetic tech. I've used the 7G and really liked it: power and control. I'm currently trying the Q Tour 295 (11.0 ounces strung, 17g N-gut @ 50) and like it too.

    Have fun,
    Dave
     
    #20
  21. bertrevert

    bertrevert Hall of Fame

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    Dave the way you describe the brace in the drawer sounded to me close to someone exclaiming - I threw away the crutches.

    More power to ya! :)

    Yes I am considering a thinner beam.

    I have always played with the more flexible thinner beams but recently over the last year I used a 25mm stiffer racquet and here I am unable to play, or at least unable to engage in competitive play, which is where questions get asked and we push ourselves to limits - it is that play I want to get back to but have had to abjure at the club.

    I play Div 1 doubles in the area. No quarter asked/given.

    TE just counts me out at that level, not possible, I can't extend my play with it niggling away.

    Not a string breaker. I like every one fell in love with poly. Gut isn't going to give me that spin so I'll have to consider a spinny frame. Thinner beam. More flex.

    Did you say you made these adjustments in order to fix the TE or you did so preventively?

    Many thanks if you have time to answer, regards
     
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  22. DaveInBradenton

    DaveInBradenton Rookie

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    My Tennis Elbow was caused by trying to aggressively hit the Roger Federer ("I want to be like Roger") topspin backhand instead of my old fashioned ("classic"?) sweeping flat or slice shot I'd used since I was a teenager. One day after practicing this shot I went home and my elbow was so sore I could not pick up the TV remote without a great deal of pain.

    I realized the cause and effect. I knew I had to make a change. Traditional advice was rest; stop playing for months, until well after the pain was gone. At 68 years old, full of enthusiasm for my comeback and trying to get back 15 years of lost tennis, I needed an alternative to "no play". I found it in the two hand backhand, plus a thin flexible frame with natural gut at minimal tension.

    In fact, I switched from one hand both sides to two hands both sides until the pain went away. Then I gradually went back to my old strokes, now using mild overspin onehanders both sides. Remember, I was retired with time on my hands and highly motivated to return to the game. I refused to just sit in my recliner and watch the Tennis Channel.

    If you think switching to 2 hand strokes is too difficult, I've heard of some people switching from right hand to left hand strokes. Now that would be hard!

    Good luck,
    Dave
     
    #22
  23. Baxter

    Baxter Professional

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    Same story except I'm ten years younger and string mine at 60. A 7G strung with gut kept me out there. I play 3x a week with zero pain.
     
    #23
  24. Chas Tennis

    Chas Tennis Hall of Fame

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    Old thread, TE story

    Old thread that I came across.
    Click ">" to go to the thread.

     
    Last edited: Sep 9, 2013
    #24
  25. hrstrat57

    hrstrat57 Hall of Fame

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    First I have had no elbow / shoulder issues since a brief expeiment with Kevlar string many years ago.

    I do find tho the only time I feel pain/discomfort and need some rest is when I demo racquets or try different setup. I suspect I tend to over hit seeking to find the limitations of the new gear.

    Why would you be demoing frames if you had previous TE and had found a great setup that allowed you to play pain free? Just pick a a couple of matched spares and smile would have seemed logical to me.
     
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