Ultrasound and Tennis Elbow

Discussion in 'Health & Fitness' started by Edberg_Fan, Nov 6, 2007.

  1. Edberg_Fan

    Edberg_Fan New User

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    I've had TE for about a month now and am doing bi-weekly PT. It seemed to help but as of recently, my therapist did some ultrasound, which aggrevated my TE. I am thinking about ditching the PT and just resting. Any advice?
    What did you do to recover? If you don't have TE anymore, what was your road to recovery and how long? Thanks.
     
    #1
  2. Edberg_Fan

    Edberg_Fan New User

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    I suppose the ultrasound aggrivation must just be me considering no responses. Seems like a long process to healing. I want to be TE free before starting back up.

    At what point did you guys start back up? Did you still have some pain at that point. Right now it still hurts to hold a medium sized frying pan.
     
    #2
  3. andreh

    andreh Professional

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    Hi,

    I've had TE now for 3 months. Still have it.

    Sadly, it seems there is only one thing that helps against TE and that is prolonged rest.

    I've tried a combo of cortisone injections - it had temporary effect - and NSAIDs (mostly Arcoxia, but also Diclofenac and Naproxen). No lasting effects, alas. I'm also wearing an elbow brace, but I can't really say it has any clear effect.

    I apply ice a few times a day, but the effect is also only temporary pain relief.

    Just rest.
     
    #3
  4. Marius_Hancu

    Marius_Hancu G.O.A.T.

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  5. Edberg_Fan

    Edberg_Fan New User

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    Thanks for the responses. I assume there are varying degrees of TE and everyone's ability to heal also varies. It would be nice if folks that had TE could post how much long the prolonged rest they took. I'm curious if there is an average duration that could be established???

    I do plan to change equipment and also my backhand technique issue (leading with elbow on contact).

    Thanks!
     
    #5
  6. scotus

    scotus Legend

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    I don't think ultrasound is a good idea while you still have pain, mainly because it is designed to promote healing by causing an inflammation first.

    I have tried it religiously for about a month, but it hurt the day after each time I did it, and ultimately I gave up on it without seeing results. But I think it may have its place, perhaps after the pain has completely subsided.
     
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  7. Oxford

    Oxford Rookie

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    stay off the anti inflamitories in my opinion...see my thread on the topic here.

    new research says it has a harmful affect on healing.

    ox
     
    #7
  8. morten

    morten Hall of Fame

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    over 2 years, still not 100 %. Nothing worked, TE travels its own path IMO
     
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  9. kevint

    kevint New User

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    I have tried ultrasound a few times, and it did not work at all.
    My GE is close to 2 years now, 95% gone, hopefully will be gone by Spring.

    just rest, avoid NSAIDs, don't try to exercise your elbow too soon, not until it's almost completely healed, IMHO.
     
    #9
  10. mhldex

    mhldex New User

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    TE more than 2 years

    Hi

    I'm in the same predicament as you are...already with TE for almost 2 and a half years.

    My elbow still hurts especially after I over-stretch my arm for e.g. carrying items of considerable weight over a prolonged period. So I am still fearful of going back to the tennis court at the moment.

    Would like to know how you cope with the intermittent pain and also have you started playing tennis? I just feel like it's been such a long time that the pain will never go away completely.....so what the heck.....should I start playing again?

    :-(
     
    #10
  11. Mister G

    Mister G Rookie

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    Man..

    On occasion I would get TE, but not even close to what you guys are talking about. I would rest a couple days and I would be ok even though the pain can be excruciating at times.

    I wish you all the best of luck - hope you get rested/healed soon.
     
    #11
  12. volusiano

    volusiano Hall of Fame

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    How is the ultrasound supposed to heal TE? What's the idea behind it?

    And what's NSAIDS?
     
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  13. Edberg_Fan

    Edberg_Fan New User

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    Thanks for the repsonses. I was hoping to see if there is a magic number. So far it seems that most of the folks here have TE for 2 years and still not gone. Among other factors, I presume you were playing through some level of TE which is probably why it has taken longer to go away 100%.

    I was hoping to see this number be more in the few months to get to 100% recovery with full-time rest.

    So far it seems the data only reflects two people with TE for a couple years.


    1 - 3 months - (none)
    6m - 1 year - (none)
    1 - 2 years - (2) mhldex, kevint
    2+ years - (none)
     
    #13
  14. Edberg_Fan

    Edberg_Fan New User

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    I forgot to add 3m - 6m (none).
     
    #14
  15. volusiano

    volusiano Hall of Fame

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    My TE lasted me in the 1-3 month range. I would say I recovered 90% and not 100%. I rested for about a month, then started playing again slowly with a heavier, headlight, less stiff, arm-friendly racket, and kept improving my techniques.

    Now about a year later, I play about 3 times a week. I may have a little mild TE discomfort after a 2-hour session, but it goes away the next day or so. That's why I say I recover 90% but not 100%. But the minor/short TE discomfort I have now is probably more attributed to the physical demand of the game and not because of doing something wrong.
     
    #15
  16. andreh

    andreh Professional

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    Don't know about ultra sound but NSAID = Non-Steroid Anti-Inflammatory Drug, i.e., common pain relief drugs you can buy at your local farmacy. Ibuprofen (Nuprin), naproxen (Aleve), diclofenac (Voltaren) etc etc.

    They inhibit the synthesis of something called prostaglandines, which are active in creating pain and inflammation in the body. The anti-inflammatory effect is negliable unless they are taken regularly for several days.
     
    #16
  17. scotus

    scotus Legend

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    Let me take a crack at this, and please understand that I am not a medical professional and might be wrong on many points.

    There are some methods of tendonitis/tendonosis treatment that are based on the theory that the injured tendon is deprived of necessary nutrients and needs more blood supply to that region for proper healing.

    So in order to get the body to send more blood to that region, the medical professional inflicts a slight "damage" to the region, which causes an inflammation and signals the body to send more blood to that region for healing.

    There are several ways of accomplishing this. One is using a surgical needle to poke some microscopic holes into the tendon. Another is using various waves. Ultrasound is, of course, much less invasive than the needle method, and is thought to penetrate the body deep enough for it to reach the tendon and cause disturbances, which leads to inflammation and a subsequent healing.

    This, of course, means that ultrasound will most likely cause pain and make the pain worse before making it better. In my case, it was all pain and no gain.

    The most recent advance in tennis elbow treatment is taking the patient's own blood, isolating the plasma rich in healing properties, and injecting it directly to the tendon, which has reportedly seen some really positive results.

    Chime in if this needs corrections.
     
    #17
  18. Edberg_Fan

    Edberg_Fan New User

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    Scotus, that sounds about right as was explained to me by my PT. Likewise, I had no benefits and after two weeks of ultrasound I decided my problem was getting worse. So now that I've taken a few steps backwards I'm going to just rest. How long, I don't know yet, which is why I was just curious to see what the general rest period is... understanding there are other factors.

    But I thought that if you have TE and you stop playing due to the issue, we have some common ground. Sounds like some folks get back into playing as they feel comfortable. So maybe I need to reconsider my question to how much rest before you are 100% or comfortable enough to starting playing relatively frequently (ie. at least 2-3x week).


    1 - 3 months - (1) volusiano
    3 - 6 months - (none)
    6m - 1 year - (none)
    1 - 2 years - (2) mhldex, kevint
    2+ years - (none)
     
    #18
  19. scotus

    scotus Legend

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    I have had two bouts with tennis elbow. Each time I had to rest 6 months. I may have had a quicker recovery but I have toddlers who want to be carried all the time.
     
    #19
  20. Edberg_Fan

    Edberg_Fan New User

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    Thanks scotus; looking for more inputs all.

    1 - 3 months - (1) volusiano
    3 - 6 months - (1) scotus
    6m - 1 year - (none)
    1 - 2 years - (2) mhldex, kevint
    2+ years - (none)
     
    #20
  21. morten

    morten Hall of Fame

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    i played... did`nt make a difference, i also think the computer contributed to my TE(mouse,switched hands now by the way) What also made my TE in the beginning was that I experimented with different grip sizes too much, first too small, then too big. Good luck.
     
    #21
  22. ironicqueery

    ironicqueery Rookie

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    I've had elbow issues for about a month now, and haven't played for 2 weeks. The elbow seem to be getting worse to me - and I'm not doing anything with it. I'm ready to give up, and just start playing again.

    Any more positive healing from people who rested their elbow completely?
     
    #22
  23. zacinnc78

    zacinnc78 Professional

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    made new post
     
    #23
  24. El Diablo

    El Diablo Hall of Fame

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    Rationale for ultrasound is absurd. Tennis elbow is lateral epicondylitis -- the "itis" means inflammation, so attempting to induce further inflammation, and I don't know that there is any evidence the ultrasound does that, is very dubious.
     
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  25. Chazzz

    Chazzz New User

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    In a nutshell the Ultrasound deeply heats up the tissues with the theory that it may relax/massage the tissues. It has a limited benefit for tennis elbow.

    In most cases, tight, scarred soft tissues (muscles, tendons, ligamnets, etc) attaching to the elbow are causing the problem.

    Active Release Techniques, ART is a relatively new treatment method with excellent resolution of the problem in most cases.

    Visit www.activerelease.com for info and a search engine to locate an ART Doc near you.

    Most Docs will treat it to resolve the soft tissue problem while giving you specific stretches and advice to prevent recurrence from activity.
     
    #25
  26. Edberg_Fan

    Edberg_Fan New User

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    I posted an update on a related thread. Originally when I started this thread my TE was not progressing well. I had tried therapy in the form of ultrasound and general massage. The ultrasound set me back and inflicted additional damage.

    During this time of frustration (2+ months), I ran into someone at my local pro shop that recommended a therapist that specializes in TE injuries and deals with soft tissue. After two treatments at $95 per treatment which consisted of 1 hr deep tissue massage for my forearm and tricep muscles and tendons, my TE is now virtually gone!

    During the deep tissue massage the treatment would be rather painful when working out the knots and breaking the scar tissue in my muscles. After the treatment, my muscles felt less stiff and more relaxed, but sore from the deep tissue treatment.

    I cannot believe it but my TE is gone. I still wear a band-it brace but no more TE. My arm gets sore after playing but I can manage that by properly warming up and most importantly, stretching AFTER playing. I plan to continue to do the deep tissue massage when I feel I need it.

    Everyone with TE should look into this type of treatment especially if you cannot get rid of your TE.

    The way it was explained to me is that think of a bunch of rubber bands all knotted up in your arm. They are shortened and causing stress at the connective tissue at you wrist or elbow. By lessing/loosing up the tissue throught the deep tissue massage, allows for more slack at the elbow. Thus there is no pain there which was TE in my case.

    Good luck!
     
    #26
  27. dan_the_man

    dan_the_man New User

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    Cause?

    What do you all believe was the specific cause (stroke) that caused the tennis elbow? 1hbh? Volley? Other?

    If it was 1hbh, have any of you switched to a 2hbh and found it an acceptable way to continue playing?

    dan_the_man
     
    #27
  28. Edberg_Fan

    Edberg_Fan New User

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    Dan,

    For me TE was brought on from switching to the K-Factor 6.1 Team (light racket), and late 1HBH with that racket. As well as not properly warming up and lack of streatching after working out.
     
    #28
  29. Edberg_Fan

    Edberg_Fan New User

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    I plan to experiment with a 2HBH to see how it goes.
     
    #29
  30. dan_the_man

    dan_the_man New User

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    For me, I believe it was a combination of several factors, all converging on the same day.

    1. I was switching to a 1hbh from a 2hbh over the past few months;

    2. I had a new, heavier racquet that day (still flexible and head light);

    3. I was hitting hard against a hard hitter that day (I've hit many balls with 1hbh against a ball machine or wall without any problems);

    4. I was probably hitting the ball late (since he was a hard hitter).

    I'm guessing these 4 factors caused it. Also, I've been holding my grip tighter on backhand volleys lately.

    dan_the_man
     
    #30
  31. dtd82

    dtd82 Rookie

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    Hope....?

    EF, I read your update today - now that I've scooped my jaw off the floor, time for me to chime in. I'm 'bout 10 year older then you, but seem to have been riding the same wave lately - started back playing during last summer after many years away (played college, taught, etc..), found and loved the K95 TEAM.....played for awhile, then in July tore the tendons in my left ankle....ok, so after 3 months in a boot, I get back to careful play with a playing brace...(surprisingly, they work..)....at the time I'd had the orthopedic Dr. MRI my right shoulder to see if we could diagnose an old injury, did, as a torn Labrum.....decided not to pursue surgery, got a cortizone shot instead, right around Halloween.....ok, now the related fun.....played for about a week, full-out, first time in 25 years it hadn't hurt....but......'bout a week later, feels like someone's sticking a hot, electrically charged poker in my elbow, and it got worse the less I moved.....out of superstition, have never mentioned the words tennis-elbow, but didn't take solace when the younger Orthopedic Dr. held back a smirk and called it an "over-use" injury when I was back for a check-up on my ankle....and shoulder.....I swear I'm not getting older....really......just over-did-it ...

    Searched here mid-November-ish, found your reference to the elbow and the K95 Team....I'm not a believer in "the racket made me do it", but I agreed with you - I likened the theory to the difference in throwing hard a tennis ball versus a baseball.....the heavier is easier, hurts the arm less.......so I bought the K95's "normal" hoping they'd work better if/when I ever play again......still haven't touched them.

    then I saw your update.......given the similarities - history, time frame, racket, possible reason for onset (again, hate to agree, but I suspect a late-backhand is a bit to blame - oh, and don't give in the the two-hander, tradition man, tradition...), today I'm hunting for massage therapists.....

    Is there some official-sounding title, certification, etc, that I should be looking for? I don't seem to be so lucky up here in Northern NJ to have someone who knows a person specializing in TE - but, I figure I can track down a "deep-tissue" sports massage person....if there's any steering you can provide, I'd be much obliged!

    Sorry for the ramble, but I'ts been a frustrating 7 months.....one thing after another, and boy, was I glad to read about your recovery! I know it's not a one-size-fits-all thing, but today, I'll take a glimer of hope.
     
    #31
  32. mary fierce

    mary fierce Banned

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    Is it a good idea to break up scar tissue? Scar tissue forms as a compensation in order to strengthen a weakened area, so how wise is it to break this up? One winds up with a weakened tendon being re-exposed to repeated stress.
     
    #32
  33. scotus

    scotus Legend

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    What kind of string are you using and at what tension?

    You will almost never find anyone specializing in TE care. But run a search on chiropractors and sports therapists who specialize on ART and also have a deep-tissue massage specialist on staff. It can all come in a package deal.

    By the way, I like ART, but it is no cure-all. I like the treatment, but I am not completely free of TE.
     
    #33
  34. Edberg_Fan

    Edberg_Fan New User

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    Scotus - I believe the technique my therapist uses is called ART (Active Release Techniques).

    Just a couple treatments and my arm is nearly pre-TE condition.

    Check out www.activerelease.com and ensure that your therapist specializes in this treatment.

    Since getting back into Tennis again I:
    1. wear a band-it brand brace
    2. get ART treatment every other week
    3. warm up and streatch before and AFTER workouts
    4. Ice after workouts
    5. Streatch throughout the day EVERY DAY.
    6. Switched from my light K6.1 Team to Head Prestige Mid. Awesome racket and very arm friendly. Have it strung with VS Team on the lower range.

    Best of luck!
     
    #34
  35. scotus

    scotus Legend

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    Well, good for you!

    My chiropractor has been performing the ART for a long, long time. While it has helped a lot with my condition, I know that my elbow is still nowhere near 100%.

    You, too, should give yourself some more time to evaluate your condition more thoroughly. Often after receiving ART, your muscles loosen up and do not pull on the tendons as hard as they used to, which leads to a substantial loss of pain. But this does not necessarily mean that your tendon has been fully healed.

    But I am happy to hear that you are satisfied with your treatments.



     
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  36. dtd82

    dtd82 Rookie

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    Scotus / EF, sorry, was away...racket was strung with VS 17g, at 58...loved everything about the racket, hate to think I have to let it go.....I'll look up the ART heading - thanks for putting some semblance of a name on it.

    EF, how does the feel of the Head compare to the K team? The thought of moving to the heavier k95 doesn't thrill me as my shoulder will be a continuing problem - still intuitively makes sense to me to find a light racket.

    As of today, EPI brace on and little as possible computer use, the elbow is better, but is certainly still there. A little more time, some ART, and then I've got to find some exercises for it....if nothing else, the arm sure feels weak now. I'm shooting for spring being back in the court, figure I'd better get moving on the conditioning now, or I'll just break everything all over again. Then again, I'm seeing an ankle specialist on Wed re the tendons down there....yeehaa.
     
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  37. Edberg_Fan

    Edberg_Fan New User

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    Scotus - I completely agree with your comment. My Elbow (tendon) in reality is not 100% after ART. You're correct, the deep tissue massage does loosen up the forearm and lower tricep muscles resulting in less tendon pain. My elbow in reality is about 90% if I had to put a number on it. I think to achieve the last 100%, I have to get back into playing tennis and put my arm though some of the same motions to build the strength back up. The weights just don't do it as they are more controlled resistance. I have been playing for a few weeks now and only playing 2x per week and take it easy. Only exerting about 70% effort at most. Warming up and cooling down as described above. I feel my arm getting stronger now that I'm playing again and am taking it slow. I'm using the next few months to build my arm back up and ensure my TE has completely gone away before I start playing. It's unfortunate as our season is starting but I may just have to watch/support the other guys and join in the post-match drinking. But you are correct, in that I am not fully healed. The ART only got me to a point where I can start back up on the courts and I can only build from here with the equipment and technique adjustments I'm making. It's quite the process. My only comment is to make sure that you have someone that works on your arm for 1 hour straight. My therapist works on feel alone and is able to find each tendon and work out the knot and relax the muscle. She does this for 1 hr straight going though my entire forearm and lower tricep. I would be happy to provide her name is you provide a means to contact you.

    DTD 82, I like the new Prestige Mid over the K Factor Team. In fact I'm experimenting with adding a 3/4 sleeve and some lead in the head. the Mid is nice as you can conceal the lead in the head under the grommet strip. Anyhow, the mid is much more stable and crisp feeling than the team. If weight is an issue, demo first. I am also thinking of going from a 17g VS gut to a 16g VS / Lux rough hybrid. I also increased my grip from 3/8 to 1/2. The shock on my arm seems to be much less on impact with the Mid. Hope this provides some input.
     
    #37
  38. dtd82

    dtd82 Rookie

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    Thanks, I'll pull in a demo of the Prestige and give it a run...I think the increase to grip size will help too - way back when, I'd play with a 3/4, but I'd dropped back to a 1/2 lately (actually a 3/8 built up) - I'm going back up to either a 5/8 or 3/4 when I re-start. I think I didn't do myself any favors squeezing down on too small a grip.
     
    #38
  39. dtd82

    dtd82 Rookie

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    Oh, and why the idea on the hybrid? I'd think the full-bed gut would be both easier on the arm, and feel/play better...?
     
    #39
  40. Edberg_Fan

    Edberg_Fan New User

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    the full bed of gut would be easier on your arm. I like the VS 17g team. I'm just trying the hybrid for a bit more spin and durability. VS in mains at 57 and Lux R in crosses at 50. Played tonight for 1 1/2 hr drills and my elbow held up good.
     
    #40
  41. dtd82

    dtd82 Rookie

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    Glad to hear 1 1/2hr and still alive....I hit more of a flat ball, so the spin aspect is less valuable then the feel - durability, on the other hand, would be nice! That's a pretty big difference between tensions - are you figuring the gut will loosen? Do you string your own?
     
    #41
  42. Edberg_Fan

    Edberg_Fan New User

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    dtd82 - Lux recommends lower string tension. I have my rackets strung by a local shop.
     
    #42
  43. bertrevert

    bertrevert Hall of Fame

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    Now in about month 3 or 4 of my first bout of TE.

    Has ultrasound at 1 month - it had no effect whatsoever.

    Think I brought it on by playing with (full) poly all the time, HH or even-balance, and grips on some unfamiliar racqs. Ouch.

    Last week have been only using synth-gut and relatively feel a bit better (not as painful).

    I attribute the main change for the better to using synth-gut rather than poly. Good luck. Really surprising when you get it eh?
     
    #43
  44. dtd82

    dtd82 Rookie

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    Surprising doesn't quite cover it - I'm thinking the fates are amping it up to avenge something.....

    Oh, been a while, but I had a blast at The Fortunes of War Tavern...know the place?
     
    #44
  45. Leelord337

    Leelord337 Hall of Fame

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    switch to natural gut strings or the strings I found comfortable are Head FXP 17s. My friend who has tennis elbow thinks he got it from using the Babolat Pure Drive. He switched to a fischer and has less pain.
     
    #45
  46. P_D

    P_D New User

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    Does your elbow make cracking sounds? I find it making cracking sounds in the middle of the night. I believe I have TE. Not sure how severe, I've rested it for about a week now. Did ultrasound last week. It's still cracking but not as bad. This is one of the most frustrating things I have experienced. I just resumed playing and was playing 3-4 times per week.
     
    #46
  47. Edberg_Fan

    Edberg_Fan New User

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    P D, my elbow does not make cracking sounds you're describing. Also, at this time I'm playing 2x per week, no more. I went out last night and hit ground strokes for over an hour. Strokes are feeling good. Decided to try switching to a 2hbh... Although nowhere as good since I hit a 1hbh, the 2hbh felt much more comfortable. And after playing and today my arm feels great. I'm going to work on my 2hbh and make the switch. The 1hbh is just too abusive on my arm considering I hit pretty hard.
     
    #47
  48. dtd82

    dtd82 Rookie

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    PD, no cracking here either...I'd be a bit concerned about those types of noises from anywhere....I've got them in my shoulder, but I know mine are do to a torn labrum....noises are made by something wrong, and I'd get it looked at.

    EF, does your elbow still tweek you when extended? Mines largely ok, but still hurt if I hold something with a bit of weight with my arm extended.....and looks like I've got some more time to rehab it - I'm due in Friday for surgery on my ankle to repair tendons I tore over the summer..4 weeks cast, 2-4 boot and rehab...but, May 1 should be much better! Good luck with the 2hbh...I'm too attached to mine to change (said now while not playing...)
     
    #48
  49. Edberg_Fan

    Edberg_Fan New User

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    dtd82, my elbow does not tweek when extended. Well, it probably would if I held a 25lb weight with a straight arm.

    I hit again today, private lesson to work on my 2hbh. It is surprising how fast I have picked it up. The Pro and I focused on ground strokes today. Cross court from both sides and hitting the corners from both side from the middle. It felt great. My arm is not sore what so ever. I am still taking precautions and iced my arm with ice cubes for 15 mins after I played. I don't ever want to get tennis elbow again! Next week, I'm going to see how the serves affect my elbow. One step at a time.

    The 2x per week and coming back slowly is working out for me. Also, hitting the gym 2x per week on other days to work on strength and flexibility.

    I think I'm on the road to full-recovery!
     
    #49
  50. dtd82

    dtd82 Rookie

    Joined:
    Nov 30, 2006
    Messages:
    126
    Location:
    NJ
    man, I hear you re not getting this again...once I clear my ankle and start playing again in May, I'll be a good boy and ice, stretch, blah blah blah.....what routines are you doing in the gym?
     
    #50

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