Originally Posted by Chas Tennis
CF, That is a very clear description with illustrations and you pin-pointed important issues.
As for the Flexibar or other treatments, I hope that there will be treatments that will produce improvements in the chronic tendonosis phase but, as usual, the solid research, independently repeated, to back up conclusions is not here as far as I can see.
For myself, I don't believe in exercises or stretches with tendinitis. Also, I have posted what I read about new acute tendon injuries - if stressed - possibly becoming tendinosis in a very short time. Again, I wish I could find this issue discussed more often by Drs and researchers. It seems that there should be a very simple rule given the uncertainty of TE & GE injuries - 'not certain of the injury - then stop playing for 3 months or more and see a Dr'.
There is some logic to eccentric exercises possibly breaking up tendinosis since eccentric contractions disrupt muscles more than concentric contractions. But in view of its importance why isn't there more research on eccentric treatment? Why isn't there more use of eccentric treatments by the medical community? I'd be surprised to hear of someone with TE that was being treated with physical therapy using primarily eccentric treatment. I would not be surprised to hear of cortisone shots.........
TE & GE are probably so difficult because many people probably have some mixture of the three conditions that you identified, all at the same tendon attachment- healthy uninjured tendon, inflamed tendinitis and old scar tendinosis (fibrosis).
Tennis elbow is a nightmare to study scientifically.
Science demands objective standards to measure.
There is no good objective test for tennis elbow; no x-ray, blood test, CT scan, etc.
And as you suggest, there is a great variety to the extent of tendonitis and tendonosis in most patients, and no good scientific way to separate those with largely tendonitis and those with tendonosis.
Who is going to do a study on tennis elbow, and what two treatments are going to be compared?
Most tennis elbow isn't even caused by tennis, but by occupations that involve repetitive arm movements - mechanics, carpenters, etc.
Compliance in those whose livelihood being told to stop working rarely happens unless the condition is nearly devastating.
Sadly, speaking with friends suffering from tennis elbow from playing tennis, and from reading about those suffering on these boards, compliance in tennis players is not much better.
As stated by Timothy Tyler, eccentric exercise involved using expensive machines prior to the use of the Flexbar.
It takes time for inflammation to dissipate.
Hence the popularity of the "magical" cortisone shot that makes inflammatory conditions feel better quicker.
For a job, for an "important" match or season, impatience wins out over a more proper approach.