Best Doctor for Tennis Elbow?

[JPW]

I'm 43 (male), live in Houston, TX, and have been playing tennis off and on for about 20 years. About 15 years ago I developed some very bad tennis elbow and probably some myocitis (sp?) and tendonitis in my forearm. It was so bad I could lift a glass and I basically quit the game for a few years. The bug hit me about 6 years ago and I got back in to it. Everything was fine until the early part of this past summer. After playing for about five minutes I noticed some tenderness in my forearm and elbow. I quit immediately for fear I would do any significant damage. Unfortunately, even though I wasn't playing the pain just got worse. I knew I shouldn't play until I had zero pain and after laying off for over 6 months it feels like I might be getting close. It is still there, but improved quite a bit.

My goal is to return to tennis pain-free and NEVER run the risk of having this problem again. The rest I'm sure did me good, but I should probably seek the advice of the best doctor possible who might specialize in treatment and recovery for tennis elbow. Does anyone happen to know anyone in Houston they could recommend? If not, is there a specific doctor that I should look for that would know how to properly treat something like this and offer steps to ensure it does not return?

[sureshs]

Falls under sports orthopedics I suppose. You could go to any orthopedist, but some people insist on going to sports specialists. There must be many sports medicine clinics in Houston.

[ian2]

I can't recommend a doctor but I can (highly!) recommend this: http://info.thera-bandacademy.com/flexbarelbow. It really works... at least it did for me.

You might also want to take a look at your equipment as it could be attributing to the problem. What racket(s)/strings/tension are you using? How often do you restring?

And of course technique... which could be the main contributing factor (note that pros have all kinds of injuries but hardly ever suffer from tennis elbow). Of course addressing possible technique issues is complicated, and depending on personal circumstances may or may not be feasible.

Good luck!

[Larrysümmers]

a doctor is just going to load you up on some anti infalmitoriys and if it still hurts come back in a month, or suggest surgery which is a temporary fix. the best thing to do is rest it a lot, know your playing limits, make sure to stretch, and do triceps workouts.

[ollinger]

A laudable goal, but completely unrealistic. Whatever you might do to improve the symptoms, nothing you can do can eliminate the risk of the problem recurring. There simply is nothing that "immunizes" you against it, particularly as you want to continue with tennis. Being over 40 in particular means greater risk of recurrence, so consider carefully how much you want to play tennis, and how often.

[JPW]

Originally Posted by ian2

I can't recommend a doctor but I can (highly!) recommend this: http://info.thera-bandacademy.com/flexbarelbow. It really works... at least it did for me.

You might also want to take a look at your equipment as it could be attributing to the problem. What racket(s)/strings/tension are you are using? How often do you restring?

And of course technique... which could be the main contributing factor (note that pros have all kinds of injuries but hardly ever suffer from tennis elbow). Of course addressing possible technique issues is complicated, and depending on personal circumstances may or may not be feasible.

Good luck!

Yea, I have a theraband. I hope to start using it more once I get completely pain-free if the doctor thinks it is best. I hit with a ProKennex Ki5 (very arm friendly) with all natural gut strung at 59#. I've got to believe the issue is not the racquet or strings, it must be my technique. I sure wish I could figure out with the culprit is in my swing (probably plenty of problems).

[JPW]

Originally Posted by ollinger

A laudable goal, but completely unrealistic. Whatever you might do to improve the symptoms, nothing you can do can eliminate the risk of the problem recurring. There simply is nothing that "immunizes" you against it, particularly as you want to continue with tennis. Being over 40 in particular means greater risk of recurrence, so consider carefully how much you want to play tennis, and how often.

I know what you are saying, zero risk of injury just isn't possible. I guess what I'm looking for is a path to get me as close to zero as possible.

The reason I have it in my mind that it might be attainable is from doing P90X a couple years ago. P90X was no joke and it involved a great deal of weight training. Once I completed the 90 days (took everything I had) my arm and elbow felt as strong as it could be. Where it feels like I may have gotten myself in trouble was abandoning weight training and simply playing tennis often. My guess is that at my age I might need to be doing the strength training to allow me to play tennis pain-free. Hopefully, a doctor will be able to give me specifics.

[Chas Tennis]

The issue of Tendinitis (with inflammation) or tendinosis (defective healing)?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445129/

TW thread including these two publications.
http://tt.tennis-warehouse.com/showt...njury+nuthouse

I do not know this Dr in Houston – Dr John Cianca. He wrote a short description of how tennis elbow or other tendon injuries might become chronic after an acute injury and inadequate time off for healing. The time discussed was very brief. I believe that his description is very reasonable and applies to some or most acute tendon injuries.

[Chas Tennis]

Originally Posted by JPW

................ I've got to believe the issue is not the racquet or strings, it must be my technique. I sure wish I could figure out with the culprit is in my swing (probably plenty of problems).

One of the most plausible causes for tennis elbow for a one hand backhand is described by biomechanical researcher D. Knudson in his very interesting & informative book, Biomechanical Principles of Tennis Technique (2006). He discusses why the wrist should be extended and not flexed for the 1hbh. He says that the pro's use extended wrists and many average players use flexed wrists. When I look at videos I see the pros using extended wrists on the 1hbh. In addition, the flexed wrist stretches the elbow muscles that are injured in TE making stress from wrist flexion seem plausible as a cause of TE injury.

Knudson description of wrist issues on the 1hbh. (1997)
http://assets.usta.com/assets/1/USTA...is%20Elbow.pdf

Knudson book. (2006)
http://www.tennis-warehouse.com/Biom...e-BIOMECH.html

Pros using extended wrists on the 1hbh-
http://www.youtube.com/watch?v=gqBEErW0vTA

See if you can find any videos of pros impacting the ball with flexed wrists on the 1hbh. ? % ?

Search terms & get illustrations: wrist extension, wrist flexion

https://www.google.com/search?q=wris...w=1334&bih=722

[LuckyR]

Originally Posted by JPW

I'm 43 (male), live in Houston, TX, and have been playing tennis off and on for about 20 years. About 15 years ago I developed some very bad tennis elbow and probably some myocitis (sp?) and tendonitis in my forearm. It was so bad I could lift a glass and I basically quit the game for a few years. The bug hit me about 6 years ago and I got back in to it. Everything was fine until the early part of this past summer. After playing for about five minutes I noticed some tenderness in my forearm and elbow. I quit immediately for fear I would do any significant damage. Unfortunately, even though I wasn't playing the pain just got worse. I knew I shouldn't play until I had zero pain and after laying off for over 6 months it feels like I might be getting close. It is still there, but improved quite a bit.

My goal is to return to tennis pain-free and NEVER run the risk of having this problem again. The rest I'm sure did me good, but I should probably seek the advice of the best doctor possible who might specialize in treatment and recovery for tennis elbow. Does anyone happen to know anyone in Houston they could recommend? If not, is there a specific doctor that I should look for that would know how to properly treat something like this and offer steps to ensure it does not return?

Some ideas:

This is something you can manage yourself if you are willing to do the effort.

True, a doctor can play a role in this issue but think about it: what does a doctor have that you don't? He can do surgery-- very rarely used for this problem and nothing you want any part of at this point. He can write Rx meds-- the only one that that is not available OTC would be steroid injections, and again they are rarely used and I wouldn't jump to it, at this point yet. Lastly, they can have experience in the problem. Trouble is, if the individual doc does not have a particular interest in this area, their experience could be less than the posters on this thread.

[JPW]

Thanks everyone for the input, but I think this thread might help explain more of how confusing all this might be. There certainly doesn't seem to be any one right way to attack an injury like this. People simply have varying opinions, which makes sense. Ultimately, all the dicussion here has helped me and I think I might elect to go to a Sports Rehab Clinic somewhere. My hope is they have doctors that can diagnose exactly what my issues are, how they can be repaired, and maintained long-term.

I only wish I could find more information around those here in Houston. I've got to believe there are plenty of high-level competitive players here and I wonder who they might recommend for injuries like this. I'll continue to hunt around and if I ever find more information I'll post it back here.

[Chas Tennis]

Talk to some of the older players to see if any can recommend doctors who have been effective for them and/or specialize in physical therapy approaches.

The Dr I mentioned above, John Cianca, wrote an article that led me to believe that he has a sound understanding of tendon injuries and treatment. I had golfer's elbow and believe that what he wrote stopped me from playing more tennis and likely helped me avoid a chronic GE injury (tendinosis). I can't know for sure but that is what I believe. After reading the review articles above I believe that many tendon injuries have mostly become tendinosis perhaps mixed with tendinitis. Effective treatment is difficult. I would seek the opinion of a Dr who would discuss both tendinitis and tendinosis with me. Get more than one opinion.

[charliefedererer]

You have the right idea - find a good Sports Rehab doctor and follow their advice.

Working with a therapist can also help guide therapy.


Still, understanding the basics in return to play should help.

As you have already done, rest is the first step until almost all the pain is gone.

A common first step is to do very gentle "range of motion" exercises.
These are not to truly "strengthen" the muscles, but rather to get the muscles and tendons smoothly gliding past one another again.
[Some internal "scar" tissue may have "glued" adjacent tendons/muscles together. Loosening up some of this internal scar tissue may cause some minor soreness, but should not cause real "pain".]
One of the most common range of motion exercises is to use the red Theraband Flexbar, doing the Tyler twist and reverse twist.
[The red Flexbar seems "too easy" to many, but again the objective is just to get the muscles and tendons moving past one another again.]

If there is no pain with the red Flexbar, it is then time to progress to the green Flexbar.
Slowly increasing the number of reps can let you begin to increase some strength without overdoing it.
Any return or increase in pain means you need to drop back a step and start over after the pain is better.


Next, strengthening the forearm even more with other adjuncts, including dumbell wrist curls, reverse curls and pronation/supination exercises can build more strength.

Return to tennis should be gradual - start with short hitting sessions without serving.


Good luck!

[comeback]

I am an instructor and tournament player. i had the worst case of tennis elbow. I couldn't lift my arm to brush my teeth, wash my hair, hold a coffee cup etc but waas finally able to heal myself with this great rehab glove..it's also reimbursed by insurance http://www.flextend.com/

[superdave3]

Originally Posted by Chas Tennis

The issue of Tendinitis (with inflammation) or tendinosis (defective healing)?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445129/

TW thread including these two publications.
http://tt.tennis-warehouse.com/showt...njury+nuthouse

I do not know this Dr in Houston – Dr John Cianca. He wrote a short description of how tennis elbow or other tendon injuries might become chronic after an acute injury and inadequate time off for healing. The time discussed was very brief. I believe his description is very reasonable and applies to some or most acute tendon injuries.

I read what the sites said, and it appears the eccentric exercise is highly recommended, but they did not describe what exercises these are-could you please explain? Thanks!

[superdave3]

Originally Posted by comeback

I am an instructor and tournament player. i had the worst case of tennis elbow. I couldn't lift my arm to brush my teeth, wash my hair, hold a coffee cup etc but waas finally able to heal myself with this great rehab glove..it's also reimbursed by insurance http://www.flextend.com/

I clicked on the website, but it does not seem to show how this works (like the theraband does). Could you please explain?

[charliefedererer]

Originally Posted by superdave3

I clicked on the website, but it does not seem to show how this works (like the theraband does). Could you please explain?

Here's a video with do's and dont's:
Top Five Mistakes to Avoid When Using Flextend http://www.youtube.com/watch?v=06dE_-oa0wQ

I don't have experience with the Flextend. It seems it was made largely to treat carpal tunnel syndrome of the wrist.

Just based on how it works, I would think the twisting motion of the Theraband Flexband http://www.youtube.com/watch?v=zB3TVb8a5mk would be a better exercise for the muscles/tendons involved in tennis elbow, but it certainly does seem that comeback had great results using the Flextend.

I hope comeback sees this and can explain further the specific exercises he used - how much flexion and extention and how much twisting exercises. Also I would love to know if he first used the Theraband Flexbar without results.

[rufus_smith]

Your TE is severe and was quick to develop. This suggests either that you may have a congenital flaw in your elbow or that you are hitting the ball with some unusually damaging technique. In other words after it heals it will come back again. Have a sports doc make and evaluate a diagnostic image (ultrasound or other) of your elbow and have tennis expert observe you on your technique. Just my opinion from having severe TE in the past.

[Chas Tennis]

FYI
2012 Review on tennis elbow treatments -

Current Concepts in Examination and Treatment of Elbow Tendon Injury, Todd Ellenbecker, R. Nirschl, and
Per Renstrom
http://sph.sagepub.com/content/early...112464761.full

NOTE- I believe that this link was providing the full paper for free earlier. All I see now is the abstract. Will check. Seems to work again for full paper. ?

[Chas Tennis]

This board has some discussions on sports injuries, most often in baseball. Sports medicine specialists in various locations are occasionally recommended by Dr Fleisig, a prominent Dr and researcher involved in pitching, baseball injuries and research.

See reply 1/30 by Dr Fleisig.
http://asmiforum.proboards.com/index...ay&thread=1908