Golfer's Elbow

TennisCanada1

Professional
I am 21 years old, high level player, and I started to develop GE. I finally told myself I would stop playing for a bit. It has been a week, and I know that is nothing, and I am going to start physiotherapy this week, but what confuses me is that I have NOT played and my elbow hurts me sometimes at night and when I wake up. I get pain when I try to straighten out my elbow and it gets really tight and stiff. Why does this happen if I am not even playing???
 

Chas Tennis

G.O.A.T.
There are lots of threads here on tendon injuries. There is usually uncertainty with diagnosis, even from Drs. How was your GE diagnosed?

Search: tennis elbow CharlieFedererer tendon healing time

You have a torn tendon. It takes time to heal - much longer than a week, months.

Understand the difference between tendinitis (with inflammation) and tendinosis (with defective healing)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

Chronic tendinosis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445129/

New tendon injury healing time. See also other replies in this thread.
http://tt.tennis-warehouse.com/showpost.php?p=6956506&postcount=14

I believe that if you play on a new tendon injury for a very short time you may have some defective healing tendinosis.
 
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TennisCanada1

Professional
I've had the pain for a few months, so I went to see a physio last month, and with one week of doing forearm curls, the pain went away 100%. But then I started playing again and stopped the exercises, it came back. I am going to a new physio tomorrow and obviously I will not stop the exercises this time, but do you really think it could be tendinosis if I was initially able to recover in a week?
 

epiczeko

New User
Your racket flex is too high. You need to go lower. Badminton rackets have a fairly low stiffness might want to look there

Hey! I also use the Prince Tour Pro! Exact same setup... whadda ya know!
 

Chas Tennis

G.O.A.T.
I've had the pain for a few months, so I went to see a physio last month, and with one week of doing forearm curls, the pain went away 100%. But then I started playing again and stopped the exercises, it came back. I am going to a new physio tomorrow and obviously I will not stop the exercises this time, but do you really think it could be tendinosis if I was initially able to recover in a week?
How was your GE diagnosed?

Stop stressing the arm and see a Doctor.
 
I went to a sports physiotherapist (not a regular physio) and I am very glad I did. I'm not a fan of getting diagnostic or therapeutic advice over the www from a bunch of forum posters.
 

SystemicAnomaly

Talk Tennis Guru
I went to a sports physiotherapist (not a regular physio) and I am very glad I did. I'm not a fan of getting diagnostic or therapeutic advice over the www from a bunch of forum posters.
One can often get some decent ideas of possibilities to consider from forum posters but, ultimately, one should consult with a medical expert.
 

TennisCanada1

Professional
Yup, I went to my physio. I need 6 weeks off of tennis as an estimate. So far, I'm done one week. Exercises 3 times a day involving 3 and 5 pound weights, and 3 times a week physio so they can ultrasound.
 

mikeler

Moderator
Yup, I went to my physio. I need 6 weeks off of tennis as an estimate. So far, I'm done one week. Exercises 3 times a day involving 3 and 5 pound weights, and 3 times a week physio so they can ultrasound.
I tried coming back after a 4 week break using ultrasound. It turned out to be 2 weeks too early. So 6 weeks sounds about right.
 

Chas Tennis

G.O.A.T.
I tried coming back after a 4 week break using ultrasound. It turned out to be 2 weeks too early. So 6 weeks sounds about right.
For a new tendon injury 6 weeks sounds like much too little healing time. What are your sources for healing time information? Any research references? How long did you have the injury before the 6 weeks?

Everyone should see a well-qualified Dr for a diagnosis and treatment.

No one knows exactly what is going on at the tendon level in any one patient suffering from tendonitis/tendonosis.

There just is not a good test that will tell us how much inflammation really is present.




The bottom line is that it takes a long, long time for tendon to heal.

It has a lousy blood supply, and has to support very high forces.



Most people are familiar with the way a skin injury heals so very quickly in a couple of weeks.

They can't wrap their heads around the concept that different tissues heal at different rates.

Skin is growing at a very rapid rate and has a great blood supply. The pulling force on skin at any one point is quite small.

Tendon isn't growing at all under normal conditions, and has a lousy blood supply. The force of muscle pulling on tendon is great.



People think 2 weeks is a long time - long enough to injured tendon to heal.

They are wrong.



 
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mikeler

Moderator
I had GE that started out as triceps tendinitis for almost a year before I decided to sit out the 6 weeks and do ultrasound therapy.
 

moonballs

Hall of Fame
^Is the ultrasound therapy part of a PT program? The PT I used before has a very short ultrasound session. The current PT I am seeing right by my office doesn't have ultrasound.
 

TennisCanada1

Professional
I've playing competitive tennis for 14 years and only started feeling it in my elbow for the last 2.5-3 months now. It started just on the serve and then the pain got more sharp. It may be that I switched to solinco tour bite, or that I switched to a racquet with a customized swingweight of 345 (although I was using a customized Prestige Pro before with the same weight), or just simply overuse.

After the 2.5-3 months, I went to see a physio. With my elbow straight and supported, I currently do wrist curls with a 5 pound weight (started with 3 lbs), upside down wrist curls, and side wrist curls, 3 times a day with 20 reps each. I also stretch it 3 times a day for 30 seconds, with the classic stretch for GE where you hold down your fingers with your other hand and straighten the elbow out to have a good pull. I go to the physio 3 times a week where I do theraband exercises there (Figure 1D and 1E in Tight Line's Post) so I do 2 sets of 10 reps for those.

This morning was the first morning in months where I was able to straighten my elbow and felt basically no pain, so the progress seems to be great.
 

struggle

Legend
The flexbar is working for me.

It's getting better while still playing minimally, using the flexbar GE exercises as often as i can stand it. 3-5 sets per day.

In fact i just played mixed states (NC) this past weekend. I played 7 matches in two divisions and honestly i think my elbow feels even better after a day's rest (post tourney) than it did before.

I have been fighting TE, then GE for over a year and it is rapidly getting better.

No joke. I was a skeptic and I am now a believer.
 
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TennisCanada1

Professional
After 2.5 weeks, I've been cleared by the physios to play "full speed groundstrokes, but no serves for the first week, and ice it for 10 minutes after practice."

I just played, and my god it felt good to hit a ball. No rust at all. No pain too, which is important. Tomorrow morning will be the real teller though.
 

mikeler

Moderator
After 2.5 weeks, I've been cleared by the physios to play "full speed groundstrokes, but no serves for the first week, and ice it for 10 minutes after practice."

I just played, and my god it felt good to hit a ball. No rust at all. No pain too, which is important. Tomorrow morning will be the real teller though.
Come back slow. Don't play a match with serves until you have a few hitting sessions behind you. Glad to hear things are looking brighter.
 

TennisCanada1

Professional
I've hit two days in a row. Did exactly what they said, full speed groundstrokes, NO serves at all. I hit maybe 2 overheads by accident but at 50% speed. I ice it for 10 minutes after practice and stretch. No pain at all!!!!!!!
 

DonDiego

Hall of Fame
I've had golfer elbow and I can tell you, it's more likely you will aggravate your case by just living, really, just living, than by playing tennis. I f you wake up in the morning in pain, it's because you arm was flexed during your sleep, still happens to me after two years. Look, I feel pain when I wipe my arse after a number 2...

Another setback for me was when I changed my wife's car tires. My advice: become a lefty in your everyday actvities. and when you get back on the court, no serves, and if you hit forehands, make sure you don't hit them late. If you want to play games or practice sets, use a lighter racquet for a while, to make sure you don't hit the ball late, especially on returns. And (if it's not already the case) learn to hit with a very loose arm and wrist like Federer on your forehand.
 
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TennisCanada1

Professional
That's great advice, thanks.
Well like you, most of my pain came from waking up in the middle of the night and not being able to straighten my arm. I am however still doing all of my exercises 3x per day to continue to strengthen the surrounding muscles so I can hopefully continue to play and live pain-free. I can't stray away from full poly, it's my go to setup, but I bought Yonex Tour Poly Pro (moving from Solinco Tour Bite) and I'm going from 60 lbs to 55 lbs.
 

TennisCanada1

Professional
So...it never fully went away. I don't have pain in the middle of the night, and I can go full speed on groundstrokes for hours if I wanted to, but if I start serving then it hurts the next day and the inflammation builds up more.

At this point I'm considering a PRP injection. Has anyone done this?
 

Chas Tennis

G.O.A.T.
So...it never fully went away. I don't have pain in the middle of the night, and I can go full speed on groundstrokes for hours if I wanted to, but if I start serving then it hurts the next day and the inflammation builds up more.

At this point I'm considering a PRP injection. Has anyone done this?
When I have gotten new Golfer's Elbow injuries, I stop tennis and stressing it for about 3 months. I don't know if 3 months is enough time for a new injury but since I want to play that is what I try to do. See CharlieFedererer healing table above. Find other research.

What is the time line since your original injury and how long have you gone without stressing the elbow with tennis or other stress? Attempting one serve with an area of your tendon weakened or detached from the bone might make an enlarged new injury.

I get slight GE twinges when occasionally I do a reverse spin serve. The arm drags the racket across the ball in the opposite direction to that for a ISR slice serve. I know someone who regularly serves with this reverse racket path.

I also believe that if I served and did ISR with too much of an angle in my elbow I would injure myself with GE. This is what I did with a misguided experimental volleying technique.


http://tt.tennis-warehouse.com/showpost.php?p=7607727&postcount=70

High speed video can show these motions. Regular video might catch the arm position also. Don't serve with pain.
 
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SpinToWin

Talk Tennis Guru
I really recommend trying a gut/poly hybrid. I too was using a full poly setup and golfer's elbow kept flaring up, but I strung up my Pro Staff 85 with a gut/poly hybrid and no arm pains at all after playing.
 

TennisCanada1

Professional
I have had the injury for 5-6 months now. I've been doing exercises twice a day with weights and bands (given by physio) and I was going to physio 3x per week for ultra sound, and massages. I took 5 weeks off of tennis too.

Nothing is helping so the next logical step is PRP I think..
 

TennisCanada1

Professional
Spintowin, thanks, I have been considering the gut. Would synthetic do the trick or does the gut make a big difference?
 

heninfan99

Talk Tennis Guru
TMI, dood, TMI.
I've had golfer elbow and I can tell you, it's more likely you will aggravate your case by just living, really, just living, than by playing tennis. I f you wake up in the morning in pain, it's because you arm was flexed during your sleep, still happens to me after two years. Look, I feel pain when I wipe my arse after a number 2...
.
 
What would be the process for having the PRP injections done? Expense?

From where I sit you probably needed something longer than 5 weeks off.
 

mikeler

Moderator
Spintowin, thanks, I have been considering the gut. Would synthetic do the trick or does the gut make a big difference?
For a tender elbow, there will be a big difference between gut and synthetic gut. It sounds like you still need to rest it and maybe move on to a more serious treatment though.
 

TennisCanada1

Professional
Thanks for the input mikeler. Would Babolat Tonic+ Natural Gut 15L String fit the bill, with a tour bite soft? I have my MRI in 3 weeks, and then I will be getting a referral to a sports doctor.

I considered cortisone but I was told it can act as a masking agent, so unless I take a lot of time off, If I'm hitting hard serves I wouldn't know if the steroid aspect is actually curing my tendon or if its simply temporary relief. I'm thinking of PRP at this point because of the research I've done, specifically regarding how it works and how the results seem to be so promising. The thing is, I can hit groundstrokes for 2 hours at 100% and not feel a THING, but its only when I serve over 50% speed that I feel some pain, so at this point, how much time is actually needed? I feel that rest is important but that PRP is a much needed catalyst.
 

RogueFLIP

Professional
So...it never fully went away. I don't have pain in the middle of the night, and I can go full speed on groundstrokes for hours if I wanted to, but if I start serving then it hurts the next day and the inflammation builds up more.

At this point I'm considering a PRP injection. Has anyone done this?

Or you might consider that if groundstrokes don't affect the elbow but overhead serving does, there might be some connection to your elbow from your shoulder region.

Like pulling a rope, you can pull from one end but feel it at the other end. You can treat the end where you feel it all you want, but until you release the pull from the other end, you'll never get satisfactory results.

Something to think about.
 

TennisCanada1

Professional
You're definitely right. I don't feel any shoulder pain but I understand what you mean about how it's all connected. That is why my physio gave me shoulder exercises with bands to do. I've been doing them so I can condition the entire general region.
 

mikeler

Moderator
Thanks for the input mikeler. Would Babolat Tonic+ Natural Gut 15L String fit the bill, with a tour bite soft? I have my MRI in 3 weeks, and then I will be getting a referral to a sports doctor.

I considered cortisone but I was told it can act as a masking agent, so unless I take a lot of time off, If I'm hitting hard serves I wouldn't know if the steroid aspect is actually curing my tendon or if its simply temporary relief. I'm thinking of PRP at this point because of the research I've done, specifically regarding how it works and how the results seem to be so promising. The thing is, I can hit groundstrokes for 2 hours at 100% and not feel a THING, but its only when I serve over 50% speed that I feel some pain, so at this point, how much time is actually needed? I feel that rest is important but that PRP is a much needed catalyst.
Go all gut, I know you want to use poly but its a bad idea right now. I tried cortisone pills about 5 years ago for GE. It went away within a few hours so I played a lot of tennis for 3 weeks. The pain came back and it was unbearable. I'm on the cortisone pills again for a swollen toe. This time I'm taking some time off before coming back. The nice thing is the pills are helping ease the inflammation in some other areas as well. Good luck.
 

kslick

Rookie
So...it never fully went away. I don't have pain in the middle of the night, and I can go full speed on groundstrokes for hours if I wanted to, but if I start serving then it hurts the next day and the inflammation builds up more.

At this point I'm considering a PRP injection. Has anyone done this?

Have you actually taken time off from all kinds of hitting? Think I would put down the racquet and just rehab before I jumped into PRP injections. I know that GE sucks and putting down the racquet is no fun but this is something you don't want to linger and always having to battle. Plus there is no guarantee PRP will work.
 

tlm

G.O.A.T.
I was just doing some internet searching to see if my pullups and chinups were possibly aggravating my GE as I suspected. Of course they were.

Anyway, I came across this link below. I'll let it speak for itself since I've only run across it, but my arm does feel relieved after just doing it.

Worth a shot!

http://tomrandallclimbing.wordpress.com/2012/11/23/golfers-elbow-a-possible-solution/
This is the best stretch for GE by far, I have a stretch routine for GE and all those stretches combined do not relieve the pain like this one stretch does. Thanks for posting
 

TennisCanada1

Professional
Update: I've now been to three physios. Nobody can say for sure that it's GE. Its in the inner elbow region, and VERY close to the site of GE, but a bit more central. I'm getting an MRI but also, a few months ago I experienced numbness and tingling in my little 2 fingers, and now today and yesterday that has come back. I looked it up and it could be something with my ulnar nerve, but I don't get how the ulnar nerve could translate to muscular/tendon pain.
 

Chas Tennis

G.O.A.T.
I forget the details but the pronator teres muscle of the forearm I believe attaches to a forearm bone and also to the humerus. The medial nerve goes between the 'Y' space where the muscle splits.

Pronator Teres Syndrome
http://en.wikipedia.org/wiki/Pronator_teres_syndrome

Illistrations with region of hand numbness.
http://www.massagetoday.com/mpacms/mt/article.php?id=13625

My golfer's elbow pain was very localized to where the medial epicondyle is. My pain was sharp and small, very similar for several GE injuries and occasional mild tweeks since.

See if you can find something that pinches the ulnar nerve. There are maps that show when a nerve is pinched where it might have been pinched between the symptoms and the brain. Neck to hand in your case.

There are many possible arm injuries and it takes a Dr to diagnose.
 
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speedysteve

Legend
I've been managing G.E. for the last 6 months.
Had the diagnosis and the 5 weeks rest from tennis (oh the agony) and physio. Agree with the poster who wrote that life can keep it aggravated - esp DIY.

Mine came on when I upped my tennis play and practise frequency - esp hard flat serves... I was murdering them down the club with my first serve and then it struck...

I read up on racquets and sought solace in weightier / 330 swing weight, softer strings - firstly Prince Premier Softflex and then I learned that lower tensions really help more - Much autumn / winter play here in the UK rules nat gut out - but I will give it a go next summer.
I like Head Rip Control multi 17g and will try a few others.

Ice packs 3 times after playing seems to stop any risk of rising inflammation.
Whilst not having access to enough ultrasound treatment for my liking - (perhaps I should buy a machine), I tried a Tens machine - used several years before on my back.
The gentle elec pulses certainly are doing the trick for me. I use it for a couple of hours programme after each playing session and you can pretty much get on with life while under the treatment.

I have had to completely rethink my serve - gone are the flat serves.
Slower kick serves are the order of the day... No aggravation from these at all. It is all shock impact for me.
Forehands are ok with the heavier racquet even inside out / shoulder high.

So, manage on I say.
 

ThreePete

New User
try out of the box therapies. Maybe acupunture to stimulate blood flow to the area or cryotherapy to reduce inflammation. also supplementing with cissus/glucosamine or "Elbow Revive", using a "Flex Bar", and "Voodoo floss". good old self applied massage is great for loosening up tthe muscles in the forearms as well.
 
Been going to town on the non-painful parts of my forearm using "The Stick." Arm feels so loosened up. Wish I had been doing this long ago.
 
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