Tennis Elbow ... maybe Supinator problem, and not Extensor

[ByeByePoly]

Note: a supinator injury can mimic TE ... Googled that ... must be true... I trust everything I read on the internet.

So I have read, and posted on some helpful TE discussion here at TT... great to see tennis players trying to help each other out. If we get good enough at playing doctor at this, perhaps we can save those doc and therapy bills. Perhaps my following observation about my TE could be helpful ... at least helpful to someone like me trying to rehab my TE without a trip to the doc.

- Got TE 2+ months ago, and been using the green flexbar ... pretty much daily, ever sense
- do the standard extensor muscle exercise with the flexbar, also roll the extensor muscles
- really haven't been doing any supinator exercises, thought I probably just had typical extensor muscle TE

I had heard backhands typically cause extensor muscle TE, and forehands typically cause GE. I have TE ... at least it hurts on the outside elbow.

So it always didn't add up to me, that when I was able to have light hits, I felt no pain at all on the backhand... slice or 2hbh. Switched to 2hbh last summer, so rarely have hit a ohb (other than slice) in recent history.

Forehand hurt some on TE side (a lot when I first got it... but improved) ... tennis band seemed to have zero effect one way or the other... if anything, it was less pain without the band (very light pain... or would not be having a light hit)

But serving was, and is still off the table. Really feel it then. So if I was going by the theory the "stroke that caused the TE" is the "stroke that would hurt", then perhaps I have a "serving injury"... which my understanding is the "supinator muscle/tendons".

A few things reinforce that possibility:
- when I first got the flexbar and was following the Jamie Dryer video... I tried what he suggested, doing supinator exercise by bending flexbar into a U. Sharp pain in elbow... didn't try that again.
- ironically today, after having on ongoing conversation about FH technique, and noticing a wrist turn (not just laying the wrist back) in Federer's initial forward swing ... I of course had to try that with some shadow swings. Whoa... that sure showed me where the supinators are {more towards the outer bone from the extensor muscles, and my spot of pain is right at the elbow just past the lateral epicondyle}.

A tennis player really should not have to ever know what a lateral epicondyle is.

So one thing that might make this TE rant useful for the next guy with TE avoiding the doc... just make sure you do exercises for both extensor and supinator TE. I don't see how it could hurt, and perhaps I am two months behind in my rehab because I was working the extensors that were fine (I guess there is the possibility both extensor and supinator could be hurt at the same time, but that doesn't sound very likely to me).

So for all you tennis players here at TT that play doctors, or for any doctors that also play tennis ... feel free to chime in.

In the meantime... ByeByePoly's supinator exercises started today.

 

[RogueFLIP]

I wish you the best of luck working on your supinators to try and resolve your pain.

I'll post again the vid from your other thread that I posted for a reminder to you and others that when you have a chronic condition, that you can't just think about treating only your symptomatic sites.

Good luck.

Also, come back to this thread if treating your supinators doesn't resolve things fully to remind you that you have more muscles that connect to your elbow that you might want to consider than the wrist flexors/extensors supinators/pronators.

 

[mmk]

On Tuesday I made the mistake of playing two games with a much stiffer racquet than I normally use (70 vs 60), and switched back to my regular racquet after those two because I could feel TE kicking in. After icing and ibuprofens I thought I was fine Thursday, but it still hurt, and at one point I felt a snap that hurt like hell. Of course being an idiot I played another five points hitting like a 2.5 before I called it quits (but I won that game). I'm hoping between ice, ibuprofen, a flexbar and taking at least a week off I'll be okay.

 

[ByeByePoly]

On Tuesday I made the mistake of playing two games with a much stiffer racquet than I normally use (70 vs 60), and switched back to my regular racquet after those two because I could feel TE kicking in. After icing and ibuprofens I thought I was fine Thursday, but it still hurt, and at one point I felt a snap that hurt like hell. Of course being an idiot I played another five points hitting like a 2.5 before I called it quits (but I won that game). I'm hoping between ice, ibuprofen, a flexbar and taking at least a week off I'll be okay.

"but I won that game"

That is an example of the beauty of this game ... a time to forget our troubles and think about nothing but tennis ... even when the elbow failed and snapped the game before

I wish you a quick recovery, but that snap thing sounds bad. If I flex my TE elbow in a certain way ... I hear a snap ... don't like that snap

 

[ByeByePoly]

Edit: Below, I refer to a "upside down U" with flexbar in Jamie Dreyer video. I had not watched it for a while, and he was actually doing a 90 degree with just the right arm. I flex both sides at same time, but nowhere close to 90.

Seem to be seeing some pretty quick benefit from adding supinator exercise to my TE exercise routine. It's only been a week since I added it ... but already feels much better, and I can now serve light serves without much pain. I still feel the TE on some forehands... but getting better. None of us really ever know if anything we do really helped. The TE could just be healing on it's own time table, and it's a coincidence if we add something to the mix right before it was going to heal on it's own anyway. I'm probably near the 3 month mark now... so if I had done absolutely nothing, could be in the same place. Who knows ... tendons obviously heal VERY frickin slowly.

That being said... and hoping it might help someone else rehab their TE faster:

I now do the following supinator exercises daily along with the green flexbar extensor exercise (follow Jamie Dreyer's video... it's linked here all over TT)
1) at the end of the Jamie Dreyer TE video, he shows how to bend the flexbar down into a upside down U to exercise the supinators. I tried that early on... and it hurt, so didn't do it anymore. Perhaps the thing that is hurting is telling you what you actually hurt. DOH!!!

This is how I have been using the green flexbar for the supinators. I find that the green bar is too much resistance for me at this point to bend into the full U. So I just put a slight bend into the flexbar... short of any sharp pain... actually short of any pain. He didn't emphasize any slow "eccentric" release of the hold, like he does with the flexbar extensor exercise, but that's how I do it. It seems like if eccentric (tendon stretch under load) is good for the extensor tendon, it must also be good for the supinator tendon. So I put the green flexbar into a slight bend... hold it for 3 seconds like the extensor exercise, and then slowly let it straighten back up. ***

2) interestingly, one of the early videos I watched when initially Googling TE exercises was a guy from a PT shop naming the 3 exercises they have everyone start with that shows up with TE. One was an extensor exercise (not with the flexbar, with a weight) and a second one was a supinator exercise, where you supported your TE arm ... like on a table or chair ... and held a hammer vertically in your wrist. Then you turned the hammer to parallel right, and then parallel left working the supinators. Before someone asks... I don't remember what the third exercise was ... probably a stretch that I blew off, because trying to stretch a hurt tendon makes no sense to me.

I do something similar, but with my tennis racquet. I hold my arm extended (right arm ... TE arm) I hold the racquet with your normal grip near the butt of the racquet, with the racquet facing up. I support the right arm at the elbow with the left hand... and slowly do the parallel right and left thing. I don't get any pain doing this... but if I did, I would just choke up on the racquet.

I think my takeaway is when someone first starts doing exercises for TE ... just do both extensor and supinator exercises from the start. Unless you are feeling pain and making it worse, how can it hurt to do both. Perhaps I wasted 1+ month of playing time not doing both. Then again... perhaps anything that keeps you off the courts for several months is good no matter what.

*** I wanted to mention how I adjust the tension level on the green flexbar when I do the extensor exercise. You see so much debate about "buy the red one, or the green one, or both". If you have a really bad case where you can't turn door knobs, etc. ... just get the red one. I also believe ... as others have said here at TT... you very likely might never need anything more than the red one... even with maintenance mode later once TE has healed. But I didn't want to buy both... and figured my TE was on the milder end and got the green one. For me, and my TE is has been great.

But for lack of a better term ... "I don't do the full Jamie Dreyer" twist. If you watch Jamie in his video, he takes the right arm and sets it near his stomach, and then he sets his left hand grip, and this all creates a good twist of the bar. I could do that from the start with the green bar ... but it felt like just a bit too much tension. So what I do instead is start by holding the right arm straight (rather than turn into my stomach), and then set the left hand grip and go into the twist. It just sets a little less tension (lbs) ... and it's about right for my TE. Interestingly, if you watch older videos where they are showing how to use the flexbar (the people who came up with it), they show starting with the right arm straight. The point being... you can adjust tension/lbs with initial wrist positions.

TE sucks... hope everyone avoids it ... and if not, everyone heals quickly. Oh yeah... one final TE tip. If you feel compelled to type TE rants here at TT ... use a keyboard instead of pecking away on your tablet or phone.

 

[RanchDressing]

Just be careful about trying to play. If you have TE brewing you need to take time off for it to heal, otherwise there's going to be very little you can do to stop it progressing.

I read some things about tendonitis vs tendonosis, and Icing helps tendonitis, but if you've had the tendonitis for a while, chances are it's actually tendonosis... Which gets worse by icing. Tendonosis is made better by warming (hot compress), massaging, increasing activity and stretching. That's generally the opposite of what helps tendonitis. So it's important to figure out whats going on. I was icing my bicep for a while, and it never got better. Then I started stretching and letting myself play, and the bicep actually feels better than when I was taking long breaks between playing and icing a lot.

 

[ByeByePoly]

Just be careful about trying to play. If you have TE brewing you need to take time off for it to heal, otherwise there's going to be very little you can do to stop it progressing.

I read some things about tendonitis vs tendonosis, and Icing helps tendonitis, but if you've had the tendonitis for a while, chances are it's actually tendonosis... Which gets worse by icing. Tendonosis is made better by warming (hot compress), massaging, increasing activity and stretching. That's generally the opposite of what helps tendonitis. So it's important to figure out whats going on. I was icing my bicep for a while, and it never got better. Then I started stretching and letting myself play, and the bicep actually feels better than when I was taking long breaks between playing and icing a lot.

You can find my recent comments about TE all over TT... but I don't do icing, heat or warming. The one exception is a couple of minutes of ice in a paper towel on the elbow after my light hits... my tennis buddy the vet thinks that could avoid scaring. I have decided the best bets is rolling the muscle trigger points, and the flexbar. If I could only do one of those, I would do the trigger point massaging.

Hard to define "being careful", because some people take a year or two break, and get TE immediately when they return. Others ... play and make it worse... much worse. If it was obvious my best odds was taking a year off, I would. It seems actually playing tennis has to be part of the rehab (i.e. best rehab exercise) ... the problem is when? What I am trying is testing with light hits. If I took a year off ... I would test with light hits. So when are you ready? For light hits? For sets? Don't think anyone knows for sure. The rule I am going by is any sharp pain, and I am packing up. I have hit once a week for a month, and my elbow feels significantly better ... but that could be the tendon healing on it's own timetable. I read where tendons don't even really start to heal until the 6 week mark... and many here have been told 6 months to 1 year is typical.

Sure seems like way too many get TE or GE these days. I think it's the poly over time ...

 

[RanchDressing]

You can find my recent comments about TE all over TT... but I don't do icing, heat or warming. The one exception is a couple of minutes of ice in a paper towel on the elbow after my light hits... my tennis buddy the vet thinks that could avoid scaring. I have decided the best bets is rolling the muscle trigger points, and the flexbar. If I could only do one of those, I would do the trigger point massaging.

Hard to define "being careful", because some people take a year or two break, and get TE immediately when they return. Others ... play and make it worse... much worse. If it was obvious my best odds was taking a year off, I would. It seems actually playing tennis has to be part of the rehab (i.e. best rehab exercise) ... the problem is when? What I am trying is testing with light hits. If I took a year off ... I would test with light hits. So when are you ready? For light hits? For sets? Don't think anyone knows for sure. The rule I am going by is any sharp pain, and I am packing up. I have hit once a week for a month, and my elbow feels significantly better ... but that could be the tendon healing on it's own timetable. I read where tendons don't even really start to heal until the 6 week mark... and many here have been told 6 months to 1 year is typical.

Sure seems like way too many get TE or GE these days. I think it's the poly over time ...

I agree except for that very last sentence lol. I went from trying every string combo ever (soft poly's hybrids etc etc), and then changed my recoil weight. That's when I was able to use rpm team which is about as stiff as 4g, at 60lbs+ in a constant pull machine.

 

[ByeByePoly]

I agree except for that very last sentence lol. I went from trying every string combo ever (soft poly's hybrids etc etc), and then changed my recoil weight. That's when I was able to use rpm team which is about as stiff as 4g, at 60lbs+ in a constant pull machine.

I said above ... "even if I waited a year I would test with light hits". What I meant was "even if you took a full year off with no tennis including no light hits ... you would still test with light hits when you came back in a year".

It would be really good if we had more specific guidelines on measuring the severity of our particular TE ... and a timetable and method to get back on the courts. It would also be good to be able to know damage we are doing prior to actually feeling the TE.

Yeah ... we will just have to agree to disagree on poly. I played with full RPM Blast 16 for 4 years @50-52lbs. I never had any major issues ... but it was the only string in 40 years of tennis where a felt wrist and shoulder soreness on occasion. As far as I'm concerned that was pre-TE warning signs. Bottom line for me ... tennis was good before poly, and it will be good post poly ... I don't need it, and no reason to risk it.

What I really need to do for my TE is never miss the sweet spot.