Treatments for Rotator Cuff Tendinosis?

[i_heart_ib]

I just got diagnosed with mild tendinosis, which sucks because I play tennis everyday and the healing time for tendinosis can range from weeks to months.

I was researching treatments for tendinosis, and I saw that some treatments were:
-Therapeutic Ultrasound
-ASTYM (Augmented Soft-Tissue Manipulation)
-Blood Flow Stimulation Therapy

I was wondering if any of you guys have gone through this before, and if so, which treatment has worked? How long did it take to recover and get back on the courts? Any help is greatly appreciated.

Thank you so much

 

[charliefedererer]

I just got diagnosed with mild tendinosis, which sucks because I play tennis everyday and the healing time for tendinosis can range from weeks to months.

I was researching treatments for tendinosis, and I saw that some treatments were:
-Therapeutic Ultrasound
-ASTYM (Augmented Soft-Tissue Manipulation)
-Blood Flow Stimulation Therapy

I was wondering if any of you guys have gone through this before, and if so, which treatment has worked? How long did it take to recover and get back on the courts? Any help is greatly appreciated.

Thank you so much

The most important treatment is REST, and the best advice is to be under the care of an experienced shoulder specialist.

The key is no tennis and just range of motion movements until pain subsides.

The next phase is increasing your shoulder strength with the thrower's ten, or whatever regimen your shoulder specialists advises.

The return to tennis should be gradual, with short hitting sessions and no serving at first.

The chance for recurrence of the tendon-itis (the cause of the tendonosis), is decreased by using a flexible, not-too-light frame with soft (natural gut or multifilament string).

Be sure there are no technique problems that could account for an early recurrence, especially on the serve:
Preventing Rotator Cuff Injury: http://www.youtube.com/watch?v=lTRvxaBMh8s&feature=related
USPTA Rotator cuff injury: http://www.tennisresources.com/inde...ail&basicsearch=1&media_name=&rv=1&vidid=3712

 

[i_heart_ib]

The chance for recurrence of the tendon-itis (the cause of the tendonosis), is decreased by using a flexible, not-too-light frame with soft (natural gut or multifilament string).

Thanks for the reply!

I am currently using the Babolat Pure Drive Cortex racket with Luxilon strings (i also have a new set of Babolat RPM Blast Black 16 as well. Is that a flexible, not-too-light frame? I'm not really good with the specifics of rackets.

I was also looking to switch over to either the Volkl Power Bridge 10 Mid or the Prince EXO3 Tour 100 racket. Are those two good?

Thanks!

 

[scotus]

Ditch the Pure Drive and poly strings.

Prince EXO3 Tour should be your new friend, but after a length rest, rehab, and complete recovery.

We are looking at at least a few months of no tennis.

 

[i_heart_ib]

Ditch the Pure Drive and poly strings.

Prince EXO3 Tour should be your new friend, but after a length rest, rehab, and complete recovery.

We are looking at at least a few months of no tennis.

Yeah...I've only played tennis once the past 2 months because of my shoulder. Now I wished I did not play that one time at all.

Speaking of the Thrower's 10, I realized that my PT a few months ago DID make me do pretty much most of those exercises. I did it about 4 times a week for 5-6 weeks, but now I'm here again with the same problem. ANy ideas what's happening?

 

[wmhipple]

I had this in the 80's .... Lot's of rest.... a few shots... and rehab.
Took me 2 seasons before I could lift a racquet again.

 

[charliefedererer]

Yeah...I've only played tennis once the past 2 months because of my shoulder. Now I wished I did not play that one time at all.

Speaking of the Thrower's 10, I realized that my PT a few months ago DID make me do pretty much most of those exercises. I did it about 4 times a week for 5-6 weeks, but now I'm here again with the same problem. ANy ideas what's happening?

Did you keep up the exercises?

Are you getting enough "breaks" from hitting during the week?

Are you doing too much serve practice?

Maybe the super stiff frame and stiff strings are part of the problem. That Volkl or Prince should be better, especially with multifilament or natural gut strings. Volkl, Dunlap and Pro Kennex tend to have the "softest" frames, though Wilson, Prince and Head have a few too. Try to look for a frame with a stiffness/flexibility index in the low 60's - it's a specification listed on all the racquets at Tennis Warehouse. Higher 70's is ultra stiff, and even at 70, your Babolat PDC is an arm killer. By not-too-light I mean you should use the heaviest racquet that you can easily swing. That should be probably at least 11 ounces. The more mass, the more shock absorbtion by the frame instead of by your arm.

Are you dropping your front shoulder on your serves like in the video's I posted?

 

[i_heart_ib]

Did you keep up the exercises?

Are you getting enough "breaks" from hitting during the week?

Are you doing too much serve practice?

Maybe the super stiff frame and stiff strings are part of the problem. That Volkl or Prince should be better, especially with multifilament or natural gut strings. Volkl, Dunlap and Pro Kennex tend to have the "softest" frames, though Wilson, Prince and Head have a few too. Try to look for a frame with a stiffness/flexibility index in the low 60's - it's a specification listed on all the racquets at Tennis Warehouse. Higher 70's is ultra stiff, and even at 70, your Babolat PDC is an arm killer. By not-too-light I mean you should use the heaviest racquet that you can easily swing. That should be probably at least 11 ounces. The more mass, the more shock absorbtion by the frame instead of by your arm.

Are you dropping your front shoulder on your serves like in the video's I posted?

Once my PT ended, I did the exercises about once a week for a few weeks, until I thought I was okay and didn't do the exercises anymore.

I probably didn't get too many breaks because of the school's tennis season. Tennis games and practices all week except for weekends, but I ended up playing on the weekends anyway just because I love playing tennis so much.

Oh, my pure drive has a flex rating of 70. The Volkl Power Bridge Mid 10 has a flex rating of 59, while the Prince EXO3 Tour 100 has a flex rating of 52.

Also, does the thrower 10 prevent rotator cuff problems (Such as tendinosis), or does it cure them? Since I already have it, would the thrower's 10 exercises help me heal, or would it worsen the degeneration?

Thanks! You're a lifesaver

 

[scotus]

When doing rehab, you want to do those thrower 10 with incredibly light weight.

If I recall correctly, the Thrower 10 videos show athletes lifting heavy dumbbells. That's for healthy athletes doing conditioning, not for those in rehab.

Start with dumbbells 1 or 2 lbs, and do more reps.

Also, listen to your body. If your body hurts more after those exercises, you want to back off a little.

Whether or not you do PT, ultimately it takes time to heal. PT is good, but too much of it can also hamper your recovery.

 

[charliefedererer]

^^^Listen to scotus.

 

[i_heart_ib]

The most important treatment is REST, and the best advice is to be under the care of an experienced shoulder specialist.

The key is no tennis and just range of motion movements until pain subsides.

The next phase is increasing your shoulder strength with the thrower's ten, or whatever regimen your shoulder specialists advises.

The return to tennis should be gradual, with short hitting sessions and no serving at first.

The chance for recurrence of the tendon-itis (the cause of the tendonosis), is decreased by using a flexible, not-too-light frame with soft (natural gut or multifilament string).

Be sure there are no technique problems that could account for an early recurrence, especially on the serve:
Preventing Rotator Cuff Injury: http://www.youtube.com/watch?v=lTRvxaBMh8s&feature=related
USPTA Rotator cuff injury: http://www.tennisresources.com/inde...ail&basicsearch=1&media_name=&rv=1&vidid=3712

Can you name some examples of natural gut or multifilament strings that are good for performance? Which ones would you recommend me using?

 

[mikeler]

Can you name some examples of natural gut or multifilament strings that are good for performance? Which ones would you recommend me using?

Mantis Comfort Synthetic is the softest multi I have tried. It is a good price if you buy the reel, packs are almost double the price.

 

[charliefedererer]

^^^mikeler really knows his strings. Check out "Mikeler's Multis" thread for maybe even more than you want to know about multifilaments: http://tt.tennis-warehouse.com/showthread.php?t=352048

A good resource for a quick guide to strings is the Tennis Warehouse Learning Center:

All About Strings & Stringing: http://www.tennis-warehouse.com/LC/StringReference.html
Natural gut, the king of all strings: http://www.tennis-warehouse.com/LC/Naturalgut.html
Basic Facts About Frames & Strings: http://www.tennis-warehouse.com/LC/BasicFacts.html


Almost everyone agrees that Babolat natural gut is the best natural gut, and most would prefer natural gut over multifilament if it wasn't "so expensive". Most natural gut strings will last longer than multifilaments, so if you string it yourself, its not that much more. I currently use Klip Armour Pro natural gut both alone and in a hybrid with gut in the mains. To save my arm, I often warm up or practice serving with the natural gut in a frame, even if I usually use the hybrid for match play. (Thankfully I've never had any arm issues.)

 

[tennisenthusiast]

I would really like to use natural gut strings but are they really made out of some kind of animal gut?

I am against cruelty of animals...do I have any alternatives to natural gut?

 

[mikeler]

I would really like to use natural gut strings but are they really made out of some kind of animal gut?

I am against cruelty of animals...do I have any alternatives to natural gut?

Yes they are made of animal gut. If that bothers you then go with a soft multifilament.

 

[tennisenthusiast]

Thank you....you rock!!

 

[i_heart_ib]

^^^mikeler really knows his strings. Check out "Mikeler's Multis" thread for maybe even more than you want to know about multifilaments: http://tt.tennis-warehouse.com/showthread.php?t=352048

A good resource for a quick guide to strings is the Tennis Warehouse Learning Center:

All About Strings & Stringing: http://www.tennis-warehouse.com/LC/StringReference.html
Natural gut, the king of all strings: http://www.tennis-warehouse.com/LC/Naturalgut.html
Basic Facts About Frames & Strings: http://www.tennis-warehouse.com/LC/BasicFacts.html


Almost everyone agrees that Babolat natural gut is the best natural gut, and most would prefer natural gut over multifilament if it wasn't "so expensive". Most natural gut strings will last longer than multifilaments, so if you string it yourself, its not that much more. I currently use Klip Armour Pro natural gut both alone and in a hybrid with gut in the mains. To save my arm, I often warm up or practice serving with the natural gut in a frame, even if I usually use the hybrid for match play. (Thankfully I've never had any arm issues.)

Thank you so much!

 

[charliefedererer]

I would really like to use natural gut strings but are they really made out of some kind of animal gut?

I am against cruelty of animals...do I have any alternatives to natural gut?

No animal is ever killed or suffers because of tennis. Natural gut is a byproduct of cattle, but it represents only a tiny fraction of a part of the animal that otherwise would just be discarded.

It is fascinating that with all the amazing discoveries in polymer chemistry, there still is not a synthetic multifilament with the elasticity and durability of natural gut. (Then again, the Engineer who developed this natural material seems to have many mysteries we can not comprehend.)

 

[i_heart_ib]

Just came home from the doctor and she told me that tendinosis was chronic tendinitis (inflammation lasting over 3 months) and not the degeneration of the tendon (which is what ive read in the internet)

Anyone know if she is correct?

 

[GPB]

She's a doctor, and we're not. She's looked closely at your shoulder, and we've not.

Listen to your doc. Or see another. But honestly, how the he|| will we know if she's correct or not?

 

[scotus]

Just came home from the doctor and she told me that tendinosis was chronic tendinitis (inflammation lasting over 3 months) and not the degeneration of the tendon (which is what ive read in the internet)

Anyone know if she is correct?

I would not agree with her completely.

I agree that tendinosis results from chronic tendinitis, such as one lasting over 3 months or however much time, but tendinosis certainly involves gradual degeneration.

In a patient suffering from TE, you will most likely see both tendinitis and tendinosis. By the time the patient reaches the operating table (followed by a long period of forced rest and inactivity), I would expect only the signs of tendinosis to remain (which is probably why some surgeons say they see no signs of tendinitis in TE patients they have operated on and even advance the argument that TE does not involve any tendinitis at all).

 

[charliefedererer]

Just came home from the doctor and she told me that tendinosis was chronic tendinitis (inflammation lasting over 3 months) and not the degeneration of the tendon (which is what ive read in the internet)

Anyone know if she is correct?

Here's my take:

Mild tendonosis can still have enough remodeling over many months that the tendon returns to "almost" normal as long as the tendonitis (inflammation) resolves by resting the tendon.

Severe tendonosis will not almost entirely resolve over time, even though some improvement can occur.

 

[Torres]

Tendonisis or tendonitis? And which tendon in the rotator cuff?

I had ultra-sound when I injured my supraspinatus a while back which seemed to speed up recovery. But really you really need to rest until it recovers otherwise you risk calcification of the damaged tissues.

 

[i_heart_ib]

Here's my take:

Mild tendonosis can still have enough remodeling over many months that the tendon returns to "almost" normal as long as the tendonitis (inflammation) resolves by resting the tendon.

Severe tendonosis will not almost entirely resolve over time, even though some improvement can occur.

The doctor did say I have mild tendinosis so I guess that's a bright spot.

I was planning to do some of the "range of motions" movements this week to help scar tissue from sticking (from the tendinosis), but would that irritate the inflammation(tendinitis) more? Would range of motions exercises be harmful if its still inflammed, or would it be ok?

thanks

 

[i_heart_ib]

Tendonisis or tendonitis? And which tendon in the rotator cuff?

I had ultra-sound when I injured my supraspinatus a while back which seemed to speed up recovery. But really you really need to rest until it recovers otherwise you risk calcification of the damaged tissues.

Doctor said i had tendonitis, bursitis, and mild tendinosis.

I talked to my doctor about ultrasound and she also said that it would be helpful in speeding up the recovery. How often did you use the ultrasound? I read online that everyday would be optimal, but since I do not own one of the machines, I would only get to use it about twice a week (when i go to the physical therapist).

Thanks

 

[charliefedererer]

The doctor did say I have mild tendinosis so I guess that's a bright spot.

I was planning to do some of the "range of motions" movements this week to help scar tissue from sticking (from the tendinosis), but would that irritate the inflammation(tendinitis) more? Would range of motions exercises be harmful if its still inflammed, or would it be ok?

thanks

It is always best to check with your doctor because they have examined you and know at what stage you are at.

In general though, it is usually okay to do early gentle range of motion "exercises" (really movements).

(Because you are being smart about it, and not just playing with the pain - and thus prolonging the inflammation - it would seem unlikely that you will end up with significant scar tissue (sticking) problems.)

 

[Torres]

Doctor said i had tendonitis, bursitis, and mild tendinosis.

I talked to my doctor about ultrasound and she also said that it would be helpful in speeding up the recovery. How often did you use the ultrasound? I read online that everyday would be optimal, but since I do not own one of the machines, I would only get to use it about twice a week (when i go to the physical therapist).

Thanks

Twice a week when I was first injured. Then that dropped down to once a week. The whole thing sorted itself after about 6 weeks and I was playing through some mild pain during the 4th-6th weeks, compared to barely being able to use my shoulder when I first injured it.

My advice would be to see a physiotherapist because unless you've been playing a lifetime of pro tennis there's usually a correctable physical cause (eg. insufficient support from the surrounding muscles) or mechanic cause (eg. incorrect serve mechanics).

In my case, I had switched to heavier racquets but was still serving in the same way, at the same pace, playing about 12 hours a week without allowing for an adjustment period. Basically, it put too much strain on the tendon in too short a period of time.

If you have a look at this video, you'll see that the tendon moves through a very small area which can result in 'rubbing' against the bursar and surrounding tissue.

http://video.about.com/orthopedics/Rotator-Cuff-Injury.htm

http://video.about.com/orthopedics/Anatomy-of-Shoulder.htm

 

[i_heart_ib]

It is always best to check with your doctor because they have examined you and know at what stage you are at.

In general though, it is usually okay to do early gentle range of motion "exercises" (really movements).

(Because you are being smart about it, and not just playing with the pain - and thus prolonging the inflammation - it would seem unlikely that you will end up with significant scar tissue (sticking) problems.)

Alright cool. That makes me feel a lot better. With proper rehab, hopefully my problem will go away forever.

Twice a week when I was first injured. Then that dropped down to once a week. The whole thing sorted itself after about 6 weeks and I was playing through some mild pain during the 4th-6th weeks, compared to barely being able to use my shoulder when I first injured it.

My advice would be to see a physiotherapist because unless you've been playing a lifetime of pro tennis there's usually a correctable physical cause (eg. insufficient support from the surrounding muscles) or mechanic cause (eg. incorrect serve mechanics).

In my case, I had switched to heavier racquets but was still serving in the same way, at the same pace, playing about 12 hours a week without allowing for an adjustment period. Basically, it put too much strain on the tendon in too short a period of time.

If you have a look at this video, you'll see that the tendon moves through a very small area which can result in 'rubbing' against the bursar and surrounding tissue.

http://video.about.com/orthopedics/Rotator-Cuff-Injury.htm

http://video.about.com/orthopedics/Anatomy-of-Shoulder.htm

Thanks for the info. Yeah, I'm going to the orthopedist specialist sometime this upcoming week (because my doctor didnt know what to do so she referred me there) and I'm pretty sure that going to a Physical Therapist again will end up being my treatment, along with ultrasound every PT session (so about twice a week).

 

[pvaudio]

I may be only 22 years old, but please do take what I'm about to say seriously because I have quite a bit of credibility in this area. I first had tendinitis at age 15, and ended up tearing the same tendon two years later regardless of physical therapy. You need to make sure that what you have is what you have. If you can and can afford it, get a second opinion. I went to 5 doctors before the final one realized that I had actually had a tear all along, and all the physical therapy had simply built up scar tissue. That was 5 years ago. Even now, I cannot serve first in a match because I just need that long of a warm up for my shoulder.

Some tips:

1. Ice is your best friend, even moreso than NSAIDs. Reason being, ice will help to reduce the inflammation, but NSAIDs will also reduce the pain. While that sounds ideal, you then are walking about with a pain free shoulder which is still damaged making it possible for you to continue to overwork it since you don't feel anything.

2. Feel good treatments are a waste of your money. Cortizone, ultrasonics and muscle stims don't work. They make you feel nice for a little while, but truly only make you feel good. They're not solving the problem on any level.

3. Rest. Rest. Rest. I have lost about 40% of my ROM in my right shoulder since it's so tightly packed with scar tissue because I did NOT rest when I should have. I was using a flexible Dunlop racquet with NRG2 multifilament strings. I hadn't even heard of poly yet, so it wasn't even a contributing factor. Put the racquet down, and come back slowly with soft strings and smooth strokes. If you note that there's a specific stroke that twinges your shoulder, stop and consider changing your technique. For me, it's too much external rotation aka kick serving.

I hope this helps

 

[i_heart_ib]

I may be only 22 years old, but please do take what I'm about to say seriously because I have quite a bit of credibility in this area. I first had tendinitis at age 15, and ended up tearing the same tendon two years later regardless of physical therapy. You need to make sure that what you have is what you have. If you can and can afford it, get a second opinion. I went to 5 doctors before the final one realized that I had actually had a tear all along, and all the physical therapy had simply built up scar tissue. That was 5 years ago. Even now, I cannot serve first in a match because I just need that long of a warm up for my shoulder.

Some tips:

1. Ice is your best friend, even moreso than NSAIDs. Reason being, ice will help to reduce the inflammation, but NSAIDs will also reduce the pain. While that sounds ideal, you then are walking about with a pain free shoulder which is still damaged making it possible for you to continue to overwork it since you don't feel anything.

2. Feel good treatments are a waste of your money. Cortizone, ultrasonics and muscle stims don't work. They make you feel nice for a little while, but truly only make you feel good. They're not solving the problem on any level.

3. Rest. Rest. Rest. I have lost about 40% of my ROM in my right shoulder since it's so tightly packed with scar tissue because I did NOT rest when I should have. I was using a flexible Dunlop racquet with NRG2 multifilament strings. I hadn't even heard of poly yet, so it wasn't even a contributing factor. Put the racquet down, and come back slowly with soft strings and smooth strokes. If you note that there's a specific stroke that twinges your shoulder, stop and consider changing your technique. For me, it's too much external rotation aka kick serving.

I hope this helps

Yeah, ive accepted my fate and havent played tennis since I learned that I had tendinosis. The only bad thing is that Ive actually had this injury since summer, but at first they thought it was just tendinitis. Like you said, they seem to misdiagnose these things quite easily.

Well, I took a MRI 2 weeks ago and the results showed that there was no tear. That should be sufficient enough for me to be reassured that I do not have a tear right?

Thanks for the info.

 

[pvaudio]

Yeah, ive accepted my fate and havent played tennis since I learned that I had tendinosis. The only bad thing is that Ive actually had this injury since summer, but at first they thought it was just tendinitis. Like you said, they seem to misdiagnose these things quite easily.

Well, I took a MRI 2 weeks ago and the results showed that there was no tear. That should be sufficient enough for me to be reassured that I do not have a tear right?

Thanks for the info.

No, not necessarily. I had 3 arthroscopies, and only on the last one did the doctor recognize the tear. All of the others had dismissed it as simply inflammation.

 

[i_heart_ib]

No, not necessarily. I had 3 arthroscopies, and only on the last one did the doctor recognize the tear. All of the others had dismissed it as simply inflammation.

Did you ever get a MRI? My doctor told me that the MRI showed no tear, and I'm pretty sure they know a lot more than we do, so I'm pretty confident that I dont have a tear.

Is it likely that you may have gotten the tear AFTER the first 2 doctors saw you?

 

[i_heart_ib]

Just a little update.

I learned today when I got the referral to the orthopedist specialist that I actually have tendinosis in my supraspinatus AND my subscapularis.

I knew about the supraspinatus one because that is the most common tendon to be injured in the rotator cuff, but does anyone have any knowledge on the subscapularis tendon?

Thanks

 

[charliefedererer]

Just a little update.

I learned today when I got the referral to the orthopedist specialist that I actually have tendinosis in my supraspinatus AND my subscapularis.

I knew about the supraspinatus one because that is the most common tendon to be injured in the rotator cuff, but does anyone have any knowledge on the subscapularis tendon?

Thanks

The subscapularis muscle is much bigger than the supraspinatus.

It is the rotator cuff muscle most responsible for internal rotation at the shoulder.

The term "pronation" has been used as the action in serving responsible for the powerful slapping motion that separates a powerful serve from a lackluster one. But "pronation" really is a misnomer, as the motion mainly consists of internal rotation at the shoulder, and only a more minor component of actual pronation which anatomically occurs in the foream musculature. (I think every knowlagable tennis pro and trainer knows this, but we are sort of stuck with the term "pronation" in tennis circles because it is so widely [mis]used. Also note that while the subscapularis is "big" for a rotator cuff muscle, it is small compared to the muscles that really power the serve - its role is more like the derailleur on a bike, although rather than changing gears, it changes the direction with which the force built up through the kinetic chain is directed.)

Because the subscapularis is a bigger muscle with a bigger tendon, even though it can become involved in inflammation from too much serving, it is less likely to suffer a complete tear like the much smaller supraspinatus tendon. Also, because of its more superior location, the supraspinatus is much more likely to be "ground" between the head of the humerus and the bony acromion process as part of the impingement syndrome.

Ask your orthopedic doctor if he doesn't see evidence of subscapularis inflammation fairly frequently in pitchers and tennis players. (My guess is that he will tell you he does, and that with initial rest and rehab you should still do well.)

 

[i_heart_ib]

The subscapularis muscle is much bigger than the supraspinatus.

It is the rotator cuff muscle most responsible for internal rotation at the shoulder.

The term "pronation" has been used as the action in serving responsible for the powerful slapping motion that separates a powerful serve from a lackluster one. But "pronation" really is a misnomer, as the motion mainly consists of internal rotation at the shoulder, and only a more minor component of actual pronation which anatomically occurs in the foream musculature. (I think every knowlagable tennis pro and trainer knows this, but we are sort of stuck with the term "pronation" in tennis circles because it is so widely [mis]used. Also note that while the subscapularis is "big" for a rotator cuff muscle, it is small compared to the muscles that really power the serve - its role is more like the derailleur on a bike, although rather than changing gears, it changes the direction with which the force built up through the kinetic chain is directed.)

Because the subscapularis is a bigger muscle with a bigger tendon, even though it can become involved in inflammation from too much serving, it is less likely to suffer a complete tear like the much smaller supraspinatus tendon. Also, because of its more superior location, the supraspinatus is much more likely to be "ground" between the head of the humerus and the bony acromion process as part of the impingement syndrome.

Ask your orthopedic doctor if he doesn't see evidence of subscapularis inflammation fairly frequently in pitchers and tennis players. (My guess is that he will tell you he does, and that with initial rest and rehab you should still do well.)

Ah alright thank you very much.

I am going to the orthopedic doctor in half an hour...I will post back with what he says

 

[tennisenthusiast]

Ah alright thank you very much.

I am going to the orthopedic doctor in half an hour...I will post back with what he says

Hi i_heart_id,

How is your recovery going on? What did the doctor say? Are you doing any rehab? Please update us...

 

[i_heart_ib]

Hi i_heart_id,

How is your recovery going on? What did the doctor say? Are you doing any rehab? Please update us...

Well, the orthopedist doctor i met today was actually very knowledgable and nice.

He's setting me up with Physical Therapist again, as he believes that increased strength in the rotator cuff muscles will help. He also said working on the hip muscles (the little ones, like the gluteus medius) will help relieve the stress from the shoulder while playing, because more hip strength means less shoulder work.

His estimated recovery time for me: 6 weeks.

I can live with that.

 

[i_heart_ib]

Forgot to add. I'm also using the therapeutic ultrasound each time i go to the physical therapist.

 

[mikeler]

Forgot to add. I'm also using the therapeutic ultrasound each time i go to the physical therapist.

Any electrostimulation?

 

[i_heart_ib]

Any electrostimulation?

What's that? I have never heard of that before. Does it help?

If so, I can ask my physical therapist about it this week and see what happens.

 

[mikeler]

What's that? I have never heard of that before. Does it help?

If so, I can ask my physical therapist about it this week and see what happens.

They put light electrical current on your skin. My PT used that and ultrasound on my elbow.

 

[i_heart_ib]

They put light electrical current on your skin. My PT used that and ultrasound on my elbow.

Hmm...I'll ask him about that when I get to my first PT appointment.

Did it help out? And is the electrical current thing while you do the ultrasound?

 

[andy_carterbx]

Actually the best thing to do is to prevent future tennis injuries. It's better to prevent than to cure. I came across a very nice article to avoid tennis injuries. I hope you find this helpful.

http://tennisbully.com/how-to-guarantee-yourself-tennis-injury/

 

[mikeler]

Hmm...I'll ask him about that when I get to my first PT appointment.

Did it help out? And is the electrical current thing while you do the ultrasound?

My PT did the ultrasound therapy massaging my elbow with the unit for about 15 minutes. Then I did 15-20 minutes of electrostimulation afterwards.

Actually the best thing to do is to prevent future tennis injuries. It's better to prevent than to cure. I came across a very nice article to avoid tennis injuries. I hope you find this helpful.

http://tennisbully.com/how-to-guarantee-yourself-tennis-injury/

Agreed.

 

[Charles Norris]

Electrical Muscle Stimulation merely masks pain. In some cases it can be used to decrease hypertonic muscles and spasms, however in the case of elbow pain or knee pain, it's primarily used to alleviate the perception of pain. Its not really addressing the real problem or issue, so I wouldn't fret if your PT doesn't offer it. Ultrasound on the other hand promotes tissue healing so I would definitely want to use that. If there are any local PT's or Chiro's that have Class IV Cold Lasers, I would contemplate using that for decreasing inflammation. The verdict is still out on whether cold laser is beneficial, but I have seen it with my own eyes work wonders for numerous people with various different symptoms and complaints. All the best.

 

[i_heart_ib]

Actually the best thing to do is to prevent future tennis injuries. It's better to prevent than to cure. I came across a very nice article to avoid tennis injuries. I hope you find this helpful.

http://tennisbully.com/how-to-guarantee-yourself-tennis-injury/

Very true. My physical therapist is also working on strengthening my rotator cuff muscles, along with some hip muscles so the shoulder does not have to do that much work during the swing. Hopefully this helps for good!

Electrical Muscle Stimulation merely masks pain. In some cases it can be used to decrease hypertonic muscles and spasms, however in the case of elbow pain or knee pain, it's primarily used to alleviate the perception of pain. Its not really addressing the real problem or issue, so I wouldn't fret if your PT doesn't offer it. Ultrasound on the other hand promotes tissue healing so I would definitely want to use that. If there are any local PT's or Chiro's that have Class IV Cold Lasers, I would contemplate using that for decreasing inflammation. The verdict is still out on whether cold laser is beneficial, but I have seen it with my own eyes work wonders for numerous people with various different symptoms and complaints. All the best.

Interesting. I dont think my physical therapist offers Cold Lasers =(. But yeah, I'm excited to get this rehab going. Ultrasound sounds legit.

 

[i_heart_ib]

At the PT, they said that apparently there is a problem with the positioning of my shoulder blade. Said something about that...something like it makes the shoulder too high and too out in front. Just working on some back muscles to try and fix it. Still kinda confused though.

 

[tennisenthusiast]

At the PT, they said that apparently there is a problem with the positioning of my shoulder blade. Said something about that...something like it makes the shoulder too high and too out in front. Just working on some back muscles to try and fix it. Still kinda confused though.

Don't get confused...just work on strengthening shoulder muscles (which includes shoulder blades) Shoulder anatomy is a complex structure where everything is connected. Shoulder blades play a vital role....that's all.

 

[i_heart_ib]

Don't get confused...just work on strengthening shoulder muscles (which includes shoulder blades) Shoulder anatomy is a complex structure where everything is connected. Shoulder blades play a vital role....that's all.

Thanks.

Yeah, I'm just going to do exactly what they tell me to do and hopefully I'll be back in time for summer.

 

[charliefedererer]

At the PT, they said that apparently there is a problem with the positioning of my shoulder blade. Said something about that...something like it makes the shoulder too high and too out in front. Just working on some back muscles to try and fix it. Still kinda confused though.

Almost all of the bones in our body are stacked one on top of the other for stability.

The scapula (shoulder blade) is an exception to this. It sort of floats in back of the upper ribs, and the two together are almost like a pair of wings.

The arm is attatched to the side of the scapula at the shoulder. So in a sense our arm/scapula comlex is free floating from the body, except by its tenuous muscluar and ligamentous attatchments. (This is much more unstable than the sturdy hip joint that attatches our legs to our torso.)

That means any weakness in the muscles of the scapula will result in a problem with the way our arm attatches to the scapula, and furthermore the way the arm is attatched to the torso.

Your exercises will include exercising the 4 rotator cuff muscles that attatch the arm to the scapula at the shoulder:

But the exercises will also strengthen the overlying muscles (trapezius, deltoid, levator scapula, rhomboids) that attatch your scapula to the posterior aspect of your upper chest. The purpose of these attatching muscles are to rotate the scapula clockwise and counterclockwise to aid in raising and lowering your arm.

Thus, you have been identified with a weakness in these overlying muscles.
A muscle imbalance exists so that the scapula has been pulled out of its usual position. You need to exercise these muscles to return your scapula to its normal position, and to provide for optimal functioning in raising and lowing your arm.

No wonder the USTA has emphasized rotator cuff and shoulder blade stabilization exercises for tennis players:

"Rotator Cuff and Shoulder Blade Stabilization

In this article we want to focus on the shoulder and muscles that stabilize that joint. When you talk about tennis and the shoulder the first thing that likely comes to mind is the rotator cuff. The rotator cuff is important in tennis, but often times strength imbalances exist within the rotator cuff that can lead to injury. Most notably, tennis players tend to be weak in the muscles that externally rotate the shoulder. External rotation is an outward rotation and is the opposite of the shoulder motion players make when they serve or hit a forehand. To improve strength of the external rotators you can perform the exercises described in this section of the web page. This exercise should be performed with the dominant arm, but should really be performed with both arms if time permits.

Not many people think of the upper back when considering how to strengthen and protect the shoulder. But try this simple drill. Place your hand on the shoulder blades of a player and ask him to raise his arms. Can you feel the shoulder blades move? Shoulder movement is very complex and involves movement of the shoulder blade as well as the actual shoulder joint itself. Weakness in the upper back muscles that stabilize the shoulder blades can cause the shoulder to function improperly and may actually contribute to shoulder pain. Exercises that train the stabilizers of the shoulder blade can help tennis players optimize performance and avoid shoulder injury.

Exercise: Standing External Rotation with Elastic Band
Exercise: Straight Arm Rowing"
- http://www.usta.com/Improve-Your-Ga...7_Strength__Conditioning_Exercise_Techniques/