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Tennis elbow from windsurfing
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isobars



Joined: 12 Dec 1999
Posts: 19246

PostPosted: Thu Apr 01, 2010 4:28 pm    Post subject: Reply with quote

Yeah, I see that SEARCH wasn't much help, but that's probably a good thing, because you aren't going to cure it or prevent recurrence with piecemeal advice from us internet wankers. Merely shutting off the pain is neither curative nor preventive, constrictor bands are primarily bandaids, rehab protocols are very specific, steroid injections are a next-to-last resort with side effects and limited success, you have to know how to use ice massage properly, and once the symptoms cease the next step is proper and vry specific long-term and permanent strengthening of the involved muscles ... and I ain't talking 2M (two reps to failure) pec (bench) presses.

I advise handling it the same way I handle any medical problem: Do enough research on reputable medical sites (and in books) that you can at LEAST separate good advice from BS from your doctor, then see the doctor (to be sure you haven't incurred any serious injury such a tendon rupture and to get a referral to PT), then get the PT (i.e., physical therapy; you're not ready for a personal trainer yet), then follow the PT's rehab and strengthening program (if it doesn't conflict with your research) for life. Strong, pliable (properly stretched and warmed up), properly used* tendons seldom present serious problems.

* Your arms are for jibing, not windsurfing. Your harness lines should carry your full steady-state load (the sail's pull and some of your weight), leaving only the transient (steering and sail trim) loads for your arms until you have to unhook to jibe (even that needn't require much arm effort for more than a couple of seconds). This applies to almost any B&J or slalom sailing, and even much of casual wave sailing. And because your arms aren't loaded much, you don't need a tight grip. I'm often very slightly pushing with one or both hands just to be sure I'm not pulling.

Mike \m/
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boardsurfr



Joined: 23 Aug 2001
Posts: 1210

PostPosted: Thu Apr 01, 2010 4:53 pm    Post subject: Reply with quote

I had elbow problems for the first time last March, when the first day of sailing was really windy after the winter break. It's still not gone completely, but does not bother me much anymore. I found that easy windsurfing sessions actually help - when I'm comfortably planing, and watch my technique. Key points for me are minimizing effort (always a good idea), and not extending my arms fully (some surf teachers may yell at you for bending your arms a bit, but they are usually young). Ibuprofen and gently massaging the affected areas also helps.

Had an interesting discussion with a friend about this just yesterday. He actually had surgery when nothing improved after several months of PT etc., and an MRI showed a substantial tear in the tendon. Certainly in line with the damage being structural rather than just inflammation (I would love to hear more about Lucaro's insights!)

On the other extreme is ABK's Brendon, who had his first bout with this cured by something that sounds like acupressure just below the shoulder blade (applied by another windsurfer who had discovered this as the last resort before surgery).

As for glucosamine/chondroitin, I think it's definitely worth a try. I don't think the effects are just from the analgesic - aspirin alone has never helped me much. There are some newer studies that show a positive structural effect of chondroitin (check the references in the Wikipedia article). I have had great results with glucosamine/chondroitin on other joint/tendon related pain. I had not tried it for tennis elbow, but after seeing bpbates post, I'll give it a shot.
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isobars



Joined: 12 Dec 1999
Posts: 19246

PostPosted: Thu Apr 01, 2010 5:22 pm    Post subject: Reply with quote

I have a couple of McKenzie books lying around somewhere that I've not used yet .... probably for back and neck. Should I just toss them out, or simply avoid the cobra? Is his advice largely, or only in a few specific areas, poor?

I haven't looked at them because a) I've found two gifted massage therapists who beat most orthopods I've seen by a mile and b) core strengthening with assists from those therapists has fixed my disabling back (S-I joint) problems.

Mike \m/
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isobars



Joined: 12 Dec 1999
Posts: 19246

PostPosted: Thu Apr 01, 2010 5:32 pm    Post subject: Reply with quote

boardsurfr wrote:
As for glucosamine/chondroitin, I think it's definitely worth a try. I don't think the effects are just from the analgesic - aspirin alone has never helped me much.


I didn't intend to discourage G-C altogether. My point was that a quick response to it may be primarily because its second ingredient is converted in the body to aspirin. I've never seen any claims even from its manufacturers that straight G-C stops pain almost overnight, as NSAIDS (including aspirin) can in many cases. Quick relief due to analgesics does not imply that the underlying pathology is cured ... i.e., it's a chemical bandaid.

Mike \m/
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LUCARO



Joined: 07 Dec 1997
Posts: 490

PostPosted: Thu Apr 01, 2010 11:33 pm    Post subject: Reply with quote

I think Isobars nailed it when he said that evaluation by a skilled Physio is most important primarily because there different types of tendinopathy that need different treatment (not to mention other problems that may be masquerading as tendinopathy) and rehab is a constantly evolving field where treatments change and progress.

Boardsufr:


The structural disorganization known as tendinosis that is responsible for the majority of tendon pain. Results in weakening of the tendon and this increases the probability of rupturing your tendon. And 99% of tendon ruptures occur in areas of the tendon that have underlying tendinosis.

Many of these ruptures are partial ruptures that will heal through a reparative process very much like a bad cut on the hand. However, the underlying tendinosis often needs to be rehabilitated to become symptom free.

Also tendinosis can exist and be asymptomatic. As the problem progresses vascular ingrowth occurs and scientists have shown this allows the tendon to become symptomatic. This is one of the reasons why i recommend preventative forearm and grip training for windsurfers climbers etc. I previously posted videos on iwindsurf.

Short term results of a corticosteroid injection is often clinically dramatic however a recent study showed that after 1 year the outcome was not as good with the injection when compared to no intervention (wait and see) so i have gone a bit cold on recommending them.

NSAIDs will have a temporary effect on the pain but in chronic cases they are unlikely to reverse the structural disorganisation and therefore unlikely to produce a permanent cure.
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WMP



Joined: 30 May 2000
Posts: 671

PostPosted: Fri Apr 02, 2010 10:12 am    Post subject: Reply with quote

I've had chronic tendon disorders in the past. Few years ago I had to back off on my marathon windsurfing sesh's because of pain in my arms and fingers. Worst of the pain was in my groin.... docs couldn't figure this one out, got referred to a sports PT in HR but I never went.

Been taking glucosamine chondroitin for the past year and a half. It was a little slow at first, but after a couple months of regular use it really made a huge difference for me. There's many varieties.... I tried all different combos (read the label, most don't have willow tree bark). I've found the triple strength works best so you don't have to pop as many pills.

Combined with calcium, magnesium and daily heat massage.... the pain is completely gone.


Hope this helps.


Last edited by WMP on Fri Apr 02, 2010 4:25 pm; edited 1 time in total
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isobars



Joined: 12 Dec 1999
Posts: 19246

PostPosted: Fri Apr 02, 2010 12:16 pm    Post subject: Reply with quote

WMP wrote:
Worst of the pain was in my groin.... docs couldn't figure this one out


Of course not; the only way most doctors know to treat soft tissue injury is with RICE and drugs. A good massage therapist, OTOH, can often switch soft tissue pain off in one session. My groin pain lasted for months before I wised up and went to an MT, who released a psoas trigger point in minutes for a 90% improvement. Proper stretching took care of the rest and it's been fine now for 2-3 years. Since then these two MTs have worked wonders on literally dozens of long-term pains doctors could not fix on just three of us (my aging, overweight, dang-near-crippled wife has been absolutely transformed). I don't even bother with physicians for soft tissue pains any more unless I suspect an injury (good MTs will refuse to treat you without seeing a doctor first if they suspect an injury or condition needing medical care.)

Mike \m/
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boardsurfr



Joined: 23 Aug 2001
Posts: 1210

PostPosted: Fri Apr 02, 2010 12:35 pm    Post subject: Reply with quote

isobars wrote:
who released a psoas trigger point in minutes for a 90% improvement

That sounds very similar to what Brendon has described.

Any suggestions on what questions to ask a MT to figure out is he's good at helping with elbow or similar pain?

Lucaro, thanks for the additional info and the link.
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isobars



Joined: 12 Dec 1999
Posts: 19246

PostPosted: Fri Apr 02, 2010 1:18 pm    Post subject: Reply with quote

boardsurfr wrote:
Any suggestions on what questions to ask a MT to figure out is he's good at helping with elbow or similar pain?


Unfortunately, no. Besides, I'd favor physical therapy over MT for "tendonitis", since it's actually an injury involving pathology (damaged tissue) and will require long periods of rehab, treatment, and strengthening more suited to physical therapy than to MT.

As for finding a really good MT, my best but still lame advice consists of a) ask around, b) try a session, c) listen closely to what the MT has to say*, and d) evaluate the results. None of them is going to cure tendon pathology quickly, but many aches and pains based more on tendons, muscles, the fascia that bind muscles into bundles, and/or adhered muscle fibers can be fixed in one session.

* I want an MT who examines my whole body from feet to head if the problem isn't as obvious and localized as tennis elbow or a jammed thumb. VERY often pain in a foot, knee, hip, back, torso, shoulder, upper arm, or neck is due to a muscle or postural imbalance or tightness inches or feet away from the obvious painful spot. A good MT will spot imbalances our untrained eyes can't see, and will know what to do about them. A really good MT can then fix the problem then and there if actual healing isn't also required, as it is with so-called epicondylitis, aka tennis (lateral) or golfer's (medial) elbow pain.

Mike \m/
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WMP



Joined: 30 May 2000
Posts: 671

PostPosted: Fri Apr 02, 2010 4:24 pm    Post subject: Reply with quote

Guess I've just had really, really good success with treating these matters myself by simply listening to what my body is telling me. It's really not that difficult, really.

I've just had nothing but bad luck with docs, PT's, MT's, etc. Wasted plenty of time and money on worthless therapy that doesn't work.

Electric massager costs around $20 and you can use it in the comfort of your own home.... it works wonders..... really, really.
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