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Tennis Elbow (Read 23616 times)

T_B

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Tennis Elbow
April 19, 2010, 11:50:04 am
Any ideas on treatment? I have had this for about 7 weeks now in my left arm. It came on after a month of campus board training (which I was doing cos I had town the tendon in my hamstring!)

It hasn't really got any worse, but pinching and undercuts are cause it to be inflamed.  It also seems to be pressing on a nerve as I get some nervy shooting pains as well. Hanging on for a long time pumped (found this out this weekend tradding for the first time in months) also hurts it.

Any tips on exercises to sort it out. I've not really been able to push it for a while now and it's starting to get a bit frustrating!


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#1 Re: Tennis Elbow
April 19, 2010, 12:15:57 pm
wrist curls (normal and reverse) aswell as press ups helped me out with elbow issues. give 'em a go unless anyone who knows more about this than me says otherwise!

T_B

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#2 Re: Tennis Elbow
April 19, 2010, 12:27:34 pm
Yes, I have heard about wrist curls. Will give em a try.

nai

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#3 Re: Tennis Elbow
April 19, 2010, 12:31:40 pm
McLeod's been suffering and blogging about his treatment. 

http://onlineclimbingcoach.blogspot.com/2009/12/rehab-for-golfers-elbow-for-climbers.html


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#4 Re: Tennis Elbow
April 19, 2010, 12:32:47 pm
Any ideas on treatment? I have had this for about 7 weeks now in my left arm. It came on after a month of campus board training (which I was doing cos I had town the tendon in my hamstring!)

It hasn't really got any worse, but pinching and undercuts are cause it to be inflamed.  It also seems to be pressing on a nerve as I get some nervy shooting pains as well. Hanging on for a long time pumped (found this out this weekend tradding for the first time in months) also hurts it.

Any tips on exercises to sort it out. I've not really been able to push it for a while now and it's starting to get a bit frustrating!

Ok, i've had it for years, had to have injections when I was younger when it got really bad once, doesn't flair up much these days, unless I do something stupid but had a nasty twinge a couple of months ago that took a week or so to get rid of, here's what I have found works for me:

For the first week or so after it flairs up, take it really easy, do not do anything at all that makes it hurt.
Ice it every day at least once, try Saunas hot/cold treatment they seem to help a lot.
Gentle stretching, all the time, as often as possible.
Self massage deep into the tricep muscle, all areas of it, a lot of pressure, knead the muscle a lot, when this gets tight, or is not stretched enough, I find it does nothing but make it worse.
Light forearm curls in both directions, sets of 10-15 reps, 2-3 times a week.
I tend to avoid anti-inflammatory drugs, as I find they delay healing and just mask pain a little too well, making your recovery harder to gauge.
Avoid pronated tricep movements like the plague, until it is healed, this includes undercuts etc.
Then when it is healed/calmed down, build back up to pronated movements slowly, they seem to cause flair ups real easy for me if i'm not careful.

Hope that lot is helpful

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#5 Re: Tennis Elbow
April 19, 2010, 12:41:38 pm
Hi Tom,
Is it definitely tennis elbow (i.e. inflammation of the insertion of the finger/wrist extensors at their point of insertion)?

What are your symptoms exactly? Do you have a definite point of tenderness on the bony knobble above the elbow, or more of a diffuse pain around the lateral elbow/upper arm?

See you, Joe

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#6 Re: Tennis Elbow
April 19, 2010, 12:54:48 pm
http://www.athlon.com.au/articles/r&i_dodgyelbow.pdf

this is a very useful article, that I was pointed to by my phsyio. It's important that you follow the advice carfeully. If you do have tennis elbow, then the exercise for lateral epicondylosis are the ones you want to do.

I would prod around a bit on your elbow and try and find the spots where you are most tender. Tennis elbow will hurt on the lateral epicondyle, see diagram at top of the pdf, the outside of your elbow. and Golfers is the medial epicondyle, near the nobbley bone on the inside of your elbow. I had a bit of tennis recently and found the exercises really helped relieve the symptoms, there is hope!

If you describe your symptoms exactly then I expect someone will be able to point more exactly to the problem and thus the solution!

T_B

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#7 Re: Tennis Elbow
April 19, 2010, 01:47:41 pm
Hi Tom,
Is it definitely tennis elbow (i.e. inflammation of the insertion of the finger/wrist extensors at their point of insertion)?


Hmm. Maybe not. Just looked at a few images on the Net. The pain is in a very specific area. If you straighten your arm and push the wrist back, it's at the top (nearest the wrist) of the 'dip' that is created on the back of the Brachioradialis http://www.physioweb.org/IMAGES/brachi_fcu.jpg

I.E. the top of that musle on the outside of the forearm.

Lifting a chair up from behind, by grasping the top of the back of the chair is the best way to make it hurt the most!
« Last Edit: April 19, 2010, 01:53:05 pm by T_B »

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#8 Re: Tennis Elbow
April 19, 2010, 02:52:56 pm
read high repute's article, is very good in targeting problem.

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#9 Re: Tennis Elbow
April 19, 2010, 08:26:03 pm
Hi Tom,

I've recently got over 6 months of Tennis Elbow and additional compression/inflamation of the radial and ulnar nerves in my shoulder and back which complicated things somewhat. Having been through six months of treatment and therapy I'm an advocate of Sausages view that pain and trouble in the elbow area can be more complex than simple golfers/tennis elbow so a good look at the back and shoulders as well as the elbow is very worthwhile.


The Sausage

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#10 Re: Tennis Elbow
April 19, 2010, 09:06:32 pm
Hi Tom,
It certainly sounds like there is some inflammation around that area, however it is usually much more complex than simple tendonitis/tendonosis. The radial nerve runs through the area where you describe the pain is most acute. Certainly, the action you describe of lifting the chair would point to some wrist extensor problem (i.e. tennis elbow). Inflammation caused by this can be enough to set the radial nerve off - it is very prone to compression in the area you describe (the radial tunnel).

My feeling is that the usual tennis elbow stretches and strengthening exercises aren't enough by themselves for climbers, as whatever was causing the original problem will likely continue to be present. In other words, I think the tennis elbow can be a symptom of weakness and lack of control in different parts of the chain - i.e. arm/shoulder/spine.

An example: Try standing in a relaxed posture - do your thumbs face towards you, forwards or away from you slightly? If they face towards you (common in climbers - if yours don't, try standing like this to see how position of the shoulders can affect the elbow) you will see that your elbow is slightly bent. Now, if this is your resting posture, the wrist/finger extensors (on the back of the forearm) will be in a slightly shortened position. They will adapt to this. Imagine you are now campus-ing. You catch a rung at full stretch. You put a massive force (i.e. tension) through the extensors anyway (they need to work to stabilize the wrist). On top of this, the muscles are being stretched because the elbow is straighter than it is in its resting position. This on its own will put tension through the muscle. So you have 2 things putting tension through the muscle/tendon/insertion.

Now stand with your thumb facing slightly outwards - your elbow should automatically straighten. Standing like this will preserve the length of the extensors and therefore decrease the amount of tension going through the muscle when it is loaded at full stretch. Et voila, less chance of exceeding the strength of the muscle/tendon and causing inflammation and pain.

You can feel the difference in tension in the forearm muscles as you bend and straighten your elbow.

I bang on about it a lot, but shoulder instability (I think) plays a major factor in causing problems further down the arm. Another example: if the shoulder stabilisers are weak, the triceps will work to stabilise the shoulder. These muscles also produce a force to straighten the elbow. The wrist/finger flexors and extensors both also produce force to bend the elbow. So, if the triceps are working to stabilise the shoulder, the wrist/finger muscles must work to counter this force. Therefore, more tension at their insertions.

And this doesn't even touch on impingement at the shoulder through decreased stability, which can cause pain further down the arm.

Blimey. time for a drink...

T_B

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#11 Re: Tennis Elbow
April 20, 2010, 08:28:00 am
Read that through twice, thanks Joe.

I've had this before and it's calmed down when I've eased off, but not this time.

3rd problem in 3 months to visit the physio for! All related no doubt. Suspected snapped ligament in left ankle (MRI scan in a couple of weeks), 20 year old left knee injury. Torn tendon in left hamstring. Tightness in left side of back and neck. Now this. In my left arm. Hmmm....

 :boohoo:

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#12 Re: Tennis Elbow
April 20, 2010, 11:35:11 am
From time to time I've found I get twinges on the outside of my elbow and I've found that doing a buttload of pressups really helps. One armed press ups feel good too, although I've found they do make the elbows a bit more tender for an hour or so afterwards before they feel better the next day.

Hope you get it sorted!

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#13 Re: Tennis Elbow
April 20, 2010, 01:10:19 pm
Sausage is spot on as usual.  I've had 2 elbow problems, both of which originated in my shoulder or back.  Coincidence I think not

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#14 Re: Tennis Elbow
April 20, 2010, 01:44:46 pm
My feeling is that the usual tennis elbow stretches and strengthening exercises aren't enough by themselves for climbers, as whatever was causing the original problem will likely continue to be present.

You suggest that people suffering from these sort of injuries need to do more than just the usual tennis elbow stretches/exercise but don't go into any more detail (unless I missed something).

I've suffered a few elbow problems recently and would be interested to hear what else I could do to help my elbows heal/prevent further damage.  How can I increase my shoulder stability?  What sort of stuff do you recommend?

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#15 Re: Tennis Elbow
April 20, 2010, 02:42:51 pm
I think it's helpful to think in terms of therapy (in the case of an injury) and then preventative exercise.  Also bear in mind that we are all unique in our strengths and weaknesses so an individual diagnosis always helps.

I've recently been through several weeks/months which started with manipulations, ultrasound and stretches of the affected area as I did have scar tissue and 'tough' bits around the elbow and forearm that needed sorting out.

But, my main problem was/is stiffness and inflamation in the 1st and 2nd vertebrae and into the shoulder compressing the nerves from being a desk jockey, lots of travel on planes and trains and general stress/tension.  So again some manipulation to loosen up the shoulder really helped along with the tricep insertion points and some acupuncture.  Now onto preventative measures..

Pressups - 2 sets of 15 to 20 fairly wide pressups every day.
Spine/Back stretches - lying on my back with two tennis/rubber balls aligned under my spine and then raising arms up and down over my head.
Overall weights/body conditioning - Burpees, Kettlebells, Core Stuff... it all helps to keep things strong and balanced.

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#16 Re: Tennis Elbow
April 20, 2010, 03:29:49 pm

 I think the tennis elbow can be a symptom of weakness and lack of control in different parts of the chain - i.e. arm/shoulder/spine.


I bang on about it a lot, but shoulder instability (I think) plays a major factor in causing problems further down the arm.

From my experience of tennis elbow I'd agree with Joe's comments above.

I had it bad in both elbows, so bad that I could no longer climb easy stuff >:( I took 5 months off climbing then started slowly & supplemented with lots of free weights. Weights generally entail pushing stuff  - shoulder presses, flat bench, inclined bench all with dumbells rather than bars with the intention of increasing stability as well as strength. I've maintained the weights to a minimum of once a week, often 2-3 times a week in the winter when I've no trips looming. I've not had a problem since, not even a twinge. Prior to the original injury i.e. 20 years of climbing, I frequently experienced elbow discomfort.

My shoulder/s are another story....1 confirmed SLAP, 1 suspected. However, despite diagnosis of the SLAP 2 years ago I remain reluctant to have surgery and continue to climb relatively pain free. Despite having F'd shoulders the weights not only deals with elbows but seems to make  my shoulders more stable & strong, less likely to dislocate & keep me off the operating table for the forseeble :thumbsup:

Tom, I think it was you who mentioned cold water plunges around the time of my elbow issues. I found these best when I began weights and climbing following lay off as there was pain in the first few weeks. By plunges, I mean as much of your arm as possible in cold water not just elbow. Great for closing the pain gate. 



 

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#17 Re: Tennis Elbow
April 20, 2010, 04:15:38 pm
Hi Tom,
Is it definitely tennis elbow (i.e. inflammation of the insertion of the finger/wrist extensors at their point of insertion)?

What are your symptoms exactly? Do you have a definite point of tenderness on the bony knobble above the elbow, or more of a diffuse pain around the lateral elbow/upper arm?

See you, Joe

Thanks for all the info Joe. But this piqued my interest. I'm getting pain in my left elbow/forearm, but it's hard to exactly identify where. It's certainly on the inside (medial thingummy) side, but I can't find a 'definite point of tenderness'. It doesn't affect me too much climbing, I just get twinges throughout the day moving my arm about, and a bit every time I straighten my arm. It's not sever pain, but annoying. Sort of feels like I've overextended it and strained it or something but that's not SCIENCE. As it's been dragging on and I'm afraid of it getting worse I've booked to see doctor now, but I'd be interested to know the significance of the distinct point of pain as opposed to the diffuse area...

Cheers.

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#18 Re: Tennis Elbow
April 20, 2010, 05:07:27 pm
I've suffered a few elbow problems recently and would be interested to hear what else I could do to help my elbows heal/prevent further damage.  How can I increase my shoulder stability?  What sort of stuff do you recommend?

http://ukbouldering.com/board/index.php/topic,10847.0.html

This is probably the holy grail of injury prevention threads. Part of the problem is there are so many different exercises that are recommended that it's very hard to know which ones to do. Trial and error combined with common sense and good luck are the best ways to go. I would say if a particular exercise make it hurt don't do it. i.e. if climbing makes your elbows hurt you should probably ease off for a bit. Denial is another big problem, you often here people saying it's fine I just need a few days rest (i think I may have said that many times), when what they really need is some proper physio etc etc

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#19 Re: Tennis Elbow
April 20, 2010, 07:06:17 pm
Sausage (Joe?)
Thats an excellent description and I'm really intrigued by your ideas that much of this stems from shoulder instability. I know little about this, but I've had a good discussion with a bloke at the cliff who was describing how my lack of oomph (last move on DWR..) was probably due to shoulder imbalance rather than lack of forearm strength.
So if much of this is down to getting shoulder balance what are the best ways/exercises to do this? Push ups spring to mind - but surely they are quite simplistic (only train one area..)... traversing? I guess this tends to work the shuolders rather than the elbows (depending on the trav of course!)? Any other simple (e.g. no/not much equipment required) exercises to work those shoulders?
T


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#20 Re: Tennis Elbow
June 01, 2010, 03:47:37 pm
For anyone who is interested in the whole tennis elbow thing, here's an update.

I finally went to see Rick at the Clinic in Sheffield. He confirmed that it's Tennis elbow, but the root cause was really my back muscle (not sure of name) beneath my shoulder blade which is super tight. This has been identified previously by a different physio as causing me back/neck problems, and to climb (i.e. pull) in a certain way.

First session he worked (acupuncture and massage) on the area just below my shoulder blade, second session on that,  plus the sore bit on the outside of the elbow, plus loosening up the elbow joint as well. Various theraband excercises to get that crucial muscle in the back firing again, as well as now doing the classic dumbell wrist curl for the tennis elbow and also other stretches for the shoulders.

It's getting better at last  :thumbsup:

Not trying to get too excited yet, but it does seem to be on the mend and isn't restricting my climbing that much (though I'm still keeping off the steep stuff for now...)

So yes, yet another tennis elbow caused by shoulder/back instability/problems...

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#21 Re: Tennis Elbow
June 01, 2010, 04:54:47 pm
...but the root cause was really my back muscle (not sure of name) beneath my shoulder blade which is super tight....
 
First session he worked (acupuncture and massage) on the area just below my shoulder blade, second session on that,  plus the sore bit on the outside of the elbow, plus loosening up the elbow joint as well. Various theraband exercises to get that crucial muscle in the back firing again, as well as now doing the classic dumbell wrist curl for the tennis elbow and also other stretches for the shoulders.
Interesting.  :-\  I got a "shoulder strength conditioning for climbers" download a few years back and it was saying the same thing, i.e. climbing overdevelops the internal rotators (subscapularis, pectoralis major, latissimus dorsi, teres major, anterior deltoid) and doesn't train the scapular retractors or the scapular depressors, which knocks the shoulder out of ideal position and leads to tondonitis and shoulder impingement. (I don't have the .pdf on this computer to check the exact wording) but the bottom line was you need to work hard on the scapular retractors and depressors.
 
I just did a quick  :google: and found a very similar article here: http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/heal_that_hunchback

Read it; follow it.  :goodidea:
 
The other important thing to remember is, climbing works those internal rotators very hard so you do actually need to build up to the point where you are working the retractors and depressors quite hard - thera-bands are a good place to start but they just won't cut the mustard. Things like Ben's Kettleball swings or doing the "power snatch" are great at really working those retractors hard.



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#22 Re: Tennis Elbow
June 16, 2010, 10:47:13 pm
I am stuck with tennis elbow.... layed off the climbing for a bit and doing hot and cold treatment wondered if running will help? my thinking is that it will help circulate blood to the tendon faster?

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#23 Re: Tennis Elbow
June 17, 2010, 07:32:49 am
As long as your not doing pull-ups whilst running...

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#24 Re: Tennis Elbow
June 17, 2010, 07:54:44 am
Wow didn't know that was possible can you run me through that one? :wank:

 

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