tennis elbow

kfgesq(z5NJ)November 23, 2003

Anybody know anything about tennis elbow? A friend of mine has it. I saw some info about cortisone injections, of course, but that appears to up the chances of a recurrence and she doesn't want to do it. Any natural remedies?

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Call it tennis elbow, call it tendonitis, call it Repetition Strain Injury, the effects are pretty much the same as arthritis. Any herb which improves the circulation and which is anti-inflammatory will help, but none will 'cure'. I've tried Gotu kola, taken regularly as a tea or eaten, with some success (over time), and comfrey leaves soaked in boiling water to soften them, wrapped around the area, will ease the pain somewhat when it gets really bad. Daily supplements of Omega-3 also helps, as will an aspirin a day (or meadowsweet or white willow bark, from which aspirin is derived) if you're not allergic to aspirin. The aspirin is not only anti-anflammatory, but a mild pain-killer as well.

Some anti-inflammatory herbs: Aloe Vera, Calendula, Chamomile, Eyebright, Fennel, Feverfew, Meadowsweet, St. John's Wort.

    Bookmark   November 23, 2003 at 5:56PM
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So Daisy it appears it is tendon Damage do you agree. If the effects are the same as arthritis can remedies for arthritis cure or help? What do you think? How about gloucasamine sulfate? (probably spelled that wrong) but that is a joint healer. Tendons, let's think friend is coming for the holidays and I promised her I would try to help. Anyone else know anything about this? Also as to anti infammatories what about cayenne?

    Bookmark   November 23, 2003 at 10:50PM
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arttulip(New Zealand)

I know special exercises curing this problem and will post them tomorow ( I have to translate them from Russian language).

    Bookmark   November 23, 2003 at 11:40PM
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Judy_B_ON(Ontario 5B)

She would be best served by visiting a physiotherapist for specitic exercises. There is also a special brace that is worn just above (or is it below?) the elbow which holds the tendons and muscles in postition so that you don't continue to strain them. My husband had this problem a few years ago, wearing the brace for about eight months cured the problem. He still uses it when doing any heavy lifting or carrying, so as not to cause the problem again.

Your friend should ask her doctor about the brace, in Canada they are available without prescription at pharmacies.

    Bookmark   November 24, 2003 at 10:24AM
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arttulip(New Zealand)

Swedish exercises with rod and weight.
take a circular rod 30-40 cm in length and tie a weight on a rope to its middle.the weight is 1-2 kg. the length of rope is 40-50 cm.
Exercise 1.Hold the stick so that the thumbs are below, alternately,with the left and right hands, reel the weight onto the rod.then reverse the movements and unwind the weight.
Exercise 2.Change the hand position on the stick.the thumbs are now on top and the four fingers are at the bottom.Pull the weight with your hands forward, and with your hands lower the weight
Exercise 3.Lower the right hand.In the fist is your stick with the weight on an unwound string.Weight - on the side of the little finger, nails of fingers "looking" forward.
1-2 - bending hand and turning fist with nails back, raise weight;3-4 - lower the hand returning it to the initial position.These exercises can be done 1-3 times a day and after games (if pain appears)
The initial weight of the weight can be 0,5 kg. exercises one and two are to be repeated once and exercise 3 to be repeated 5 times.Gradually, the weight can be incresed to 2kgs, and the number of repeated exercises (adding one at a time) can be increased to 4-5 for the first exercises, and to 20 in the third one.Relax the muscles between exercises, by shaking the hands while raising and lowering them.After the exercises - a light self-massage of forearm, elbow and arm (from the fingers to the arm upwards).A warm bath for the arm is also useful.Contractions and weakening of the muscles of the hand and forearm during these exercises(especially in combination with self-massage and the warm bath) massage the blood and lymphatic vessels in these muscles, increase the metabolism and get rid of the pain.

    Bookmark   November 25, 2003 at 12:11AM
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Judy_B_ON(Ontario 5B)

Here is a web site with info and pictures of exercises.

Here is a link that might be useful: Tennis Elbow

    Bookmark   November 25, 2003 at 10:36PM
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Some of the exercise shown in the web site recommended by the posting above are good, but should only be done when your arms become flexible. Building up arm strength is good for preventing future injury. However, The general guideline is that if you can't do something 20 times in a row without it hurting, it's not good for you at the time.

The posting above that posting seems like it is for nonserious injuries. Pain is a bad sign. You don't want to be doing anything that hurts.

Tennis elbow is a form of tendinitis. I am currently healing from an advanced case of tendinitis in both arms, affecting all areas of the tendons. I have it more in my hands/wrist/forearm then I do in my elbow though. I got it from doing nothing but playing videogames, piano, and guitar. Take my advice with this in mind;

Get a Strong Medication:
First you need a strong anti-inflammatory. Aspirin, ibuprofen, Tylenol; none of these are strong enough. I think the best thing out there right now is naproxen, also called naprocen. There is another drug called celebrex but it is speculated as being very dangerous. You need a prescription for these drugs. You need to see a doctor. A physiatrist is the best person to see, this can be difficult. A physiotherapist is also necessary.

Stretching is vital to healing a RSI. There are two specific stretches that stretch the arm the best. However, You have to decrease the inflammation to some degree before you can safely stretch your arms. Important for both stretches! Never stretch so that it hurts at all. Never stretch so that it hurts afterwards. If either of these two occur, you are either stretching too far, or you aren't ready to stretch yet. For my injury, I was advised to do both these stretches three times in a row, at three different times in the day.

Stretch number one; hold your affected arm out forward, palm up, lock your elbow. Using your other hand pull the affected arm's hand back by holding on to its fingers. You must hold this for a count of 30 [20 seconds, any less will be useless]. An arm with healthy tendons will allow the hand to be pulled back 90 from the forearm. Don't try to do this right away. It could take months or years to get this level of flexibility. Over stretching will aggravate your injury.

Stretch number two; your affected arm is in front of your body and the upper arm is close to vertical and the elbow is bent, forearm pointing towards the ceiling [the arm is making a V shape]. Your palm is facing as close as possible to the ceiling, although you may not be able to bend your wrist very far. With the other hand you will press the thumb of the affected arm's hand slightly down and out to the side. You must hold this for a count of 30 [20 seconds]. Again, over stretching will do more harm than good. Pain is bad.

Stretching and reducing inflammation are only a small part of healing an RSI. If you have isolated the particular activity that has caused your injury you should stop doing this immediately. You can build up your ability to do this task again, but you have to do it very slowly. The details of this are discussed below. It is important to understand that once you have developed an RSI, many activities will aggravate it further in addition to the ones that caused it in the first place. For example, walking can be extremely problematic for a serious arm based RSI, regardless of whether or not you keep your hands in your pockets.

Building up Your Endurance
Seeing a doctor is important because there is a certain amount of time you should wait, letting inflammation decrease and stretching your arms, before you recommence your physical activities [building them up slowly].

Healthy and well functioning arms function as a result of gradually increasing a time limit on the activity that can, or did, damage them. Some people have healthy and well functioning arms and don't pay attention to Time limits. There are a variety of reasons why this isn't necessary for these people. Obviously the better in shape you are in, the better you eat, the more resilient you are to this injury. Also, something you do only rarely, you may be able to do for a longer period of time without injury than if you did it on a regular basis.

Time limits are things that must be taken into consideration for people who are performing a repetitive task on a regular basis. Under these conditions, When your arms are pushed to the limits of their capabilities, there is a definite time limit of usage your tendons can tolerate per day.

Generally, it is a good strategy to start any new physical activity at 10 minutes per day. When recovering from a serious RSI, it might be better to start from five minutes per day. It is an accepted theory in human physiology that you should not increase the time limit of an activity more than 10 or 20% per week. When healing from a repetitive strain injury, this is the technique for building up more arm usage time on a weekly basis.

The theory is that your arms capability for endurance can only increase at this rate. The tendons grow thicker without tearing in this way. Time limits must be implemented consistently. If you take half a week off using your arms, you are interrupting the thickening of the tendons. This will make you unprepared for an increase of time in the next week, making you more susceptible to further injury.

It is important to keep in mind that if you have very advanced tendinitis, the time limit placed on the activity that caused it may represent that total daily usage of the affected limb. That means that everything else you do with this limb in the day, other than what you do in the time limit, is adding injury to your arm. The following is a partial list of activities that can be very aggravating to RSIs;

Placing your arms on your chest or stomach while you sleep [if you are sleeping on your back]. The rising and falling of your chest will really pull on your tendons all night.

Walking, with hands in pockets or dangling outside, will really aggravate arm RSIs.

Brushing your teeth, flossing. Get an electric toothbrush and use mouthwash sometimes instead of flossing everyday.

Writing, typing, using a mouse. Get voice activation software from chapters or Office Depot etc.


Lying on the ground and leaning on your elbow. Very bad.

Being very vigorous, pressing very hard, while you wash your hair, or wash your face, or apply moisturizer, etc.

Smoking. This is terrible for your circulation, which directly relates to inflammation. Also, constant hand use will aggravate the injury.

The Wrist Brace
Some people swear by this. Never use it too tightly or you will decrease circulation and aggravate your injury further. If you have to use this continually throughout your life, you probably aren't taking care of your injury properly. I found that using wrist braces made my injury worse, as constantly taking it on off and adjusting the straps aggravated the tendinitis in my hands and wrists.

What causes RSIs?
The science behind the functioning of tendons is not totally understood at this time. However, it is known that tendons are more resilient to injury when they are thicker. Tendons can be made more thick through their proper use and well-planned exercise. This means that although RSIs occur in tendons that are overused, overused is a relative concept depending on the health and condition of the tendons in question. A tendon that is resilient to RSI is one that has been built up and strengthened gradually over time.

Keeping the above information in mind, an RSI develops when a tendon repetitively performs a task that it isn't prepared to do. Additionally, tendons are very prone to this type of injury in general when a task is repetitively performed for long periods of time with out taking breaks. Whether you're typing on a computer or playing tennis, regular breaks are extremely important.

Pressure inside your arm exerted against moving tendons can create tears in the tendon. These tears create inflammation and ultimately scarring. Both inflammation and scarring create the problematic characteristics of the injury; pain and lack of flexibility. Scarring irritates the inside of your arm creating more inflammation. Inflammation increases the pressures inside your arm causing more tears which causes more inflammation. It is a ongoing cycle.

An untreated RSI gets worse when the tissue surrounding the tendons becomes inflamed as well. This is when these injuries become severe. This is one of the reasons why carpal tunnel syndrome is a very serious RSI. The space in between the carpal bones of your wrist where the tendons pass through is relatively narrow. It is much easier for inflammation to occur in surrounding tissues and much easier for the surrounding tissues to irritate the tendons.

It is extremely important to have your RSI treated as soon as possible by a professional. There is the reason that the progression of your injury for better or worse occurs exponentially. However, a more serious concern is the condition of nerves located near your injury. Nerves can be damaged by RSI and can possibly be irreparable. This is another reason why carpal tunnel syndrome is very serious. The median nerve passes through the carpal tunnel and can be potentially damaged. You have to see a specialist to have your nerves checked for damage!

I am currently writing a lengthy guide about my case of RSI. This small guide has been made from a compilation of my notes, and has been proof read hastily. I would be happy to give you a link to the finished document when I am finished, and would answer any questions that you e-mail to me.


    Bookmark   December 2, 2004 at 6:35PM
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Make sure you don't take a drug that is only a painkiller. This will make things worse in the long run. I've heard that cortisone is not an effective anti-inflammatory, but I don't really know anything about it to be honest.

    Bookmark   December 2, 2004 at 6:39PM
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restricting the movement is the key to healing all muscle and tendon problems. but try arnica cream, comfrey cream and or thyme as a poultice, angelica and willow tinctures should also help, good luck
love ella:)

    Bookmark   December 4, 2004 at 7:11PM
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There is a lot more to healing a tendon problem, if it is severe [you cannot pick up a cup], than just restricting movement. Clenching is another action that aggravates the injury. Generally, I would personally only take advice from someone who had experienced a severe injury of this type [tendon, not muscle] for themselves.

    Bookmark   December 7, 2004 at 12:05PM
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I've had serious RSI too. Exercises and rest (meaning: not doing the things that hurt you) are very important. But almost as important is: drinking a lot of water, and taking fish-oil capsules! You need extra omega 3,6 and 9 fatty acids... to improve the blood flow and remove wastes stuck in your muscles. You can combine this with taking herbs that improve blood flow as wel, such as Aesculus hippocastanum (Horse Chestnut).

Do not expect miracles very quickly, it takes some time before you notice results. It took me a year to get from 'fase 3' to 'no complaints at all'.

And then still: you will have to adjust your lifestyle, so the RSI won't come back (know your limits, and do not go past them.) Not neccesarily a bad thing though: Looking back, it has changed my life in a positive way. Even though I had to stop playing keyboard, which caused my injury.

Hope this helps.


    Bookmark   December 7, 2004 at 1:46PM
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Many musicians recover their ability to play music after developing a case of tendinitis. Diana Krall is an example, she had to quit playing for six months. If you have to outright avoid certain activities, you probably aren't doing as much as you can to repair the injury.

    Bookmark   December 7, 2004 at 7:34PM
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With regard to my previous posting above, recovering your ability to do activities which caused your injury may be complicated/limited if your injury has existed for a long time and you have developed a chronic pain condition, which can be a separate problem in addition to tendinitis etc. The Mayo Clinic is a good place for learning to understand chronic pain conditions.

I'm posting this follow-up because it's been a few years since I posted the previous messages in this thread and I've recently reread them and noticed a few corrections that need to be made. Someone e-mailed me about my postings recently and wanted a link to the guide I was working on, which unfortunately I haven't finished and probably won't have finished any time soon (long story). The most essential information is in my previous postings anyway (even without the corrections). Anyway, I thought I would provide corrections to some of the information above here.

1. I explained total daily usage of an affected limb badly. My statement that "everything else you do with this limb in the day, other than what you do in the time limit, is adding injury to your arm" is not phrased very well. I'm really referring to other things you do in the day that are similarly strenuous to the activity which caused your injury, including computer usage and other things like that which are typically associated with repetitive strain injury. While you are gradually rebuilding your ability to do the initially aggravating activity, you should do these other similar things sparingly. And eventually it may be a good idea to introduce these other things with the same 10% a week duration technique as well.

2. Although a very long walk can aggravate some severe injuries, it is important to stay mobile; avoiding walking entirely is a very bad idea. Going out for walks is good for your knees particularly.

3. Two things mentioned in the list of things that aggravate RSI's, placing your arms on your chest while sleeping, and vigorous grooming habits really had more to do at the time with a chronic pain condition I had developed (it was difficult at the time to distinguish the two). Obviously you will have to assess your own sleeping position with regard to your specific RSI, and perhaps your doctor or a physio (physical therapist) can help you understand what would be best.

4. The assertion that tendons get thicker as they develop more endurance is something I heard from only one doctor several years ago, and nowhere else since. It doesn't even make sense to me that an increase in width would help an injury that gets worse when inflammation occurs and pressure on the nerve increases...

5. Be very wary using wrist braces, unless you have been given very specific instructions by a doctor who is well specialized in these types of injuries. The biggest danger with wrist braces is overusage, which can stiffen up soft tissues drastically, making them much more susceptible to injury (which I know from experience) from range of motion activities/exercises. In my experience, wearing wrist braces 24/7 is a terrible terrible idea, unless for some reason it is medically necessary for you and you have been advised by a well specialized medical professional. Anyway, if you have been wearing wrist braces excessively, and then stop wearing them, be especially careful about starting up new exercises and stretches. Start gradually with these under these circumstances.

6. Naprocen/naproxen is one of the anti-inflammatories that is particularly hard on your stomach, and not indicated for long-term usage. I had good results from the anti-inflammatory Meloxicam/Moxib over a long period of time, although anti-inflammatories are generally drugs you shouldn't take long term. Eventually I was just trying to treat a chronic pain condition with it, which is not effective. Nonetheless, stopping an anti-inflammatory too soon can also cause significant, potentially permanent, complications. In my experience it is necessary to attain a significant level of flexibility before ceasing anti-inflammatory medications, otherwise permanent soft tissue complications may occur. My experience with this was contrary to some advice that I got from some doctors [not specializing in RSI] at all the, whose principal concern generally is that you get off the medication.

7. Although it is important to reduce or stop your aggravating activity for a while as a response to your acute RSI, and then build that activity up again gradually, over the long term if you reduce your limb usage too much you can cause inflexibility which will not help your situation. Working with the right health professional will probably help you find the right balance for this (keeping in mind the importance of building up new, or previously aggravating, physical activities at a rate of 10% a week).

8. There are a couple other simple thumb stretches you can do to loosen up that part of the hand. Right now when I do a round of stretching I do one of the kind mentioned in my earlier post, as well as one of each of these two mentioned now. One is to stretch your thumb out to the side, that is just directly away from your pinky finger. You can do this with your other hand pulling on the thumb, or you can rest your thumb on a surface and push down on the wrist [gently at first, don't overdo it of course] with your other arm to create the same stretch. In my experience if you only put the very tip of your thumb on the surface, you stretch it in a weird way and aggravation occurs more easily and you don't really get as full a stretch. I usually place the thumb on the surface close to the first knuckle. The other thumb stretch is to just stretch your thumb straight back, in the same direction your hand goes when you're doing a wrist stretch. You just use your other arm to push your thumb back until it starts bending the wrist and you get a good stretch. These two thumb stretches, in addition to the one mentioned in my earlier post, work on thumb flexibility in a few different directions, which is good.

9. Additional wrist stretch techniques. It can be difficult or unproductive to use one arm to stretch the other (specifically for wrist stretches), which is the technique I described in my original post. There are other techniques to do the wrist stretches which avoid this. One is to stand beside the edge of the table, as high as somewhere about half way between your waist and knee [whatever gives enough room for your arm and is comfortable; you can accommodate a little lower surface but not higher]. Placing your fingertips approximately 8 cm from the edge of the table, palm facing forward, you can drop your arm down (applying a little body weight downward for advanced stretches), keeping your elbow straight, causing a bend at your wrist. Keeping your hand near the edge of the table keeps your thumb out of the way so that you can just focus on stretching out your wrist with this particular stretch. Remember to keep your thumb and shoulders relaxed, keep the arm next to your side and make sure that the wrist is fully rotated so that the palm faces forward (when unstretched obviously).

9b. If your wrist is so rigid that you cannot even put your hand in the position to start the above described stretch technique, there is another technique you can use which is a little bit more complicated. I will only describe it vaguely, and if anyone is more interested they can e-mail me and I could show them a picture of the setup I used for this. Personally I started with this technique when my hands were very stiff, and then moved on to the one mentioned above. I kept doing the thumb stretches the same way I was doing them as they are mentioned much further up this thread (in one of my 2004 posts), although I will mention a couple more useful thumb stretches below in this particular post.

Anyway, the technique is that you lay your arm over the top of a chair [a standard, simple kitchen or desk chair, nothing oddly shaped or fancy], making contact with the forearm just below the elbow, palm facing up, and the chair itself has been raised from the floor so that your arm is at least 45° from the floor or something like that, probably higher is better but your arm doesn't need to be sticking straight out from your body. Whatever is comfortable while stretching. You will need to fashion some sort of compartment which you can slide your four fingers into, up to the web of your thumb [making it out of two CD cases might work for you]. It's just something that will keep your fingers straight, and you will attach a strap to the end of this small device (closer to the index finger side).

The path of the strap is a little complicated and goes as follows: from the finger compartment near the tip of your index finger, under something that is taped onto the side of the top of the chair [right arm = right side of chair], over the top of the top of the chair [on the other side of something you tape onto the top of the chair in the middle, to prevent the strap from sliding up next to the arm you're stretching], and then the strap will hang down [which might work out better if your chair doesn't have a completely solid back] and be attached to a counterweight heavy enough to hold the stretch, but not so heavy as to create additional stretch without you having to pull on the strap [very important to get this weight sorted out correctly, using coins in a bag is a good way to get the right weight]. Basically the way this works is that you can pull on the strap somewhere [before it goes around the thing taped to the middle of the top of the chair is a good place to pull on] and increase the stretch on your wrist, and when you let the strap go friction at the places it is wrapped around the chair will keep it held in place without you having to hold on to it for the duration of the stretch. You may have to use your imagination to understand my setup, or use your imagination to create a setup which works better for you. The important thing is to make sure the strap is pulling your wrist in the right direction, which you can check out by just putting your arm on the chair and pulling on the strap and figuring out the first place the strap needs to go around [basically the positioning of the thing taped to the side of the chair is very important for this]. Anyway, I can provide a picture of my own device if anyone ever needed to see it. Don't overstretch, and tighten and release the strap slowly and carefully!!!!!

Sorry for anyone who read my previous guide and may have been thrown off or were affected negatively by some of the information which is not completely correct, or just false. Nonetheless, the most important aspects of recovering from an RSI are included in that information. It has been a long learning experience for me dealing with RSI, but I'm back now with a good level of functioning and am regularly playing a significant amount of music on the musical instruments now, even with my chronic pain condition.

    Bookmark   May 29, 2008 at 11:17PM
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Anyone here afraid of being caught practicing medicine without a license?

    Bookmark   June 4, 2008 at 6:29PM
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Obviously not. I'll take the chance mostly because a startlingly small percentage of doctors and physical therapists know how to treat these injuries correctly, and even less of these professionals have an extensive knowledgebase of things/techniques that are actually helpful to people with these injuries. A person who has successfully recovered from an RSI, recovering all or most of their previous abilities, is likely to be a person worth learning from. Nonetheless, it is very important to first have your injury checked out by an appropriate medical specialist [not just a GP, if possible], particularly if it turns out that you have a different condition, some abnormal problem, or particularly damage to your nerves which need special medical attention.

    Bookmark   June 26, 2008 at 1:24PM
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>> Anyone here afraid of being caught practicing medicine without a license?

What does it mean to practice medicine? If a friend or co-worker says he has had a dull headache since mid-morning, and you say you have aspirin or ibuprofen handy, is that practicing medicine? If athletes in a locker room are trading methods for dealing with aches and sprains, or two people at a cocktail party are discussing their diabetes or indigestion, can that be practicing medicine?

I think there is a big difference between discussing ideas related to health and disease, and practicing medicine.

On a side note: I remember hearing about when the local library first got a copy of the Physicians Desk Reference, and several doctors made it known that they did not approve of making that information available to the general public. The librarian noted their protest and duly ignored them.

    Bookmark   June 26, 2008 at 6:13PM
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If you have serious tennis elbow and have been fighting it for years, the best treatment I have found is treating it nightly with the Pro Med 350 TENS unit for 30 minutes. A physical therapist told me about it when I was out of physical therapy visits from my insurance. It cost approx $40.00. I hav been using mine for 3 years and would not take $1000.00 for it. It works great on all types of inflamation. Also the Swedish exercise with the rod and the weight (broom handle and water bottle) will strenthen you after you get rid of the inflamation with the TENS unit.

    Bookmark   June 25, 2009 at 7:31AM
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