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Medial epicondylitis / Golfer's Elbow - what an experience...

Discussion in 'Injuries' started by Cheung, Jun 6, 2013.

  1. Cheung

    Cheung Moderator

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    Medial epicondylitis is a recurring theme in the injuries forum as can be seen from some of the links below.

    http://www.badmintoncentral.com/forums/showthread.php/122402-Golfer-Elbow-Pain-HELP!!!?highlight=elbow+pain

    http://www.badmintoncentral.com/forums/showthread.php/114442-Elbow-Pain?highlight=elbow+pain

    http://www.badmintoncentral.com/forums/showthread.php/108914-Epicondylitis-thread-Golfers-elbow-through-badminton?highlight=elbow+pain

    http://www.badmintoncentral.com/forums/showthread.php/127244-Pronation-and-elbow-pain


    I have just suffered from this. The background is very interesting and I want to share some of my experiences.

    You can find a synopsis of Golfer's elbow in this link

    I have been using the same model of racquet for the last ten plus years. My usual tension is to have thin gauge strings (0.67-0.68mm) pulled around 26-28lbs. I am pretty conservative about strings having four of the same racquet strung with the same strings at the same tension in my bag.

    I'd been using nanogy 98 at 28lbs for a while now but the stringer is getting reluctant to string to that tension citing damage to the racquet. So in a compromise, I dropped the tension to 26lbs and asked him to use BG66. The stringer is a usual stringer and a pretty good stringing pattern. I get three racquets back and start playing with them immediately.

    Unfortunately, this period also coincided with me getting less practice time. When I came back, the shuttle feels a bit dead on my strings. I put it down to my lack of practice - after all, the strings are still pretty new. After a couple of weeks, 'bam' - on a smash, the inside of my elbow feels like it had a mini-explosion. I had to stop the game immediately and ice it. I know it's Golfer's elbow - don't ask why I am so sure ;)

    I give the arm a few weeks rest but not much other treatment. It used to hurt when picking up bags but it does get better. At this stage, I try getting back on court. Nope, I can still feel it and dare not put any strength into pronation. That means clears become 3/4 length and smashes are no-go at all.

    Hmm, so it's not that simple a problem to solve after all. Luckily, finding a physiotherapist is pretty convenient. I know physios come in different shapes and forms (no, they are not beings from outer space). The physio I go to happens to be involved in sports medicine and has a Masters degree. I imagined I'd get some exercises to work on the affected area and this would solve the problem.

    Strangely, the physio asks to look at my posture, raise my arms, lower my arms, raise one arm on its own and then the other arm. The physio then presses my neck and shoulder and ribs. This is all very well but my problem is the elbow - isn't that the interesting area? The physio explains a lot is due to posture problems and diagnoses a very stiff right side of my body. I have some skepticism until the physio starts pressing certain areas on the right side (neck, ribs, leg) which hurt but pressing the equivalent place on the left side of my body cannot reproduce the pain. This starts to convince me there is something deeper than just my elbow. The first session gets me these painful prods and some stretching exercises to do. I have to admit I have been rather lazy with my pre-badminton stretching in recent times. I used to have a very good stretching routine that originally came from martial arts.

    This take home stretching exercise I found particularly useful. Go to 2.10 of the clip

    [video=youtube;iklojqcUjgE]http://www.youtube.com/watch?v=iklojqcUjgE[/video]

    It's something I do daily and very easy to do. There are a couple of other exercises but I haven't found the clips on youtube.


    After a few sessions being poked on and the stretching, the physio says I have to work certain muscle groups for injury prevention. I will be embarking on this stage soon.

    I go back and play a bit with the racquets and also try out s couple of new racquets for review. I look back at my racquets and notice something a bit strange. My BG66 doesn't look like BG66. It's marked BG85 but the gauge seems pretty thick. Almost, BG65 thickness. I didn't even check the strings when I got the racquet back. Eventually, it seems the cause of the elbow pain has two origins. One, my technique has got worse - I knew it's been slacking for the last year or so from an irregular playing schedule. Two, the change of strings pushed the elbow over the edge....

    So the plan is to do some rehab exercises strengthening my lower body and deficient muscle groups, work on my overhead technique (using more hip and body rotation), continue the stretching exercises and hopefully cure the Golfer's elbow.

    Seems like a lot of work - strange but true!
     
  2. visor

    visor Regular Member

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    Wait... so you asked for BG66 and you got BG85 instead? And you haven't scolded your stringer yet?

    And you still using 2u or 3u Cab 20? What's their bp and wt?

    Oh... and stop playing so much golf... :p
     
  3. Cheung

    Cheung Moderator

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    Using 2U Cab20's - the original version.
     
  4. visor

    visor Regular Member

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    So the obvious question is... how come you haven't changed to something like Arc 7/10/11, or similar. There are many newer rackets that are more powerful and require less effort than Cab 20.
     
  5. visor

    visor Regular Member

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    Oh.. and grip size? You probably know that too big will cause this problem.
     
  6. Fidget

    Fidget Regular Member

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    When we're young, we smirk at those old guys with braces and straps who do extensive warm-ups. Pathetic weaklings!

    But as the decades add up, the habits of bad posture and long work hours put us at risk for a night like Cheung's: fine.. fine.. Yee-ouch! Old tendons fray and snap like dried-up elastic bands.

    Cheung's therapist is so right. You have to look not just at the sore spot, but at the imbalances that led to the injury. Eg. Scapular exercises help the rotator cuff ; strong abs and flexible hamstrings help the back; etc.


    Really like your physio's approach , Cheung! :)
    (Of course there is the other common strategy suggested by visor: everything can be fixed by buying a new racket ;-) ).
     
  7. visor

    visor Regular Member

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    ^ Hey... the next best thing to a new arm is a new racket! ;)
     
  8. Cheung

    Cheung Moderator

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    More accurately, I have been using these racquets since 1999, kept the same diameter of grip (which is not thick) and not had golfer's elbow before.;)

    Therefore, I don't believe it is a problem with the racquet.

    But yes, a good question on why I haven't changed racquets in all these years. Err, well, number 1 - the cab20 is simply a great racquet - let's see, the 2000 Olympics and 2003 World Championships were won with this model. From a marketing point of view, that's bad news for Yonex for a World Champion to still be using a model that was released in 1984-5. They probably pushed newer players to use the new models. Number 2 - the racquets haven't broken yet so no good reason to buy another racquet..... The last racquets I bought were last year. 3 more cab20's second hand at a good price :)

    I will change racquets if I get some sponsorship. hahaha.

    Really, the main point is from this experience is that changing strings will be a big factor in the developing medial epicondylitis. Any change of string and tension has to be done gradually. Prevention is better than a cure.

    The second point is for the cure, it's not such an easy process. Most of us would think of going to a doctor who can do the diagnosis and not to a physiotherapist. Very few doctors would actually know what the physio can do to help cure. My post is there to show the appropriate physiotherapist can offer more help. I have to pay for my sessions but I think it's worth the cost. YMMV for other people regarding the cost aspect.
     
    #8 Cheung, Jun 6, 2013
    Last edited: Jun 6, 2013
  9. visor

    visor Regular Member

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    If everyone were like you with your Cab 20, the wheels of commerce would grind to a screeching halt. :p

    But seriously, have you tried out other rackets and what did you not like about them?
     
  10. visor

    visor Regular Member

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    And if you feel such a noticeable difference with different string and tension, wait till you try out different rackets. ;)
     
  11. quixilver

    quixilver Regular Member

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    That is 100% correct.

    Lessons learnt, I was carelessly increased the string tension of my rackets quite drastically and here I end up with golfer's elbow. I used to think that I've had played with a higher tension (~30lbs) in the late 90s during my younger days, so I thought it's gonna be fine to do the same. However, after almost a decade long of "No Badminton" period, these old muscles are not as strong and flexible as they were, it's time for them to take their tolls :(

    Cheung, I have a couple of questions regarding your experience :

    1. After you realized that your elbow was injured, did you totally rest and stop playing at all ?
    2. What are the indications that made you think you're able to start to play again ?
    3. Did you use cold/ice or warm treatment before you do the stretching ?
    4. What are the indications that made you think you're able to start to play again ?
    5. What string are you using now ? Would it help if you switch to a softer ones (i.e. BG70 or BG68Ti ) ?

    Thanks again for sharing this post.
     
  12. visor

    visor Regular Member

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    Good point above about string feel. Your previous Nbg98 is medium whereas Bg80/85 is vectran based and is very hard feel.

    So, a mishit on a power shot like a smash in your case can result in harsh vibrations and forces going up to your arm instead of into the shuttle. That's what you felt as a mini explosion.

    Moral of the story: use softer feeling strings and lower tension.
     
  13. visor

    visor Regular Member

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    And if you're willing, sometimes chinese teetda can fix sprains and tendinitis that physio can't.
     
  14. Cheung

    Cheung Moderator

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    LOL, yes. I am tough nut to crack when it comes to buying a new racquet - if a salesman can get me to buy a new racquet, that person should be awarded a medal.

    Yes, I have tried other racquets. It's not about what I don't like about them. It's more of a case of "what more than they offer given the price" especially as I would buy 3 of the same model at the same time. People who live in more exotic places such as UK, Canada, Australia are seemly able to keep changing racquets every year...

    I haven't written about that as it's not available in lots of parts of the world. But, yes, it's an option if accessible.
     
  15. Cheung

    Cheung Moderator

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    Answers

    1) First injured the elbow. Ice and total rest for 2-3 weeks
    2) Reduction in pain
    3) No, just do the stretch and hold for 20 seconds
    4) Less discomfort
    5) a) Oh good question. I have just received a newly strung racquet and am testing one of the Adidas strings.
    b) Softer strings? Not really. Softer strings don't give the same feedback. I was trying too hard to make the shuttle work for me with a softer string and then got injured. The strings I normally use don't 'fight me'.
     
  16. quixilver

    quixilver Regular Member

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    I've been totally resting about one week and doing similar stretching exercise as the video above at the same time. The stretching takes about 20-30 secs for each direction and repeated 2-3 times. I try to do it 3-4 sessions daily. Beside that, I take high dossage of fish oil (3×1500mg) daily to reduce the inflammation.

    The pain is significantly reduced but some movements and pressure on the palm are still causing a bit discomfort on the affected area of the elbow.

    Will continue to keep doing the same remedy and see how it goes after 2 weeks.
     
  17. kidbadmint

    kidbadmint New Member

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    You can do the same exercises for golfers elbow as you do for tennis elbow. The only difference is the location of your injury(golfers elbow - inside, tennis elbow - outside).

    Re-evaluate your technique and form and keep up with the stretches and exercises. This is a recipe for success.
     
  18. Cheung

    Cheung Moderator

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    Time for an update.

    I still continue the physio.

    The physio is still able to find a lot of tense areas of muscles.

    I do stretching regularly even when not on court.

    I am much, much better.

    I still feel a twinge in the muscle so I pace my smash strength judiciously going for technique (better body rotation) rather than power. All other shots are fine.
     
  19. vajrasattva

    vajrasattva Regular Member

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    this plagued me for the longest time too! and it was a vtzf 4U at 27lbs, bg66um that triggered the sharp pain in the elbow that had never happened to me before.

    i shifted to cope with it by moving towards fast racquets that were whippy and arm swing based, couldnt smash without the pain coming in for months.. its frustrating because of the doubles groups that i play at sometimes when your partner shouts.. SMASH!! and.. you give a half hearted weak smash and dirty looks are shot at you etc..

    its probably some kind of "ultrasonic" damage, usually some super hard impact vibration that travels down and terminates at the elbow

    in an attempt for the body to naturally repair itself i took quite a bit of fresh milk, half a litre before bed regularly.. it finally went away a few weeks ago.. the thing that helped the most was not playing the injurous shots i.e. very hard back hands at full extension where the elbow joint can be hurt, smashing less. increasing grip size was the most helpful, right now i play with slightly bigger than g4 than my former thinly gripped g5. it feels big and clumsy, not as nimble as a smaller grip, but with it I can smash comfortably right now with no more pain! and i hope it stays that way....
     
  20. quixilver

    quixilver Regular Member

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    It's been almost a month since I got this injury and nearly 3 weeks of total rest without playing. I felt much better and did not feel any pain when I tried to swing my rackets on various speeds and positions at home, so I thought las Saturday was a good time to I pick up my gears and give myself a try on the court. Before this, I went to see a shinshe (traditional chinese doctor) and I got a session of waxing, "deep tissue" massage and accupuncture.

    First, I stretched my lower arm following the video on Cheung's post earlier and after that I wrapped my elbow with a Bauerfeind EpiTrain which is supposed to support the elbow joint and reduce any pain caused by golfer's/tennis elbow.

    Started with a couple of slow strokes during warming up, I did not feel any pain or discomfort when I hit the shuttle before it passed me. Forehand drives and backhand clears were smooth with only just a bit self-hesitation to put more power on the shots.

    The real test came on the first MD game of that session and I played it mostly with standing at the front court as much as possible. Whenever I moved to the back court, I played slow drop shots and follow in forward to go for a rotation and my partner moved closer to the baseline to cover the rear court... I thanked him for the understanding !

    After a few points, my hesitation went down and I was carried on by the game. I started to unleash more power, then the pain started to appear when I tried to do a stick forehand smash where the shuttle was at the further right of my standing position so I need to flick my wrist and pronate my right hand more. After this happened, I noticed the pain was gradually getting worse and very obvious when I do forehand drive with my right arm fully stretched sideways at the shoulder level.
    I did not enjoy the session at all and most of the time I was frustrated in deciding what kind of shot that I was to execute and whenever the pain occured, I lost focus on the next shot. I was totally beaten off by my own minds.

    The day after, I felt a mild pain on my inner-elbow when I woke up in the morning but the pain was gone after a few repetitions of stretching. I went to visit the shinshe again to do the same series of treatment, this time he told me to go back to a total rest for another 4-6 weeks and the treatment should be continued once a week within the period :crying:
     

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