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    Default Epicondylitis thread (tennis/golfers elbow)

    hey I haven't seen a thread about this in a while so lets have a discussion!

    I'm currently going through really bad golfer's elbow (inside elbow, as opposed to tennis = outside elbow)...

    Anyone else had it? Know any good supports that work well? creams? gels? pain killers??

    Might have to go down the steroid injection route soon if the anti-inflammitories don't work this time :S

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    Squeezing stressball regularly should do the trick. You overused a certain set of forearm muscles and need to balance it out. Doing the 'Plank' exercise with your fingers would exercise your arms too. Supports maybe counterproductive as they allow you to continue the kind of workload you should be avoiding. Resting your arm more should alleviate the pain.
    Last edited by cappy75; 04-22-2007 at 04:54 PM.

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    Have you had this condition for a while -- is it chronic or acute? Do you know for a fact that it is an inflammatory condition?

    There are actually 2 flavors of tendinopathy -- tendinitis is an acute condition (days or weeks) that involves inflammation whereas tendinosis is chronic (month & months) and does not include inflammation. Epicondylitis is the term for a tendinitis associated with tendons of the elbow -- epicondyle of the humerus -- (golfer's elbow involves the medial epicondyle and tennis elbow is the lateral epicondyle).

    http://www.tendinosis.org

    Anytime you see -itis it implies inflammation, whereas -osis refers to a non-imflammatory chronic condition. Unfortunately, the term tendinitis (or epicondylitis) is commonly used, even by doctors when talking to patients, for a condition that may or may not involve inflammation. Tendinopathy should be the general term, not tendinitis.

    Ice, ice, ice along with rest should be your primary means to deal with either tendinopathy. Ice massage is a great variation of this. Try a BC or google search on ice massage. Heat should only be used just prior to exercise in order to warm up the muscle, tendon & joint.

    Other treatments of your tendinopathy will depend on whether it is an -itis or an -osis. (For the latter, refer to the link above). For the remainder of this post, I will assume that your condition involves inflammation.

    Ibuprofen (IB) & other NSAIDs (aspirin & naproxen) are often suggested to deal with both the pain & inflammation. To derive an anti-iflammatory response from NSAIDs, you probably need higher than normal pain-relieveing doses. For IB, this is usually 600mg (sometimes 800mg) doses several time a day. However, this high dosing schedule should probably not go much past 10 days.

    You should drink both green tea & cherry juice as a dietary means to alleviate inflammation. There are also a number of spices & herbs that can be used as an adjunct or even as an alternative to NSAIDs. (I will try to dig up a post on thse herbal anit-inflammatories my followup in this thread).

    Some post-exercise lotions/gels that I've found helpful: BioFreeze, Arnica gels, Ibuprofen cream (from Germany or Euro sources), Traumeel, or ointments that combine MSM with Emu oil. (Note that glucosamine & chondroitin are used for repairing cartilage & might not have any benefit for tendon problems).

    Prior to exercise, if you really must exercise, I would use a topical analgesic ointment such as IcyHot or a SalonPas patch. A Capsaicin lotion (or patch) can also be very useful for helping to warmup your elbow for exercise. Note that these lotions are primarily superficial counter-irritants and might not get very deep into the tissue. To really help you to warm up your elbow joint (muscles, tendons, etc), you should use a heating pad just prior to heading out to the gym.

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    Default Ice massage & herbal anti-inflammatories

    For more about ice massage & dietary alternatives to NSAIDs, check post #32 in the following thread. About half way into that rather long post, I discuss those topics...

    badmintoncentral.com/forums/showthread.php?t=40224&page=2

    In addition to the spices that I've mentioned in that thread, you should also include celery seed and sources of omega-3 fatty acids. The best sources for the anti-inflammatory omega-3 fats are flax seeds (ground) and fish souces, especially salmon, anchovies, & fish oil. You can also use flaxseed oil but I feel that the ground flax seeds are more beneficial to health.

    (Don't get me started on the relative merits of fish vs flax -- best bet is to use both as sources of omega-3 fatty acids).

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    Default Several articles here

    Check out http://sportsnmedicine.blogspot.com and click the label 'elbow' or 'badminton'. Hope this helps!

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    SystemicAnomaly, thank you so much for taking the time to write out all that information.... that's just fantastic info there, thank you again!!

    I'm not sure if it's chronic or acute yet... I can add the following information about my condition and maybe you can tell:

    The cause of the pain is my activity schedule on a Wednesday, I play badminton from 4:30 til 7pm and then volleyball training 8:30-10:30pm....

    I think it's mostly the badminton session (this is quite a hard session, lots of men's doubles - fast and hard hitting!)....

    I feel no pain during the session, sometime however it springs up during volleyball. The problem is if I come to play badminton again, say Friday night, I get agonising pain in the inside part of the elbow, extending throughout and sometimes also on the outside... this happens even if I am only playing really easy, it doesn't take much!

    Like I said, it's interesting that it doesn't hurt during my wednesday session... I am trying a new elbow support this week and anti-inflammitory cream, which doesn't actually help much but it does help the pain go away quicker only once i've stopped playing....

    Once again, thank you very much for all that information!

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    Sorry Docaroo, I can't really tell if is is acute (inflammation) or chronic. I've got a pain or 2 of my own that I'm not quite certain of. Duration is probably the biggest clue. If it appears to flare up every once in a while for a few days (or a couple of weeks), then it is very likely that it is acute.

    If it is pretty much a daily pain that lasts for months, it's a good bet that it might be a chronic (degenerative) condition. If this is the case, then NSAIDs and other anti-inflammatory strategies may be a waste of money -- unless they happen to alleviate the pain. In either case, ice or ice massage should help.

    If you consult a physician about the problem, see if you can find out if inflammation is indicated. Ask the doctor how the determination is made.

    Your medial epicondylitis (if it really is an -itis) is most likely an overuse injury. It is often a result of a strong flexion of the hand (wrist) or fingers. Check out the Causes section in the following link (it talks about inflammation versus tissue degeneration)

    orthogate.org/patient-education/elbow/medial-epicondylitis-golfers-elbow.html


    My guess would have been that v'ball was the primary cause with badminton as an added aggravation due to overuse. You may have developed micro-tears in the tendon in a previous session. The long badminton session may cause a further inflammatory response. During v'ball, the condition finally manifests itself as the pain your feel. But, then again, perhaps you are correct in assuming that badminton is the initial instigator of the condition.

    V'ball probably uses stronger wrist flexion action since there is very limited use of forearm pronation in the sport. Serving, spiking (and blocking) can all make use of vigorous wrist flexion action that could possibly be a major factor in your tendinopathy. The relatively heavy ball puts an added stress on wrists and shoulders. (I developed a serious rotator problem from v'ball years ago).

    Perhaps you are using too much wrist flexion (forward bend) in badminton instead of using adequate pronation. Badminton tends to use more wrist extension (laying the wrist back) rather than flexion. The wrist flexion actions in badminton should be short and limited -- rackets are just too long to get away with too much flexion as a means to generate power.

    Another factor could be that you are gripping the racket too tightly when you play. Your grip should be fairly loose most (95%+) of the time. You should just let it tighten naturally, on its own, whenver you accelerate the racket head.
    Even when your grips tightens (just prior to contact), you probably require much less than 1/2 grip strength. At the conclusion of each stroke, your grip should once again be very relaxed.

    The elbow support may help by changing the geometry of your forearm a bit so that you are putting less stress on the medial epicondyle. An elbow strap can also be used as an effective feedback mechanism -- if you grip your racket too tightly or too often, you should feel your forearm muscles straining against the strap -- let this be a signal to loosen up.



    Last edited by SystemicAnomaly; 04-23-2007 at 07:30 AM.

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    I think it's probably due to volleyball, the impact on the arm when you hit the ball is a lot greater than in badminton, and since your arm muscles are already fatigued the impact takes a greater toll on your arm. If you want to do both, maybe you should play badminton for an hour less than you do currently, until your arm strengthens enough? I wouldn't play if your arm is still hurting, because you might do longterm damage to your tendons.

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    Thanks for the info guys, and once again thanks to Systemic Anomaly!!!

    I think it is at the acute stage at the moment, the pain does not last more than an hour or 2 after I stop sports, and anti-inflammatory cream decreases this time to under an hour suggesting inflammation is the cause of pain!

    there's some great information posted there about treatments and I'll work my way through some of them and let you know.... if no improvement I'll go back to see my doctor/physio and go from there!

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