Tendonitis Issues - Looking for input

[JKD1334]

I'm looking for any input on what alternative strategies people have had success with in correcting tendonitis (especially in the elbow area) when it's gotten to the point of surgical recommendations.

I've been struggling with lateral epicondylitis since November 2011. Physical Therapy, rest, ultrasound, anti-inflammatories, stretches, and extensor exercises, have all proven insufficient to alleviate the problem. Cortisone injections alleviate the discomfort completely, but only last for 3 months. I have gone through three cortisone injections that each lasted almost exactly 3 months, and now my ortho says he won't inject it any more and I should have surgery or lay off of it for a YEAR and see if that fixes it. The pain is bad enough that I can't continue to just work through it indefinitely, and that would probably just make it worse any way.

Any insight about other solutions that you've had success with are much appreciated.

[GKC45]

How often are you doing stretches for it? At least once per day?

[Cruiser]

I had a tendonitus / bursitis issue in my elbow about 4 years ago. Had the cortisone as well. I was told NOT to work through it if it got worse. They said it could cause permanent damage. I stopped lifting altogether for 3-4 months, I think. When it felt better, I got back into lifting and it has not caused any problems since.

I took care of it right away and it worked out. It looks like you have pushed yourself quite a bit further...surgery and all. I am not a doctor, so I will not advise; just giving you input from experience.

Cruiser

[anonymous]

that doesnt sound like tendonitis (which is a short term accute inflammation) it sounds like tendinosis - WTF the anti-inflams and cortisco shots are for I dont know, absolute horrible idea.

google 'tendinosis' and you'll see the concensus is loaded VERY slow eccentrics, NO2 to carry more blood to the tendon, PRP (scam imo), stem cells, and anything else you can get a good dr to prescribe to increase collagen synthesis (you'll have to shop around , the majority of them are closeminded and stubborn and last read a research paper in the late 80's if you're lucky)

[weiss1967]

I have my own way of dealing with tendonitis, which I have regularly. In a nutshell: when it is acute and bothering me I increase collagenous food intake, and do self-massage. For collagen I buy load of soup bones and boil very thick stock, it is basically bones just covered with water boiled for 10-12 hours. I scrape everything off of bones and take it as a hot soup. Should have no other ingredients, not even salt to work as a medicine. Clove of garlic and shot of vodka is okay. Idea is not mine, Armenians (or Georgians ?) were using something like this for ages. But this mediaval supplement works poorly on its own. Self massage, deep and painful intrusive massage of particular tendon that is bothering me, this is what complete the procedure. 15 minues of painfull fingering and next day I am like new. By the end of the week I will work out full bore, and sometimes I work right through it, a bit less agressively maybe. Anyways, this is what I do. Can't say I am entirely healthy fella, since my tendonitis returns once in a blue moon and I have to take care of it again. Took me a while figuring out the way of dealing with it, few years back I nearly quit working out because of this. Doctors probably have a ****load of magic pills, maybe better and faster acting, but I like the collective wisdom of alternative madicine.

[dwing]

Been having issues for a few weeks involving my wrist(base of thumb). Been taking motrin and wearing a brace at night and when I drive. I just took the last week off from working out but doing cardio and legs until it's better. I work with an ER doc and he told me if that does not help I might need the cort. shot.
Ive had three shots before, 1 in each elbow and a shoulder that locked up. I've been good since those. I tell ya' getting older stinks.

[BearLovesLuna]

I'm looking for any input on what alternative strategies people have had success with in correcting tendonitis (especially in the elbow area) when it's gotten to the point of surgical recommendations.

I've been struggling with lateral epicondylitis since November 2011. Physical Therapy, rest, ultrasound, anti-inflammatories, stretches, and extensor exercises, have all proven insufficient to alleviate the problem. Cortisone injections alleviate the discomfort completely, but only last for 3 months. I have gone through three cortisone injections that each lasted almost exactly 3 months, and now my ortho says he won't inject it any more and I should have surgery or lay off of it for a YEAR and see if that fixes it. The pain is bad enough that I can't continue to just work through it indefinitely, and that would probably just make it worse any way.

Any insight about other solutions that you've had success with are much appreciated.

Just went through this. Never had it before in my life. Tennis elbow.

I was rapidly increasing my weight and reps on my first true "bulk". I believe that my major muscle groups were outpacing the muscles in the forearm. During the period of two workouts the pain went from introductory nuisance to "I'm done, that's the last rep for a while."

Having been a pretty solid athlete in school, and having had good coaching, I know where the point is where you need to recognize that any more "effort" to work through the pain is going to lead to prolonged recovery periods or even permanent damage. I was at that point. I stopped lifting for three weeks straight starting mid Dec. last year.

During the three weeks I pondered which exercises were the culprit. I thought I had it narrowed pretty well at first- hammer curls, upright rows- as it turned out, and I learned this later, those were not the cause, but they were heavily exacerbating the problem by creating inflammation due to being worked.

After the three weeks, I started lifting again, and during this time I started to realize what had caused the problem. Too much weight on lifts like deadlifts and shrugs (no I am no weight lifting monster- I mean just too much weight for my "whole" body- my forearms were not ready to grip that much apparently). While hammer curls and upright rows hurt, I don't think they were the cause.

I immediately removed deads and shrugs from my routine for the next couple weeks, then started adding them in again a couple weeks ago at lighter weights. I discovered that a lot of people use straps for this reason- that they cannot grip effectively and without possible injury the weight they want to work out with on some exercises. So where you are suspending the weight and your fingers have to actually grip the weight, your brachio radialis can get strained. Hammer curls you have to grip a little harder than conventional curls, and upright rows utilize the same muscles, but the weight I use on those is nowhere close to as "damning" as the increases in weight I had seen on deadlifts and especially shoulder shrugs.

Interestingly, changing my grip (pronating it) on shrugs seems to help a great deal. But I STILL cannot lift the weight I was working out with when I injured myself. I would say I am at 90-95% recovered.

My point- I think you need to determine what you want your end result to be, and decide how you want to achieve it. Surgery- not sure I like this approach, at least not without you taking some REAL time off what ails that tendon. You said you tried "rest" but did not specify the time. I think you are looking at about 2+ months, probably more, before you can even think about using those muscles/tendons intensely and directly, again. I would guess you will need about 4 months to heal to the point I am now, at 2 months.

Cortisone is just a bad idea on an injury like this. You are just "working through it". You cannot heal something with cortisone. You can heal it with rest, maybe... You may have injured this tendon to the point it will never fully recover, but I would find out first if that is true by truly dedicating yourself to real rest of that tendon. There is a LOT you can still do to lift...

Ice- I iced the area once per day (a few times twice) for 10-20 minutes. Usually 20, but you might have to adjust the ice pack (I use real ice, in a large freezer size ziploc "block" form) as it will become rather uncomfortable sometimes. But just try to get at least 10 min a day.

Squeeze balls- ( no, your balls, not mine...) I used one of these, not pressure straps, etc... The ball, squeezed, when your arm is fully extended downward, will possibly hurt like an SOB, but do this 10-20 times several times a day, and then just after, move your arm (contract bicep) and re-extend, over and over. Might hurt like a son of a bitch too, but you need to mobilize this thing.

You need to be patient and take some rest of this thing seriously. Surgery may be a last option, but it will be the only option if you don't wise up about how to treat a serious injury that you could carry your whole life if you don't (wise up).

[jellodirt]

Same thing here. I trained myself to sleep different and that helped more than anything. When I lay on my side it irritates that tendon. So if I'm on my right side I sleep with my right hand on my left shoulder withy right elbow out in front of me rather than underneath.

It wasn't hard to get in the habit of doing this because when the pain would wake me up I'd get back into position. Now I sleep fine and my elbows feel pretty good.

[JKD1334]

How often are you doing stretches for it? At least once per day?

Yes - at least once per day on the stretches - often more than that.

[JKD1334]

that doesnt sound like tendonitis (which is a short term accute inflammation) it sounds like tendinosis - WTF the anti-inflams and cortisco shots are for I dont know, absolute horrible idea.

google 'tendinosis' and you'll see the concensus is loaded VERY slow eccentrics, NO2 to carry more blood to the tendon, PRP (scam imo), stem cells, and anything else you can get a good dr to prescribe to increase collagen synthesis (you'll have to shop around , the majority of them are closeminded and stubborn and last read a research paper in the late 80's if you're lucky)

I'm glad you mention this. The MRI showed "mild tendinosis" around the lateral epicondyle. Both of the ortho surgeons I've seen, one of whom is an "upper extremity specialist", refer to it as tendonitis though. The specialist said it's no different than tendonitis really, but also described it as a cellular degeneration of the tendon. He still prescribed no different treatment than doing those stupid stretches everyday and some reverse wrist curls with a tiny weight. If anyone has any success with any of the various "tendinosis" remedies here I am interested to hear.

[JKD1334]

Just went through this. Never had it before in my life. Tennis elbow.

I was rapidly increasing my weight and reps on my first true "bulk". I believe that my major muscle groups were outpacing the muscles in the forearm. During the period of two workouts the pain went from introductory nuisance to "I'm done, that's the last rep for a while."

Having been a pretty solid athlete in school, and having had good coaching, I know where the point is where you need to recognize that any more "effort" to work through the pain is going to lead to prolonged recovery periods or even permanent damage. I was at that point. I stopped lifting for three weeks straight starting mid Dec. last year.

During the three weeks I pondered which exercises were the culprit. I thought I had it narrowed pretty well at first- hammer curls, upright rows- as it turned out, and I learned this later, those were not the cause, but they were heavily exacerbating the problem by creating inflammation due to being worked.

After the three weeks, I started lifting again, and during this time I started to realize what had caused the problem. Too much weight on lifts like deadlifts and shrugs (no I am no weight lifting monster- I mean just too much weight for my "whole" body- my forearms were not ready to grip that much apparently). While hammer curls and upright rows hurt, I don't think they were the cause.

I immediately removed deads and shrugs from my routine for the next couple weeks, then started adding them in again a couple weeks ago at lighter weights. I discovered that a lot of people use straps for this reason- that they cannot grip effectively and without possible injury the weight they want to work out with on some exercises. So where you are suspending the weight and your fingers have to actually grip the weight, your brachio radialis can get strained. Hammer curls you have to grip a little harder than conventional curls, and upright rows utilize the same muscles, but the weight I use on those is nowhere close to as "damning" as the increases in weight I had seen on deadlifts and especially shoulder shrugs.

Interestingly, changing my grip (pronating it) on shrugs seems to help a great deal. But I STILL cannot lift the weight I was working out with when I injured myself. I would say I am at 90-95% recovered.

My point- I think you need to determine what you want your end result to be, and decide how you want to achieve it. Surgery- not sure I like this approach, at least not without you taking some REAL time off what ails that tendon. You said you tried "rest" but did not specify the time. I think you are looking at about 2+ months, probably more, before you can even think about using those muscles/tendons intensely and directly, again. I would guess you will need about 4 months to heal to the point I am now, at 2 months.

Cortisone is just a bad idea on an injury like this. You are just "working through it". You cannot heal something with cortisone. You can heal it with rest, maybe... You may have injured this tendon to the point it will never fully recover, but I would find out first if that is true by truly dedicating yourself to real rest of that tendon. There is a LOT you can still do to lift...

Ice- I iced the area once per day (a few times twice) for 10-20 minutes. Usually 20, but you might have to adjust the ice pack (I use real ice, in a large freezer size ziploc "block" form) as it will become rather uncomfortable sometimes. But just try to get at least 10 min a day.

Squeeze balls- ( no, your balls, not mine...) I used one of these, not pressure straps, etc... The ball, squeezed, when your arm is fully extended downward, will possibly hurt like an SOB, but do this 10-20 times several times a day, and then just after, move your arm (contract bicep) and re-extend, over and over. Might hurt like a son of a bitch too, but you need to mobilize this thing.

You need to be patient and take some rest of this thing seriously. Surgery may be a last option, but it will be the only option if you don't wise up about how to treat a serious injury that you could carry your whole life if you don't (wise up).

Outstanding, and very thorough, reply. Thank you for the great input. I did identify some culprit movement types and remove them after I returned to working out after resting it (almost completely) for about two months. I still don't do the movements that I suspect really exacerbate it, and most of my workouts now are oriented around relatively light weight movements and complex body weight type movements. I'm not a BIG guy - I'm 5'9 and running about 155lbs at 6% BF, so I'm more about staying lean and getting performance out of my body.
My old days of being big wore me down too much - I was as much as 188 at about 8-10%, but it got me some serious arthritis trying to maintain the heavy movements. Thanks for the advice!

[AAOBob]

For me it's just the opposite. I have chronic right knee tendinitis. I had it checked and the bone is fine. The only thing that helps it are heavy squats. It was really bad when I started working out seriously and I was very worried I'd not be able to squat, and like magic it was gone.

If I don't squat for over a week or so it comes back. I'm one of the only people who gets LESS leg pain due to leg day . Course leg day is 3 times a week.

[SleeperService]

I never understand the 'work through it' mentality. If you have an inflamed and irritated tendon then subjecting it to the same load that caused the problem in the first place is crazy. Even reducing the load is not necessarily the best thing to do. If you break a leg you don't go hopping down the road as soon as the cast is on.

It's quite simple: if it hurts then stop doing it. Sure, use light weights and limited ROM if you can tolerate it pain free. The most common reason for acute injuries turning chronic is non compliance by the patient to treatment protocols. As mentioned, cortisone masks pain. It may help with recovery but will not address the underlying issue.

Existing chronic issues and management of these may be slightly different but for acute injuries it's the same story time and time again.

OP, I'm sorry but I think you just have to take the hit here and have surgery.

[philipj]

For any similar pain, I learned from Dr. Julian Whitaker;s "Health & Healing" news letters about a product called DMSO, used in Vet medicine. It comes in a 70% sray solution(shower before you use it) and in a base white cream. I use it 3X @day, and it does wonders.

[lensperson]

Cortisone is just a bad idea on an injury like this.

there has been an exhaustive study of "tennis elbow" which revealed that when cortisone was used the long term outcomes where not as good as for those who did not receive cortisone injections... the study is EZ to find, research it... and your doctor is wise to stop at three injections this seems to be SOP for the medical community...

Ice- I iced the area once per day (a few times twice) for 10-20 minutes.

Hand a rehab specialist tell me that over the years he has been totally amazed at the healing properties of icing... yes 15 minutes is ideal, never exceed 20 minutes (frostbite is serious stuff) Was advised to use a 50-50 mix of alcohol and water in one of those good old red rubber hot water bottles, place in the freezer and you've got a highly effective treatment tool... btw, the rehab pro told me to research Sandy Koufax of the Brooklyn Dodgers, his career was extended for years by emerging his entire pitching arm in an ice bath after every game... Ice will actually promote healing... I have used many, many times for injury such as this... btw, it's cost effective and a highly effective component in pain management...

You need to be patient and take some rest of this thing seriously. Surgery may be a last option, but it will be the only option if you don't wise up about how to treat a serious injury that you could carry your whole life if you don't (wise up).

Overuse injuries are one in which the patient is THE major player in the mix... please honor your pain, it is a messenger, it's function is to protect you from serious damage... listen to your body very carefully...

all the best on your journey...

[JKD1334]

Thanks for all the great input. I am definitely resting it now. I'm at least going to try a series of stretches and strengthening movements every other day (although it hasn't really worked well previously, I'm trying a modified plan), along with a daily or EOD 15 minute ice regimen.

Does anybody have input/advice on "cross fiber massage" (how you did it?) or using one of these theraband bars that are supposed to help tennis elbow.

I'm a little nervous about the DMSO suggestion after reading up on side effects.