Hi guys, apologies because this is a big post, I have adapted it from a previous post I did on another forum (kitesurfing) so sorry if I miss any of the kiting related suggestions. Please take the time to read and post comments if you wish.
Lots of people complaining of "tennis elbow" type symptoms on here linked to casting and changing rods or fishing after a long lay off, this is directed at you, if you have any questions I will post back on this thread.
This thread will tell you the pathology/problem, discuss some of the causes and also discuss treatment/prevention and who to see for it, it is meant as a guide and not to be exhaustive so don't grumble at me please.
tennis elbow- medical term Lateral epicondylitis, this means inflammation of the lateral epicondyle (which is the nobbly bit on the out side of your arm bone, above your elbow (Humerous). the reason this area of bone becomes a problem is that all the muscles that extend your wrist and fingers have a common origin from this segment of bone ,tendons are the extension of muscles that attach to bone, this means that this area of bone can be exposed to high degrees of stress at the site of the tendon attaching to the bone. These are the tendons that work to maintain wrist position during the cast and maintain the rod position during the retrieve or whilst fighting/playing a fish.
Research over the last 10 years has failed to show inflammation of the tendon, these studies have taken tissue samples, collected fluid and measured cells from the area in many people, non of the studies have shown inflammation of the tendon (tendinitis) instead they show degeneration (tendinosis). The studies were done on people with symptoms generally longer than a month, so I accept those with a short period of symptoms may have some inflammation, but this is highly unlikely as what causes degeneration is different to what causes inflammation, also inflammatory/degenerative disorders have very different presentations.
It is key you understand and accept this as medical fact, despite your doctor, physio, best mate in the pub, boat partner or dog disputing this. If you accept this you will realise that simply resting a degenerative area of tissue will not miraculously make it better. This is why many of you have had symptoms for prolonged periods of time without improvement.
Why it is degenerative our body is normally constantly repairing (during rest/sleep)tissue whilst we damage/wear tissue (physical exercise), this process is normally in balance, however add more things that wear tissue (such as casting/fishing more often, bigger/heavier rod, windy conditions, casting/trying harder, narrower or bigger handles (insert any activity) then our body actually falls out of balance, and the rate of damage/wear exceeds the rate of repair. This will cause gradual symptoms over a few sessions/weeks. If your symptoms suddenly started during a physical exercise then you have likely torn the muscle, this sounds scary but is probably very minor and more likely to improve because this will have a definite inflammatory reaction. If your symptoms started after one particular event (one days fishing), but did not start suddenly then you have overused these muscles and some “relative” rest will help. This does not mean totally avoiding all physical exercise or fishing but being realistic about the amount that you do and listening to your symptoms.
FACTORS OTHER THAN USE- may also effect the healing, so if you have health disorders like RA, diabetes, smoker, are dehydrated, poor nutrition, lack of sleep/rest then your healing rates may be limited, this could predispose you to developing these problems. Bizarrely if you have gone grey early, are ginger (yes that’s correct) or have other tendon problems then you are likely to develop problems with other tendons, this is due to premature aging of your bodies collagen.
The actual dysfunction(problem) may occur in 3 different areas :1/ the muscle tendon junction (MTJ), mid tendon, or the teno-osseous junction (TOJ= the area the bone and tendon meet). the TOJ is the real problem area as there is a poor blood supply and it takes a long time to heal 8-10 weeks, whereas the MTJ may take 4-6 weeks (with the right treatment)
Soreness for a few days after fishing in the muscle belly with a full recovery in between, and not tendon, is related to delayed onset muscle soreness (DOMS) and not a tendinopathy (problem with the tendon).
One of the key problems with lateral epicondylagia (pain around the lateral epicondyle) is that many different structures may be causing the pain you think is tendon related, e.g. trapped/irritated radial nerve, referred pain from elsewhere, trigger points, elbow joint pain. It is crucial that you have an accurate diagnosis so that treatment may be correctly administered and time (and maybe money is not wasted). Unfortunately this depends on the skill of the person assessing you, and like builders they are sometimes cowboys.
Since we are all hopefully in agreement about it being degenerative we can now understand why rest, antiinflammatories, ice etc are not useful (or only as a placebo), therefore analgesics (painkillers) like paracetamol and cocodamol can be better.
Treatment needs to be directed at the cause, often this is a complex interaction between weakness of the muscle, tightness of the muscle and the overuse/misuse/abuse applied to the tendon. (A weaker muscle loads the tendon more and therefore increases the strain causing excess loading and eventually degeneration)
The epiclasps do work to reduce loading through the tendon and a treatment called MWM’s can often be useful (google scholar search it)
but the best thing is a special exercise where instead of shortening the muscle under contraction you lengthen it.! example a bicep curl, as you pull the weight up so your hand comes up to your shoulder the muscle shortens, as you lower the weight the same muscle lengthens, so the principle of the exercises is to lengthen under contraction but not shorten the muscle, how do you do this??
well- you sit next to a table place your arm on it , palm down, with your wrist over the edge, hold a small weight (tin of beans) , now use your other arm /hand to pull your wrist in to an extended position (bring the back of the hand up towards your arm) let go with your other hand and slowly lower the weight so your wrist goes into flexion (bringing the palm towards the floor and forarm), now again use the other arm to lift the weight back up (do not use the arm you are exercising) and repeat 15 times , 2 sets twice a day for 2-3 months and a chronic "tennis elbow" should resolve. (this is an eccentric regime)
What does this exercise do? 2 theories! 1/ eccentric exercises really stress the muscle/tendon so may cause minor trauma leading to a normal healing pattern 2/ eccentric exercises stress the tendon/muscle causing an increase in tensile strength, an increase in muscle stress means the tendon takes less force as the muscle absorbs more, so problems don't develop. This principle has been shown to work with chronic achilles and patella tendinopathy (which also is degenerative)
cross training may help- going to the gym, swimming, climbing etc where you don't rely on this muscle for long lengths of time as this ensures the strength is maintained and your general fitness is good.
Casting problems – definitely have some lessons to check technique, don’t force the cast use the momentum and balanced tackle, try altering the grip on the rod, either thicker or thinner, but more importantly check the wrist position and avoid having it “cocked backwards” as this is the position that loads the two most effected muscles/tendons (extensor carpi radialis longus and brevis). Reduce pressure on handle (don’t throttle it).
During recovery gradually increase the amount of time you do the offending activity, this gives the tendon time to heal. A new tendon cell takes 3 months to grow, and the tendon cells won’t be fully replaced for 18 months.
I have missed loads but I would be here all day otherwise, keep trying to do this between patients! bad choice,
Why should you believe me? because you just should , and what do you have to loose, so do the exercises (if your diagnosis is correct)
Should probably have a disclaimer now............
Oh yeah and get a physio from here
Welcome to the MACP Website or here
::Physio First::
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offshore? no really??
How to treat a tennis elbow
)? Could well minimise tennis elbow.
. I decided to back to weight training a while back to gain stength and get fitter, and of course my tennis elbow flaired up big time, but I found the stronger I was getting and the muscles getting larger it made the area affected stronger also, mainly doing a layed down narrow grip ezey bar french press for the triceps on top of my very hard bed. For a few weeks it hurt like the dickin's but after a few months of slogging at it its cured completely..no pain whats so ever, so my advice is to train the arms for strength and make the weak area stronger...worked for me a treat.
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