SquibRound Posted December 18, 2012 Share Posted December 18, 2012 (edited) I have recently experienced a severe bout of tennis elbow (shooter's elbow), which has been a somewhat recurring issue for me. This episode however was the most severe I have ever experienced and actually interfered with my shooting and work. Since I am still actively recovering from this condition, I thought I would add my experience with various treatments for the benefit of the forum. I aggravated the condition by repeatedly drilling my presentation, which I had changed slightly in the way I acquired the initial grip on the pistol. The new method stressed the extensor muscles of my forearm and after a week or so of daily dry practice I was slightly sore. Not to be a quitter I of course kept at it, and predictably really inflamed the condition. It was at thais point that I left for a 4 day stent at Frontsight for the combat master prep course. I spent the four days doing presentations all day. By the completion of the course I literally couldn't move my strong-side arm without severe pain. A handshake became an intolerable social activity. The outside area of my elbow was swollen and warm, and the entire are of the lateral epicondyle (bony bump on the outside of the elbow) was exquisitely tender. The condition at that point was now significantly interfering with my work, and I could not shoot, so I felt I really needed to do something other than ignore the condition (my usual first line treatment). I do have a medical background, and I do have access to several Orthopedic surgeons and Physical Therapists whom I hold in high regard. In shooters the problem is due to mico-tears and strain of the extensor tendon/muscle complex. The ligaments of the lateral elbow can be torn/strained as well in this condition, but this is usually with more stress such as with racquet-sports. After some significant R&D I began the following program which has been wildly successful: WEEK 1-2 1. Stop doing the activity that caused the problem.... This was the worst part of the treatment, but I did lay-off for 2 weeks. 2. Stretch the extensor muscle/tendon complex every morning, every night and whenever I thought of it during the day. I did this by hyper-extending my elbow, flexing my wrist as I rotated my wrist away from my body and compressed the flexed wrist to put a bit more stretch on the tendon/muscle. 3. Ice the outside of the elbow every evening, as well as during the day if possible. I would put a thin cotton sleeve over the elbow, followed by the ice-filled plastic bag which I kept tightly applied to the elbow with an ACE wrap. 4. Anti-inflammatory meds (OTC) religiously. 5. I purchased a ACE brand tennis-elbow brace. I always thought these were placebo, but they really work, and the Orthopedists I spoke to all used them as well (all 3 surgeons suffer from the condition!?!). Evidently the compressive brace redistributes the force of the extensor tendon away from the lateral epicondyle and over a broader area. WEEK 2 6. I got two fairly thin rubber bands and placed them around the outside of the fingers of the affected hand and began 10 rep sets or finger extensions. I did this in the car on the way to work and back. Once I started to feel better I did this during the day a few times as well. Be careful with this when you first start the exercise. If it hurts a lot, stop and rest some more, you are not ready yet. Over the course of the last 4 weeks I have slowly added resistance in the form of additional rubber bands (I'm up to 4 bands now). 7. I had an injection of the lateral epicondyle- cortisone/marcaine. Hurt like hell, but it was definitely worth it. In two days it felt like I never had the problem, which is the problem with the injections. Most knuckle-heads will then go right back to the activity that caused the problem in the first place like nothing ever happened and screw the pooch royally (don't be that guy). 8. Re-started shooting with special attention to form- and yes, I did adjust my pistol grip to avoid the stress from my ill-conceived new technique. 9. stopped the ice in the middle of week 2. WEEK 3-4 10. Added exercise with the Theraband Flexbar. The instructions on how to use this wonderful device are on Youtube. I purchased the green level flexbar (15 lbs resistance). I highly recommend this device- it has really worked well. I started with three 10 rep sets about three times a day, and have worked up to 20 rep sets done 6-8 times a day over the course of 2 weeks. 11. Stopped the anti-inflammatories this week. Still doing the stretches, rubber-bands extensions and tennis-elbow compressive brace. WEEK 5-6 12. Added active extension exercise to my Theraband Flexbar sessions. I do a 20 rep set of the eccentric contraction (muscle-lenghtening when the flexbar pulls on the wrist) and added concentric contraction- what you would consider "normal" muscle-contraction exercise, by twisting the Flexbar against the twist (Look at the Youtube video, it will make sense). The first week I did 5 reps concentric for every 20 reps eccentric. Week 6 I increased to 10 reps concentric for every 20 reps eccentric. WEEK 7-8 13. I plan to increase the concentric reps over these two weeks to 15/20 and 20/20 for weeks 7&8 respectively. 14. I will wean out of the tennis-elbow brace for all activity except very stressful forearm exercise. WEEK 9 15. Plan to start wrist extension exercise with free weights. 16. Plan to start using grip-strenght exercisers. Both of these activities I will take very slowly. Things I learned: 1. Don't ignore tennis elbow- if it becomes truly chronic you are in for a major issue that may culminate in surgery. 2. My draw now is faster than it was prior to the problem. I feel this is due to the fact that I needed to slow down and really pay attention to my technique. I could only go so fast to keep away from re-injuring myself. Slow is smooth, smooth is fast.... Hope this helps someone. Edited December 18, 2012 by SquibRound Link to comment Share on other sites More sharing options...
toothguy Posted December 18, 2012 Share Posted December 18, 2012 Great post, thanks. Link to comment Share on other sites More sharing options...
Matt Griffin Posted December 18, 2012 Share Posted December 18, 2012 (edited) Yep, I didn't lay off like I should have, my ligaments went at the World Shoot, and ten months after surgery I still feel it. The most important thing to understand is that tendons and ligaments don't heal like muscles do. They take months to repair the same damage that a muscle fixes in a week. Edited December 18, 2012 by Matt Griffin Link to comment Share on other sites More sharing options...
Not-So-Mad Matt Posted December 18, 2012 Share Posted December 18, 2012 Presenting a pistol doesn't seem like it should strain tendons and ligaments. What about the motion is so damaging? Link to comment Share on other sites More sharing options...
SquibRound Posted December 19, 2012 Author Share Posted December 19, 2012 Presenting a pistol doesn't seem like it should strain tendons and ligaments. What about the motion is so damaging? Matt, I had the idea of snatching the pistol from the holster by moving my hand from the "relaxed-at sides" ready position, up to target presentation. I was doing this to avoid the "up and down" motion most use to get a grip on the pistol, and thus avoid any lost time when changing the direction of my hand movement from driving down on the pistol and then bouncing it out of the holster. Well, to do this technique effectively the grip is initiated by the last three fingers only, with no thumb wrapped around the backstrap of the gun. This technique causes a lot of torque to be generated when the gun is snatched out of the holster which was absorbed by my forearm extensor complex. It also is not as stable under duress, since it relies on more fine motor skills than a standard draw, thus leading to an unreliable grip on the pistol on several occasions. When the technique worked it was quite fast, but due to the injury (which slowed me down) and the reliability issue (which became apparent at Frontsight when there was some pressure, I have abandoned the technique. I have since switched to a technique very similar to that demonstrated in Matt Burkett's instructional video series with very good success (and speed) without the pain. Link to comment Share on other sites More sharing options...
SquibRound Posted January 2, 2013 Author Share Posted January 2, 2013 OK, So I'm perking along, doing fine when a snow storm hit my area, necessitating the use of my industrial sized snowblower. Unfortunately the engine wouldn't start. After appropriate diagnostics, it was obvious I needed to tear the top of the engine off to remove the carburetor, which was non functional due to a stuck float. In short, a lot of rusted bolts et. later, it was clear I had undone the last 4-5 weeks of "rehab" for the tennis elbow. I'm was basically back to the way I felt at the end of week two, without the benefit of the injection! That was just short of a week ago. I have stopped the finger-extension band exercises, restarted religious stretching of the tendons and have no plans on abandoning the tennis elbow brace anytime soon. Restarted the anti inflammatories as well, and continue to use the thera-band flexbar with good result (really like that thing). On a positive note, I am continuing the strengthening of my support hand grip, now using a 100# gripper which I can almost close for three full sets of 10 reps. I plan to slowly progress through the various steps outlined above for the tennis elbow over the next few weeks. Anything else happens that I think might be useful to someone I will post. Link to comment Share on other sites More sharing options...
jaggy13 Posted January 2, 2013 Share Posted January 2, 2013 I injured mine ( strong side) back in August. I had a couple big matches in September so I tuffed it out. Made it through that and started a very similar regiment very similar to yours. Even started with an orthopedist. I'm on month 4 of light duty with no shooting or even dry fire until today which is a one time deal. I'll be continuing my rehab without a pistol for a while yet. Mine is very slowly getting better but only if I compare it to several weeks ago. The healing is so slow even a week has no effective change. I tried working the extensors with rubber bands like you described, but I'm still a ways out from that. Lifting my pistol from the holster to presentation is excruciating. If I manipulate the pistol week hand, I can break shots without pain, but if I draw, the pain is there for days. Then pulling the trigger is so painful I have a hard time not pulling shots low. When I took my break, I set my sights on today ( New Year's Day match) to mark my return/ recovery. Now I am hoping to be ready for area 1 in May.... For what it's worth, twisting a screw driver or turning a wrench as well as grip pressure are what I have noticed hurt the affected tendon. Link to comment Share on other sites More sharing options...
GrumpyOne Posted January 2, 2013 Share Posted January 2, 2013 I hurt my left elbow (weak arm) shooting a classifier back in June. My guess is, when I transferred the gun after the draw, I was squeezing the grip too hard, and maybe torquing my arm a bit. It still hurts today. I'm gonna try some of the exercises suggested... I'm already wearing an arm band just below the elbow everyday. Link to comment Share on other sites More sharing options...
SPRSkip Posted January 2, 2013 Share Posted January 2, 2013 Great post. I too have been fighting this and am close to being back but it has taken so long I am very careful with everything I do not to re injure myself. I was probably too impatient when trying most of the things you describe as I didn't find anything that seemed to help other than the stretching. I think this should be a sticky as there are other things you list that I did not try. Link to comment Share on other sites More sharing options...
SquibRound Posted January 2, 2013 Author Share Posted January 2, 2013 I injured mine ( strong side) back in August. I had a couple big matches in September so I tuffed it out. Made it through that and started a very similar regiment very similar to yours. Even started with an orthopedist. I'm on month 4 of light duty with no shooting or even dry fire until today which is a one time deal. I'll be continuing my rehab without a pistol for a while yet. Mine is very slowly getting better but only if I compare it to several weeks ago. The healing is so slow even a week has no effective change. I tried working the extensors with rubber bands like you described, but I'm still a ways out from that. Lifting my pistol from the holster to presentation is excruciating. If I manipulate the pistol week hand, I can break shots without pain, but if I draw, the pain is there for days. Then pulling the trigger is so painful I have a hard time not pulling shots low. When I took my break, I set my sights on today ( New Year's Day match) to mark my return/ recovery. Now I am hoping to be ready for area 1 in May.... For what it's worth, twisting a screw driver or turning a wrench as well as grip pressure are what I have noticed hurt the affected tendon. I agree about the screwdriver/wrench issue- annoying since I used to make my living turning wrenches (obviously lost the arm strength I once had). It is the dread of shaking hands when meeting someone that is the most frustrating part of this ordeal. Look into the Theraband Flexbar- I am using the green one (15#), but if you can't do the rubber bands extensions yet, I would get the lowest resistance flexbar available. This device gently stretches the tendon/muscles and encourages the condition to heal properly. They are cheap and available through Amazon. I have been very impressed with the results of this thing. Link to comment Share on other sites More sharing options...
toothguy Posted January 12, 2013 Share Posted January 12, 2013 (edited) http://www.youtube.com/watch?v=GlAnb5TeZoU I have one of these and it does seem to help.http://www.youtube.com/watch?v=vz3p6gYEEy8 This is the upgraded model. Edited January 12, 2013 by toothguy Link to comment Share on other sites More sharing options...
jaggy13 Posted January 13, 2013 Share Posted January 13, 2013 I had my shot this week and it does seem to help. the swelling is definitely down from before. My doctor reminded me again that rest was the most important thing... I've been stretching and resting it. He told me I could do some very light weight reverse curls. 1 to 5 lb's....3 reps of 10 and that's it. I think the grip trainer will help prevent it, but I don't think it would be a good idea for my elbow right now... It's something I will be adding to my daily exercises, once I heal that is! If someone could take anything away from my experience it is; don't overdue it and only do work that doesn't hurt. My tenancy is to want to crank out reps with heavy weight and make it strong fast... That just doesn't work with this injury. Thanks for posting this, it's great knowing I'm not the only one going through this. Link to comment Share on other sites More sharing options...
SquibRound Posted January 21, 2013 Author Share Posted January 21, 2013 I had my shot this week and it does seem to help. the swelling is definitely down from before. My doctor reminded me again that rest was the most important thing... I've been stretching and resting it. He told me I could do some very light weight reverse curls. 1 to 5 lb's....3 reps of 10 and that's it. I think the grip trainer will help prevent it, but I don't think it would be a good idea for my elbow right now... It's something I will be adding to my daily exercises, once I heal that is! If someone could take anything away from my experience it is; don't overdue it and only do work that doesn't hurt. My tenancy is to want to crank out reps with heavy weight and make it strong fast... That just doesn't work with this injury. Thanks for posting this, it's great knowing I'm not the only one going through this. +1 For what it is worth, I repeated my entire routine (except the injection) and I am seeing a difference. Back to doing active wrist extensions with the Flexbar. I have also noted that classic grip training- with COC's or equivalent, does not engage the extensors the same way that you use your grip to do other things- such as shake hands. With grip that requires stability- as in shaking hands- you use the extensors a lot more and this motion tends to aggravate the tennis elbow symptoms. I could use the grip trainer long before I could hope to shake hands (which I still cannot do pain free). Stay with the rest and strengthening- it will pay off in the long run. It is poison to rush recovery of this condition, since any extra stress will put you back to square one more than likely. Link to comment Share on other sites More sharing options...
Aglifter Posted January 21, 2013 Share Posted January 21, 2013 You might want to try lowering your shoulders, and rotating the elbows down some - there's a post discussing doing that - it feels much better in dry-fire, and, although I was slower - it felt quite solid w. my G20 - really seemed to reduce the recoil. Link to comment Share on other sites More sharing options...
Jerome Posted January 25, 2013 Share Posted January 25, 2013 I've been bothered by tennis elbow for about 8-9 months now and have tried everything I could find short of shots. I've never had the problem before and am kind of surprised that there is little you can do about it if you don't catch it early. I found this ineresting article recently: Platelets, steroids may not aid tennis elbow http://www.foxnews.com/health/2013/01/23/platelets-steroids-may-not-aid-tennis-elbow/?intcmp=HPBucket " Over a few months, neither steroids nor platelet injections are any better than injections of inactive salt water when it comes to treating tennis elbow, according to new research. Read more: http://www.foxnews.com/health/2013/01/23/platelets-steroids-may-not-aid-tennis-elbow/?intcmp=HPBucket#ixzz2J03QAtiq " Link to comment Share on other sites More sharing options...
Matt Griffin Posted January 25, 2013 Share Posted January 25, 2013 I've been bothered by tennis elbow for about 8-9 months now and have tried everything I could find short of shots. I've never had the problem before and am kind of surprised that there is little you can do about it if you don't catch it early. I found this ineresting article recently: Platelets, steroids may not aid tennis elbow http://www.foxnews.c...intcmp=HPBucket " Over a few months, neither steroids nor platelet injections are any better than injections of inactive salt water when it comes to treating tennis elbow, according to new research. Read more: http://www.foxnews.c...t#ixzz2J03QAtiq " I believe it, once the scar tissue forms there's not much to be done. That said, even if the scar tissue has formed don't let it sit, get arthroscopic surgery to repair the site, or you might get worse from the weakened area continuing to tear. A year out and I'm just now somewhere in the 97% range of ability after the ligament repair. I've started lifting weights again, but it's hard to trust the elbow with anything despite it feeling good. Link to comment Share on other sites More sharing options...
SquibRound Posted January 26, 2013 Author Share Posted January 26, 2013 http://www.youtube.com/watch?v=GlAnb5TeZoU I have one of these and it does seem to help. http://www.youtube.com/watch?v=vz3p6gYEEy8 This is the upgraded model. This gizmo is very interesting. Your post reminded me that I actually had one of these things in my office closet from a past Christmas gift. I dug it out and tried it. It really does work the forearm and doesn't aggravate my symptoms- a bit of fun to use as well! Link to comment Share on other sites More sharing options...
SquibRound Posted January 26, 2013 Author Share Posted January 26, 2013 I've been bothered by tennis elbow for about 8-9 months now and have tried everything I could find short of shots. I've never had the problem before and am kind of surprised that there is little you can do about it if you don't catch it early. I found this ineresting article recently: Platelets, steroids may not aid tennis elbow http://www.foxnews.c...intcmp=HPBucket " Over a few months, neither steroids nor platelet injections are any better than injections of inactive salt water when it comes to treating tennis elbow, according to new research Read more: http://www.foxnews.c...t#ixzz2J03QAtiq " This is an interesting article. What I take away from it is that a steroid injection, although not significantly beneficial at one year, will make you feel better much faster in the short run (1-3 months). I remember the severity of pain in the early days, so I would jump at the steroid injection again if I had to do it all over. That said, chronic (repetitive) steroid injections are another issue altogether- steroids used chronically can weaken the tissues and interfere with proper healing, so I would not suggest this route (makes you wonder why so many people waste their time on repeated spinal injections when the injection has no hope of fixing any spinal problem). Platelet rich protien injections have been used in several areas of surgery experimentally since theoretically the PRP can accelerate our natural ability to heal. A lot of the research is inconclusive, and frankly done quite poorly, so I am afraid the jury is still out on this issue. What complicates the issue further is the fact that the condition we are collectively calling "tennis elbow" is a mixed bag. For example, my tennis elbow, which I now consider a relatively limited tear of the musculo-tenonous junction of my forearm extensor muscles, is far and away more benign than that of Matt Griffin's case, which sounds like an out-and-out disruption of the extensor complex, that has gone on to become a chronic inflammatory condition. Clearly these are two different cats. This being said then, the sure-fire "cure" for one type will fail miserably for the more serious condition. When rest, modalities (heat/ice/massage), anti-inflammatories, an injection and exercises done in a reasonable and progressive manner fail to address the issue, careful medical evaluation and diagnosis is in order. Link to comment Share on other sites More sharing options...
MikeSLC Posted January 27, 2013 Share Posted January 27, 2013 +1 on the flexbar. Link to comment Share on other sites More sharing options...
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