"Shooters Elbow"

[Thomas a44592]

I have been shooting a lot over the past five or so years and have had this condition come and go in my left arm for a while but then last fall both forearms got real bad and I could not even pick up a glass of water etc with out extreame pain- no grip stength - and my hands would be numb when I woke up in the mornings. I have been seeing a chiropractor for the last 10 weeks and the left arm is almost fixed and the right is much better. He said that there is a lot of scar tissue that built up and he has been using ultrasound- some electrical thing and been rolling a plastic bar with rollers up and down my forearms(very painfull). I am glad that it is getting better but it sure was a long process. I feel sorry for anyone who has to go through this!! I am glad to get this taken care of over the winter as least and hopefully will be good to go this spring.

[concealed_ny]

http://www.fixpainnow.com/SUPERTOUCH.htm It worked for me. One treatment pain is GONE.

[eth77]

I'm new to this forum, but not to elbow pain. For that matter, I've enjoyed hurting myself periodically my entire life - goes with the territory I guess.

A couple of things I've discovered that help pain and heal tendons. One, get some digestive enzymes - you can get them at the drug store, some grocery chains have them, your local health food store, or online. There is an European preparation Wobenzym which also works - it's directed a joints, but is used in EU for athletic injuries. Two, get a good MSM, Glucosamine, and Chondroitin product. In both cases, capsules work better than pills. Google the research done on both of these. There is a bunch. In particular, there are a number of double blind studies - these eliminate bias in evaluating the results.

Avoid analgesics. They make you feel better, but they inhibit the ability of your body to repair the damage.

All of this has worked in improving my health after a massive skiing injury, after racquetball elbow, and shooters elbow. Physical training works in conjunction with these. Oh, and make sure you're taking a good multivitamin, in all of this you need your body at healthy baseline, and that starts with the basics.

[badchad]

A couple of things I've discovered that help pain and heal tendons. One, get some digestive enzymes - you can get them at the drug store, some grocery chains have them, your local health food store, or online. There is an European preparation Wobenzym which also works - it's directed a joints, but is used in EU for athletic injuries. Two, get a good MSM, Glucosamine, and Chondroitin product. In both cases, capsules work better than pills. Google the research done on both of these. There is a bunch. In particular, there are a number of double blind studies - these eliminate bias in evaluating the results.

I just did a pubmed.com search for research regarding all the supplements you list and tendinitis. I came up with zero studies, double blind or not. If you know of any particular study that demonstrated effectiveness please cite it.

[eth77]

A couple of things I've discovered that help pain and heal tendons. One, get some digestive enzymes - you can get them at the drug store, some grocery chains have them, your local health food store, or online. There is an European preparation Wobenzym which also works - it's directed a joints, but is used in EU for athletic injuries. Two, get a good MSM, Glucosamine, and Chondroitin product. In both cases, capsules work better than pills. Google the research done on both of these. There is a bunch. In particular, there are a number of double blind studies - these eliminate bias in evaluating the results.

I just did a pubmed.com search for research regarding all the supplements you list and tendinitis. I came up with zero studies, double blind or not. If you know of any particular study that demonstrated effectiveness please cite it.

Try tendonitis, typos get me too. There are a lot of testimonials, those are anecdotal, but interesting. I'll go looking for the University testing and post it later.

On Wobenzym : Klein G, Kullich W., “Short-term treatment of painful osteoarthritis of the knee with oral enzymes: A randomized, double-blind study versus diclofenec”, Clin Drug Invest. 2000;19(1):15-23.

Edited October 9, 2008 by eth77

[badchad]

Try tendonitis, typos get me too. There are a lot of testimonials, those are anecdotal, but interesting. I'll go looking for the University testing and post it later.

No typo, tendinitis is the most frequent and accepted correct spelling, tendonitis is correct by some standards as well. Newer terminology includes tendinopathy and tendinosis to reflect the fact that tendinitis is not an inflammatory condition as the "itis" in the name implies.

On Wobenzym : Klein G, Kullich W., “Short-term treatment of painful osteoarthritis of the knee with oral enzymes: A randomized, double-blind study versus diclofenec”, Clin Drug Invest. 2000;19(1):15-23.

Tendinitis and osteoarthritis are two separate diagnosis.

[eth77]

Try tendonitis, typos get me too. There are a lot of testimonials, those are anecdotal, but interesting. I'll go looking for the University testing and post it later.

No typo, tendinitis is the most frequent and accepted correct spelling, tendonitis is correct by some standards as well. Newer terminology includes tendinopathy and tendinosis to reflect the fact that tendinitis is not an inflammatory condition as the "itis" in the name implies.

On Wobenzym : Klein G, Kullich W., “Short-term treatment of painful osteoarthritis of the knee with oral enzymes: A randomized, double-blind study versus diclofenec”, Clin Drug Invest. 2000;19(1):15-23.

Tendinitis and osteoarthritis are two separate diagnosis.

I'll bow out of this discussion. I've offered a pointer to information which has helped me. I'm not pretending to be an expert.

[SteveU]

I'll bow out of this discussion. I've offered a pointer to information which has helped me. I'm not pretending to be an expert.

Being an expert doesn't help with recommending treatment in this condition. Here's a good read for all. Some things work for some people and not others. No treatment has been validated as beneficial experimentally, though almost anything works anecdotally.

J Shoulder Elbow Surg. 1999 Sep-Oct;8(5):481-91.Links

Lateral tennis elbow: "Is there any science out there?".Boyer MI, Hastings H 2nd.

Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.

As orthopaedic surgeons, we are besieged by myths that guide our treatment of lateral epicondylitis, or "tennis elbow." This extends from the term used to describe the condition to the nonoperative and operative treatments as well. The term epicondylitis suggests an inflammatory cause; however, in all but 1 publication examining pathologic specimens of patients operated on for this condition, no evidence of acute or chronic inflammation is found. Numerous nonoperative modalities have been described for the treatment of lateral tennis elbow. Most are lacking in sound scientific rationale. This has led to a therapeutic nihilism with respect to the nonoperative management of this condition. An examination of the literature can only lead us to believe that most, if not all, common nonoperative therapeutic modalities used for the treatment of tennis elbow are unproven at best or costly and time-consuming at worst. Most of the published literature on the nonoperative treatment of patients with lateral tennis elbow consists of poorly designed trials. The selection criteria are nebulous, the control group is questionably designed, and the number of patients is often too low to avoid a serious loss of study power. These studies therefore have a high beta error, implying an inability to detect a difference between groups, even if one truly existed. If clinical signs and symptoms persist beyond the limit of acceptability of both patient and surgeon, then an array of surgical options are available. These range from a 10-minute office procedure (the percutaneous release of the extensor origin with the patient under local anesthetic) to an extensive joint denervation, in which all radial nerve branches ramifying to the lateral epicondyle are directly or indirectly divided. How is the surgeon to choose, given the fact that most of the published surgical studies are case series of one type of operation or another, consisting of patients operated on and evaluated by the same surgeon, who has a vested interest in his or her own patients' successful outcome? The orthopaedic surgeon therefore has very little on which to "hang his hat" when it comes to objective data to guide treatment of patients with lateral tennis elbow syndrome. In the final analysis we are guided simply by our own subjective viewpoint and clinical experience. In 1999, to have such a common clinical condition have such a paucity of peer-reviewed published data of acceptable scientific quality is disappointing. In this review article we will examine the "myths" of tennis elbow: the name, the salient features on history and physical examination, the diagnostic modalities, the pathology of the "lesion," the anatomy of the lateral elbow and extensor origin and why it has led to such confusion in differential diagnosis, the nonoperative and operative treatment of tennis elbow, and finally the various studies that have been carried out on elbow biomechanics as it relates to the pathoetiology of true "tennis elbow." It is our hope that the reader will emerge with a clearer picture of the pathoetiology of the condition and the scientific rationale (or lack thereof) of the various operative and nonoperative treatment modalities.

PMID: 10543604 [PubMed - indexed for MEDLINE]

and just for fun:

J Hand Surg [Am]. 2008 Jul-Aug;33(6):909-19. Links

Injection of dexamethasone versus placebo for lateral elbow pain: a prospective, double-blind, randomized clinical trial.Lindenhovius A, Henket M, Gilligan BP, Lozano-Calderon S, Jupiter JB, Ring D.

Harvard Medical School, Boston, MA, USA.

PURPOSE: We tested the hypothesis that there is no difference in disability, pain, and grip strength 1 and 6 months after corticosteroid and lidocaine injection compared with lidocaine injection alone (placebo). METHODS: Sixty-four patients were randomly assigned to dexamethasone (n = 31) or placebo (n = 33) injection. At enrollment, disability (Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire), pain on a visual analog scale, grip strength, depression (the Center for Epidemiologic Studies Depression Scale; CESD), and ineffective coping skills (the Pain Catastrophizing Scale; PCS) were comparable between treatment groups. At 1 and 6 months, DASH, pain, and grip strength measures were repeated. Univariate and multivariate analyses were used to determine predictors of disability. Analysis was by intention to treat. RESULTS: One month after injection, DASH scores averaged 24 versus 27 points (dexamethasone vs placebo), pain 3.7 versus 4.3 cm, and grip strength 83% versus 87%. At 6 months, DASH scores averaged 18 versus 13 points, pain 2.4 versus 1.7 cm, and grip strength 98% versus 97%. CESD and PCS scores correlated with disability as measured by the DASH questionnaire. The best multivariate models included CESD at 1 month and PCS scores at 6 months and explained the majority of variability in DASH scores. CONCLUSIONS: Corticosteroid injection did not affect the apparently self-limited course of lateral elbow pain. In secondary analyses in a subset of patients, perceived disability associated with lateral elbow pain correlated with depression and ineffective coping skills. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

PMID: 18656765 [PubMed - in process]

Edited October 9, 2008 by Surge

[badchad]

Being an expert doesn't help with recommending treatment in this condition. Here's a good read for all. Some things work for some people and not others. No treatment has been validated as beneficial experimentally, though almost anything works anecdotally.

I wouldn't say it's that bad. I'll reference my article again:

http://absolutept.com/tendinitis_article_html.htm

In my bibliography all but two of the studies I listed are directly linked to medline.

[redmanfixit]

Now for something completely different! (Sorry Monty!)

There is a quiet revolution going on in biology now as regards a growing understanding of bio-films. The implications for this growing field of knowledge promises a conceptual shift regarding relationships between microorganisms and large organisms as only one area which will be affected as this research continues. The essential bio-film in this case is the colony that inhabits the human digestive system. It does so apparently as a symbiont. When it is composed of the right mix of organisms, it performs an astonishing variety services for us that include synthesizing vitamin complexes which do not pass intact through the human digestive system. Among them are various members of the B family. These vitamins are essential to synovial fluid formation as well as many anti-inflammatory processes in the human body. There are an enormous variety of disease processes that are characterized by low grade inflammation that persists through time and is generally of uncertain cause. They are not the point here but are similarly affected by the lack of B vitamins that would be synthesized by the members of the colony in a healthy bio-film in the lower intestine. As insults are visited on this mass of "bugs" existing as a complex, interdependent community, their function as far as their relationship with us, their host, changes in ways that are no longer exactly described as symbiotic. The nature of these insults is variable. Too much sucrose. WAY too much corn syrup as a cheap additive to processed food. Various common preservatives in packaged food. Loss of enzyme complexes as a result of preservation processes and sterilization methods. Another potent source of insult to this complex community is, sadly therapeutic mycotoxins. (Antibiotics literally from Latin, anti-life) The organisms which cause diseases in our species are often tough and dirty. They appear intent on devouring our tissue and fluids and poisoning us with their metabolites. When in a weakened condition our personal colony of residents is unable to fight off infection and we get sick. Antibiotics, although wonderful in their ability to help us fend off an overwhelming invasion of pathogens, leave in the aftermath of the therapeutic regimen an unoccupied fertile area for unchallenged growth. Your gut. A rather quiet and incremental series of disease processes begin as a result of lack of the healthy symbiotic processes being replaced by parasitic processes. Any of us that have had courses of antibiotics and the usual increasing pattern of recurrent infections which require more and more powerful antibiotics in larger and larger doses to arrest infection WILL be sick in this way. There is an excellent body of information and references at www.ercprobioticenzymes.com in the FAQ area

So....What?? I have found the following treatments to work remarkably well in a large variety of people. If you have a Vitamin Cottage in your community go there and buy Sublingual B Total. If they don't have it, they can get it, it is in their system. This is a B supplement that bypasses your digestive system and is taken directly into your circulatory system passing through the capillary network under your tongue. It does not even taste bad!! It is also inexpensive. It addresses a variety of nutritional deficiencies that result when your biofilm gets screwed up. Find, get on and STAY on a good quality probiotic. ESPECIALLY immediately after you have had a course of antibiotics and MOST ESPECIALLY after you have taken a course of Zithromax. Doing this will make you more infection resistant and overall, healthier than anything else you can do for yourself. You will live longer and be smarter than you would if you don't do this. This path addresses repetitive stress injuries like carpal tunnel syndrome also. It directly addresses system wide inflammatory processes that are the substructure of a wide variety of chronic deteriorative disease processes in humans.

When your body is not being flooded by bacterial toxins produced by pathogens in your personal biofilm, the food you eat is no longer being transformed into poison and you will be healthier in a remarkable number of ways. Try it out and see. I have!!

B Total is made by Nutraceutical Solutions in Corpus Christie TX. 1-800-856-7040 I am in no way associated with this company OR Vitamin Cottage. I make NO money from these businesses and will receive no personal benefit from this working for you OTHER than knowing that I've seen it work for a lot of people and that I gave you good advice.

I am connected to ERC and if putting this pointer here gets me in trouble, I will grovel and scrape and try to make it up. I just hate to see people be sick and die too soon when there are simple things to do that make a difference.

Shoot WELL

See Everything!

Edited October 9, 2008 by redmanfixit

[lugnut]

I'm prone to this condition and have "cured" it many times over the years only to have it return. I follow all the therapy protocols, stretch, ice, strengthening blah blah blah, but pretty much every time I start getting pain and inflamation around my elbos I can look directly to my load recipe for the cure. I'm back to using very fast powder again in my .40's (I prefer that feel) and as soon as I switched from slower to faster I started getting pain. Just the duration of the recoil pulse seems to overload the tendons, much like ballistic training with wieghts will. Why do some get tendonitis and some don't using the same loads? I dunno, maybe it has to do with the predominant types of muscle fibers each individul has....? I know how to fix it though. Just don't want to for now.

Hello. If it is tendinitis you have (which it does sound like), or tendinosis as the condition is being more correctly called today, you can ignore most conventional advice. My day job is physical therapy and tendinosis is one of my areas of specialty.

The short answer is it's not an inflammatory condition so ice, and anti-inflammatory medications should not be expected to work, and in some studies have been directly shown not to work. Rest and stretching won't do much either and I'm fairly agnostic with regards to the various elbow bands. What has been shown to work (about 80% of the time) in what is becoming a plethora of research is eccentric exercise directly to the muscle involved.

For the long answer, I have an article at my website that his highly referenced but still in fair layman's terms that I put a lot of work into. I wrote it before I became involved in IPSC shooting but the info should still be pretty relevant and can probably be done at home with minimal exercise equipment. After reading it, you will be more up to date than probably 95% of medical practitioners out there. If you or anyone else has any further questions after reading it let me know.

Here's the link http://absolutept.co...dinitispage.htm

Chad, do you have a new link for this article? My elbow has started to act up again and I could only find your exercises on Youtube. I'm giving them a go now.

Ironicaly- I'm probably one of the few on this forum that got if from tennis! However has you know other things flare it up..... like shooting.

Thanks!

[badchad]

[Chad, do you have a new link for this article? My elbow has started to act up again and I could only find your exercises on Youtube. I'm giving them a go now.

Ironicaly- I'm probably one of the few on this forum that got if from tennis! However has you know other things flare it up..... like shooting.

Thanks!

Sorry for the late response but I just noticed your post. Here's my article.

http://absolutept.com/tendinitis.php

Also for what it's worth, as of recent there have been some additional research studies done on the effectiveness of various exercise programs and it's enough that I have started to modify my exercise protocol, but I haven't seen enough patients with the my newer protocol to say if it's much of an improvement. I'm sorting through the studies right now for a new paper and I'll post it here when I finish.

[lugnut]

[Chad, do you have a new link for this article? My elbow has started to act up again and I could only find your exercises on Youtube. I'm giving them a go now.

Ironicaly- I'm probably one of the few on this forum that got if from tennis! However has you know other things flare it up..... like shooting.

Thanks!

Sorry for the late response but I just noticed your post. Here's my article.

http://absolutept.com/tendinitis.php

Also for what it's worth, as of recent there have been some additional research studies done on the effectiveness of various exercise programs and it's enough that I have started to modify my exercise protocol, but I haven't seen enough patients with the my newer protocol to say if it's much of an improvement. I'm sorting through the studies right now for a new paper and I'll post it here when I finish.

Thanks Chad... I'll read it all tonight.

[lugnut]

[Chad, do you have a new link for this article? My elbow has started to act up again and I could only find your exercises on Youtube. I'm giving them a go now.

Ironicaly- I'm probably one of the few on this forum that got if from tennis! However has you know other things flare it up..... like shooting.

Thanks!

Sorry for the late response but I just noticed your post. Here's my article.

http://absolutept.com/tendinitis.php

Also for what it's worth, as of recent there have been some additional research studies done on the effectiveness of various exercise programs and it's enough that I have started to modify my exercise protocol, but I haven't seen enough patients with the my newer protocol to say if it's much of an improvement. I'm sorting through the studies right now for a new paper and I'll post it here when I finish.

Thanks again. I was watching some of you videos as well. Let me ask you a question if I can... I hope to get the terminology correct.

For tennis elbow (outside the elbow) I think you recommend reverse wrist curls.. But which is most beneficial- concentric or eccentric reverse wrist curls? I know asking you to make a recommendation might be a stretch (no pun intended) but I'm curious as to what the benefit of each style of reverse curl would be. Thanks.

PS- I also liked some of the back/neck exercises you had videos of... good stuff.

[badchad]

Thanks again. I was watching some of you videos as well. Let me ask you a question if I can... I hope to get the terminology correct.

For tennis elbow (outside the elbow) I think you recommend reverse wrist curls.. But which is most beneficial- concentric or eccentric reverse wrist curls? I know asking you to make a recommendation might be a stretch (no pun intended) but I'm curious as to what the benefit of each style of reverse curl would be. Thanks.

PS- I also liked some of the back/neck exercises you had videos of... good stuff.

Thanks. About the concentric vs. eccentric, that's one of the big questions. The early research was done primarily with eccentric exercises and there were a couple studies I mentioned in my paper that compared it to concentric (the concentric being concentric only) while a normal up and down repetition has both a concentric and eccentric component. Since I wrote that article a number of newer studies were published, and one in particular used “heavy slow resistance” exercise both concentric and eccentric and found better long term improvements in both pain reduction and function. So that's part of what I've been testing out is using more conventional weightlifting movements as opposed to eccentric only for the affected tendons. The other questions that that I'm sorting through again is recommendations on whether or not, or how much you should rest from irritating activities, optimizing frequency of training etc. So right now I'm setting up a spreadsheet of all the relevant studies, what exercise protocols they used, what results they got, and what other factors are involved, so that I can continually update and post to my website regularly rather than another static paper that may also become dated over time.

Glad you liked the other stuff too, I'm looking to add more and more as I get the time.

[seanmc]

Badchad is right. Anti-inflammatory meds don't help. They are just good for an analgesic effect - meaning it may help the pain but not the underlying condition causing the pain. My day job is not a physical therapist, but rather a web-based nutritional and exercise consultant. I work with athletes all day long. I've seen and experienced issues with tendonitis on both the medial and lateral areas of the elbow/forearm. A lot. in fact, it's one of the most common issues for athletes, shooters included. There are a few things we need to do here.

First, there is a cause. So we need to remove that motion(s) from the training. This may mean modifying your actual workout or your shooting or both.

Secondly, we need to make sure that whavever we replace it with is acceptable and not causing more pain. A lot of times an athlete will get an issue like this, replace the painful motion with something else and find that the new motion is not helping the cause at all.

Third, we need to treat the injury. The best thing I have found over the years is to use an ice massage a couple of times a day to help break that inflammatory cycle. Cryo-Cups are worth their weight in gold for this. Google that....best 5 bucks you'll ever spend if you train a lot.

Finally, we need to slowly re-introduce the motions that you cut out initially because chances are, they are good and normal motions in the gym or on the range. This is where a lot of folks get in trouble....we tend to get too aggressive too fast during rehab. And as you can guess, that will set you back pretty fast if you are not careful. Patience is a tough thing. But a bad case of tendonitis can take upwards of 8 months to heal sometimes. It just depends on how aggressive you are with treatment and how you manage your injury in terms of exercise, shooting, et.

Sean McCauley, CSCS, CISSN

[mwx40x40]

Wow, I am afraid if I quit shooting for 8 months, I may never come back. However, I need to something , as I have a bad case of this shooters elbow. I will try changing routine and go as easy as I can.

[seanmc]

If it's really bothering you, it's pretty acute. That being the case, ice massage. It'll help a lot.

[Wild Gene]

As a farmer/rancher, I am fairly active. I finally developed "tennis/shooters elbow", I think from raquetball, anyway, after several months of pain doing nothing except wearing the brace thingie and massage, I went and had the shot, it helped for a little while, but I believe what really kicked it was an accupuncture treatment. Now massage can keep up easily with any pain I may have.

WG

[Tul9033]

A cortisone shot from my D.O. usually gives me 3 months of relief. Even though many articiles say it won't work, it works for me.

Mine is definitely reloaders/shooting elbow.

[John Thompson]

I just had two nickle sized bone spurs taken out of my elbow. Either get the inflammation down in your elbow or get ready for some arthritis.

[badchad]

So right now I'm setting up a spreadsheet of all the relevant studies, what exercise protocols they used, what results they got, and what other factors are involved, so that I can continually update and post to my website regularly rather than another static paper that may also become dated over time.

I finished my spreadsheet with a lot of new material since I wrote my paper. http://absolutept.com/tendinitisresearch.php

I'm working on a tendinitis/tendinopathy FAQ that I plan to place above the table that I can continually update as I add new research to the table, and I plan to have one of the questions address shooters elbow in particular.