Tendonitis - Any Suggestions

[badchad]

Here's a paper I wrote on tendinitis a few years ago.

http://absolutept.com/tendinitis_article_html.htm

Inflammation is hardly ever present. When’s the last time you saw a warm, red and swollen case of tennis elbow? Lots of peer reviewed studies linked at the bottom of the article.

[azeric]

nsaids

nsaids= non-steroidal anti-inflammatory drugs

Aleve (naxonpren sodium), (Advil) ibuprophen, etc.

<-------- Fitness and Nutrition Professional. Ice, NSAIDS, rest, massage, and light strength training with bands/elastic resistance.

Or... switch to Production and shoot mouse-fart 147s... LOL

JeffWard

Be careful with nsaids, (ibuprophen) gave me a nasty ulcer with no warning until it just started bleeding. Bottom line the advice offered here is all good, just don't take the nsaids unless the pain is to much.

[Aloha Robert]

Here's a paper I wrote on tendinitis a few years ago.

http://absolutept.com/tendinitis_article_html.htm

Inflammation is hardly ever present. When’s the last time you saw a warm, red and swollen case of tennis elbow? Lots of peer reviewed studies linked at the bottom of the article.

This opinion is not mainstream thought. In fact it is the opposite. Inflamation almost ALWAYS occurs in sports injuries and as a sports medicine MD with 30 years expereience treating these injuries my opinion is concurrent witht the almost universal view that inflamation is a final common pathway for almost all injuries.

The article referenced is largely annecdotal and not hard science.

The article also references treatments advocated by Physical Therapists and states many dont work. I have know about those for 30 years which is why Physical Therapy only works in small number of specific injuries with inflamation. Now THAT is something most Physical Therapists wont tell you.

Again I stress there are LOTS of types of tendinitis with different types of inflamation. Some have more of less of the micro pathologic changes alluded to in the referenced article.

The rhetorical question of "When’s the last time you saw a warm, red and swollen case of tennis elbow?" is misleading because most athletic injuries are deep enough not to show superficial signs such as warmth or redness. HOWEVER YES I have seen hundreds of cases where the inflamation of deep tissues is so bad that there is visible redness and palpable warmth.

If you want to make your treatment decissions based on Rhetorical questions, your odds of successful treatment are diminished. But here's a rhetorical question for you. Why is it that almost ALL acute injuries at least improve to some degree with Anti-Inflamatory medicine? If there is no inflamation, how can this be? Whatever answer you give, certainly understand Anti Inflamatory Medication is not a cure all but certainly it is one of the "guns" in the doctor's arsenal.

All this is misleading, Again common sense should prevail here.

Get yourself to a specialist who is experienced with your problem. To put it bluntly all this extraneous stuff is really just misdirection to keep you from getting the proper treatment.

[Jake Di Vita]

That being said the inlamation needs treatment before symptoms resolve.

....sounds like a cause to me lol.

Well gents, I've said what I needed to say in this thread and been ridiculed in PM's by physicians who "know better."

As I responded in one of those PMs, I prefer to believe what I see is literally improving quality of life for myself and my clients every day. I'd rather use what I see working in real life than what someone tested in a lab under lab conditions. I want my data to be measurable, observable, and repeatable in real life.

BTW, I never argued against seeing a specialist. Then again, I try to practice preventative maintenance and care of the human frame first.

On that note, I'm done with this thread. All you who are in pain from tendinitis, I wish you the best in your recovery. I'd happily answer any mores questions privately.

[Woody Allen]

Jake:

Assuming a terrible diet of sugar, junk food, caffeine, nicotine, and alcohol. Add to that stress, complete lack of exercise, lack of sufficient sleep, and age-we guess where the front sight is. What supplements would you recommend for us weekend warriors. The "just get and take this" list, and where to get them. A "your are too stupid to change your lifestyle-just take this-it may help" list. Thanks

Edited December 6, 2009 by Woody Allen

[badchad]

The article referenced is largely annecdotal and not hard science.

The article referenced, I wrote, and I threw in a bit of anecdote for sure and tried to make it clear when I did so. However a good portion of it was researched and referenced with what I would consider as hard a science as you can get in human/biological/exercise studies. This includes the studies in which they did biopsies of tendons and found a dearth of inflammatory cells present with tendinitis. To be fair I did a Pubmed search last night and I think newer studies (for which I have only read the abstracts) have found some inflammatory cells but it seems they really have to look hard for them.

The article also references treatments advocated by Physical Therapists and states many dont work. I have know about those for 30 years which is why Physical Therapy only works in small number of specific injuries with inflamation. Now THAT is something most Physical Therapists wont tell you.

I mostly agree, largely since I wrote the article. I’m a PT myself and I consider most of my colleagues to be morons who not only treat people with methods not proven to work but often proven not to work. But what are you going to do, see a Physician who gives you a cortisone shot? In the long term the research tends to show that leads people worse off than if they did nothing.

Again I stress there are LOTS of types of tendinitis with different types of inflamation. Some have more of less of the micro pathologic changes alluded to in the referenced article.

I partially agree here. For the original poster, playing the odds, inflammation is probably not the problem with regards to his elbow, as I feel pretty sure about my diagnosis of epicondylitis and I don’t think there is much to suggest anti-inflammatory medications would be helpful at all. With his shoulder who knows. When I diagnose rotator cuff tendinitis, it’s a lot more speculative. Maybe it’s the bursa, maybe it’s a subacromial bone spur or type II or type III acromium, maybe it’s a rotator cuff tear, maybe it’s a tight joint capsule that causes impingement when he elevates his arm. In the shoulder I think there it is much more likely that there is inflammation, but mostly because I think tendinitis/osis is much less likely to be the primary issue.

The rhetorical question of "When’s the last time you saw a warm, red and swollen case of tennis elbow?" is misleading because most athletic injuries are deep enough not to show superficial signs such as warmth or redness. HOWEVER YES I have seen hundreds of cases where the inflamation of deep tissues is so bad that there is visible redness and palpable warmth.

But a lateral epicondyle is right below the skin, without too much fat over it and they are never (at least almost never) warm, red and swollen. In contrast with an arthritic knee which is every bit as deep and it will often at least be warm and swollen.

But here's a rhetorical question for you. Why is it that almost ALL acute injuries at least improve to some degree with Anti-Inflamatory medicine? If there is no inflamation, how can this be? Whatever answer you give, certainly understand Anti Inflamatory Medication is not a cure all but certainly it is one of the "guns" in the doctor's arsenal.

I have often wondered about that. If tendinitis is not inflammatory, or at least primarily so, why does the cortisone shot make it feel better initially? I don’t have an answer for that, but I am well aware of the fact that research shows cortisone makes it feel better at first, but once you get past 10/12 weeks or so, groups that had cortisone shots are worse off than groups that were left untreated. I have not done a review of NSAIDS but it seems these guys did…

http://www.ncbi.nlm.nih.gov/pubmed/1844642...mp;ordinalpos=7

… and they concluded there was not much to show they worked either. Seems in their review supported the use of eccentric exercise though, which is how I treat it.

So who do you tell the original poster to see? In spite of all the research I have yet to meet a PT who does eccentric exercise without having heard it from me. Docs going to prescribe drugs that don’t help, or send them to a PT that’s going to do ionto and cross friction massage. It’s a tough question. Nobody, including health care providers, main stream or not, reads enough and stays on top of the research.

[Woody Allen]

The article referenced is largely annecdotal and not hard science.

So who do you tell the original poster to see? In spite of all the research I have yet to meet a PT who does eccentric exercise without having heard it from me. Docs going to prescribe drugs that don’t help, or send them to a PT that’s going to do ionto and cross friction massage. It’s a tough question. Nobody, including health care providers, main stream or not, reads enough and stays on top of the research.

Ding ding ding. We gotta winner. You nailed it!!!!!

Ya gotta find someone who reads enough and stays on top of the research. Someone who sees patients with these issues often. Someone who gets results. Someone who BENEFITS from patients getting results. Someone who does more than orders the tests, prescribes meds, and hands off to the 20 year old PT with the purple finger nail polish who says "today we will do clay therapy......" Someone who's solution is not always surgery (a surgeon). Note-surgery always helps-your extremity is immobilized for months-gonna feel better-yup-till you resume your sport. Rocket science at work here.

Go where the money is. Worker's Comp (work related injuries) have there own protocol, all dictated by the insurance companies-often not in the patient's best interest. Joe Blow sees the doctor-put'em through-all tests-hand off to the PT-bill the bajezeus out of the insurance. If you get better-luck.

The difference between someone who KNOWS often is months/years of pain and inactivity or being CURED, i.e., resuming your sport without pain and disability. "Seek out a specialist..." Got ocean front property in Nevada to sell...... The answer is to find the guy/gal who treats the high dollar patients-pros, college athletes with full ride scholarships. You get a referral to "the man/gal" who takes your insurance plan. The medical field is an "inside" game. The players (nurses, PTs, coaches) know who gets results. It ain't on the net. The starting point is find those who treat athletes.

Edited December 7, 2009 by Woody Allen

[Service Desk]

nsaids and elastic bands. These issues are never truly cured, but managed.

Found I had a slightly torn tendon in my shoulder, and surgery is not an option I care to take.

Visited my ortho and got the whole exam, x-ray, mri, etc. So his Rx, nsaids (aleve 500 mg) and exercise with bands/light free weights.

The difference has been dramatic. Without the pain from the inflammation, which was stopping me from exercising the shoulder, I am able to get back tonear normal, though at 55 doing what I did in my 20's and 30's is not going to happen. I now accept that.

Will I be the aggressive volleyball player I used to be? No. Same with basketball, but I can do them on a more limited basis now as opposed to not at all. Same with tennis and frisbee.

I still do setup and tear-down at my local club, but not the heavy lifting over my shoulders I used to try to do. Just a matter of priorities and pacing.

If I had replied to this thread.... I couldn't have given a clearer or more truthful response. My physiotherapist recommended an almost identical treatment for a shoulder injury and associated lateral epycondilitus and it worked.

I am 53 so I watch what I do and do what I want - shoot, ride motorcycles, use a computer - but I do my stretching and weights every day. When I get a little sore.. a couple of days of NSAID's and I am back into it.

[Aloha Robert]

First let me appologize you any one who feels they have been ridiculed. That is not my intention and if the words I chose were offensive I am sorry.

I was merely trying to make the point is you answers all over the map and it is not know with precission what the original problem is.

Also you see that folks tend to drift of the subject and Tendonitis is not the same as a ruptured tendon nor not the same as a variety of shoulder conditions mentioned.

Again the message is get someone experienced who can give you precission in diagnosis first.

The one great pearl I did note was the notion of eccentric exercise ( for lay folks, resistance while the muscle tendon unit is lengthening rather than contracting, like lowering a weight rather than lifting it). This concept was very popular in 70s and 80s but you dont hear as much about it now. But it is still the best way I know to rehab AFTER the problem is mostly in control.

[eric nielsen]

I would like to add that this thread, while still painful for me to read in its entirety, seems to have produced enough food for thought that perhaps it has - overall - served a useful purpose.

While I am still pretty much unmoved from my view that some knowledge is frequently worse than no knowledge, and that wrong or misunderstood therapy is usually worse than no therapy, I will say that you have people here pointing you in a good direction. I have peeked at Robert's body of work and can tell you we are fortunate to have him around.

I've also had a substantial and respectful back-and-forth with Jake and it has been a benefit to both of us. I can confidently recommend the fitness and sports instruction that he offers and am confident that he is on the path to becoming a star in his chosen field.

[Silversmoke]

I will avoid any medical suggestions, but will share with you how I solved a similar problem. Several years ago I developed tendonitis from shooting in my right elbow. It made drawing from a holster excruciatingly painful. I tried many of the suggested remedies in this thread, but only one worked for me. I had to stop shooting with my right hand and let the elbow recover from the strain of too many draws with too heavy a pistol.

Being an avid shooter, I couldn't tolerate simply not shooting for an extended time period while the right elbow healed. So, I decided to switch to left-handed shooting. It seemed very awkward at first, but with practice I found that in a surprisingly short time I could shoot as well with the left hand as I had with the right hand.

I also switched to a lighter pistol in a minor loading to help prevent tendenitis from occurring in my left elbow. In a few months my right elbow healed itself even though I was shooting a lot with the left. Interestingly enough, even after the right elbow healed I continued to use my left as the strong hand. A very nice side benefit is that I am now a pretty good ambidextrous shot which makes those "weak hand" courses of fire much easier these days. YMMV

[chuckie]

Well, then have Matt (AKA Kid Pebbles) rub you down with fish oil and give you a deep muscle massage. Get some pictures and post them.

I am joking arround, but in all seriousness, he has been hurting for a while.

Need to go find a good Doctor!!

I shot 37,000 rounds in 6 weeks about 20 years ago at a shooting school and got it bad.

Had to lay off that tendon as much as I could for nearly a year before it went away.

For some reason, rubbing 3 or 4 subsequent layers of Tiger Balm helped; I think it just took my mind off the pain.

Dumbbell curls seemed to help, as well.

The ticket, I think, was not duplicating the trigger pull action with other activities. Rode a desk until it finally got better.

Edited December 21, 2009 by chuckie

[coreydog]

I agree with the doc's suggestion to get an exam by someone who knows what they are talking about. The link to active release is good. try this one as well, www.grastontechnique.com Also look for someone who does prolotherapy (proliferative therapy)

I also treat sports injuries but only have 15 years experience. I do treat athletes from a top 10 program and have several national championship rings (clearly makes me such a superior doc. joke) I am one of the "go to guys" used in perisistent cases.

Here's my recommendation: follow the doc's advice. find someone who treats your type of problem mainly. Your typical primary care physician is not prepared to treat this persistent case.

Find someone who will evaluate the entire kinetic chain and determine the root issue. Find someone who can discern the difference between pain in the lateral epicondyle and pain in the radial head and knows what to do about it. Find someone who will take time to listen, evaluate and do the necessary patient education. Find recommendations not based on HMO or insurance restrictions on referral/diagnostic procedures/therapy recommendations. good luck on that.

As the doc said; specific diagnosis is mandatory. I do not believe a typical Primary care doc is prepared to do this. PRP could be useful but , again, you need someone who can tweeze out the issues and determine the proper course of care. Don't put the cart before the horse. diagnose the problem first. THEN plan a course of action.

Get on line and pull up the web site for the most local college or university with the most successful athletic program. Find the director of sports medicine, the head athletic trainer. Call them at a time of day when they are not involved in practice or rehab or staff meetings. (good luck with that. Probably early or mid morning) and ask who they use for difficult problems. Make it clear you are not asking for medical advice, just who do they use for these cases. ask for all their providers, no matter the profession. Someone somewhere has the answer for you. You need someone well trained who uses creative thought. You do not need someone using a cook book.

If you have used anti inflammatories and procedures with no response, that is a clue. If you have used them with response but recurrence. That is a clue.

Good luck

[pmd]

I would like to add that this thread, while still painful for me to read in its entirety, seems to have produced enough food for thought that perhaps it has - overall - served a useful purpose. ...

In November I had my yearly phyisical. I told my doctor about the constant pain in my elbow. He rubbed/felt it and said - Well it looks like you have tennis elbow - take 600mg of Ibuprofen and ice it.

I just read this entire thread - and will now be looking at options and a PT.

Thanks!

[lugnut]

I would like to add that this thread, while still painful for me to read in its entirety, seems to have produced enough food for thought that perhaps it has - overall - served a useful purpose. ...

In November I had my yearly phyisical. I told my doctor about the constant pain in my elbow. He rubbed/felt it and said - Well it looks like you have tennis elbow - take 600mg of Ibuprofen and ice it.

I just read this entire thread - and will now be looking at options and a PT.

Thanks!

Let me know how it goes for you. It seems my tennis elbow comes and goes. WRT shooting... I have no issues shooting my G34 with minor loads.. but when I shoot major or wheel guns I notice it. Not horrile but I notice it.

[99gski]

I have been fighting tendonitis in my shoulder/elbow for the last two years and haven't been able to shake it. I got from playing too much softball and now it is affecting my ability to shoot and practice. The last two years I have been been a drain on shooting without being able to practice or maintain any consistancy.

I have tried everything that has been suggested to me so far, anyone have any ideas to get rid of tendonitis?

So sorry to hear you have struggled with this. I just had my first bout of it this year after I tried to "cram" for the nationals with some hot loads and high round count practices. My doc has prescribed rest, stretching and anti-inflamatory meds for now and we have a plan to slowly repair & build up strength to make me ready for 2010.

Hope you and everyone else who has these issues is healthy and back to shooting at 100% ASAP!

Julie

[Round_Gun_Shooter]

You need to exercise the extensors in your arm . I have had it and it occasionally comes back when I neglect the exercises.

I use this kit http://ironmind-store.com/Strong-and-Healt...ctinfo/1428-EB/

I also use: http://www.amazon.com/OPTP-Handmaster-Plus...e/dp/B002C9ERSI

Keep the proper band with you all the time. Great when driving. It takes a week or 2 of exercise to relieve he pain. When the pain is gone, don't stop....... Ever

Edit to add: Watch out for the anti inflammatory drugs, they will do a job on your stomach. Acidophiles is your friend

Edited December 25, 2009 by Round_Gun_Shooter

[wwp512]

So, how the OP's tendinitis?

I had a bout of elbow tendinitis from reloading!! trying to do too many with a single press loader. I had to take about 8 months off from reloading. Sold my single and bought a Dillon 550B... if I don't watch out, I'll still get pain, but at least I'm making 5x more bullets before the tendinitis acts up!