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I've got a friend who's a coffee bar owner. He makes espresso all day long and has, what the doctor says, is tendonitis (tennis elbow).
He's been told to wear one of those straps below the elbow to do whatever it is those are supposed to do. It never gets better, although he says it feels better with the straps.
As time went on, both elbows started hurting. Two straps, now.
With a job like his, what's a good strategy for curing this issue and keeping it from recurring?
I get the feeling that the straps relieve the symptoms but don't actually do anything to help, long term.
The straps reduce the tension on the tendon which in some cases decreases the pain but doesn't fix the problem. It's not tendonitis, it's tendonosis.
He needs to "fix" it.
Do a search for bryanc's tennis elbow program. It's a really good start. Some IASTM (instrument assisted augmented soft tissue mobilization) will also be helpful in most cases.
Once he's asymptomatic, he needs to raise his forearm and grip strength/strength endurance levels.
Just noticed this post. I'm suffering from tendonosis myself now. I'm wearing the "strap" on my right arm too.
I suspect my job (which has numerous and various gripping, twisting, etc motions) and my lifting have aggrevated. I'll check out the search for bryanc's tennis elbow program, however I've always considered my forearms to be pretty strong. I train them about once a week. I wonder if a specific focus on training them could BE my problem?
Thoughts?
It's not about strength. It's about cumulative trauma. How often is the muscle used, what loads, what frequency, and how much rest.
For instance, low loads applied for extended periods of time without rest periods (such as keyboarding, prolonged gripping, etc) are just as destructive and acute overload strains.
High frequency stretching and eccentric loading work best. Eccentric loading is usually painful, but normal.
Augmented soft-tissue mobilization does wonders. You'll find it under IASTM, SASTM, ASTYM, or ASTM. It's all the same thing. There should be a practitioner in your area. That combined with ART is a great combo.
Bill is so right about IASTM treatments. He recommended it for my "golfer's elbow", hurts on inside elbow bone, and it was cured in five treatments. He is the man.
For sh*ts n' grins, if anyone is interested in learning about the condition, I've added an excerpt from a paper I did on Lateral Epicondylitis for the Hand Clinic where I did my clinicals at. There are some opposing views of it, but this is the one I believe in.
The majority of my paper is on new reasearch/treatments of Lateral Epicondylitis, such as Extracorporeal Shock Wave Therapy, Autolgous blood injections guided by ulltrasound, Botox injections, etc.
Eccentric training has got a lot of good reviews in the literature and has apparently been more beneficial than using only standardized rehabilitation techniques.
Here's the excerpt:
Lateral epicondylitis was originally thought to be an inflammation of the tendons of the lateral epicondyle (i.e. “itis” = inflammation). However, it is now believed that lateral epicondylitis may not involve inflammation. Instead, the problem is within the cells of the tendon. This condition is referred to as tendinosis (i.e. "osis" = pathology of chronic degeneration without inflammation). Histological exams also reveal partial or complete tears of the extensor tendon, and acute or chronic inflammatory cells are absent. The main problem for someone with tendinosis is not inflammation, but failed healing. Also, the term “tennis elbow” implies that tennis players are the ones most often affected, when in truth, it is more of a work related condition. (Research Into Tendinosis, 2004).
It is believed that instead of inflammatory cells, the body produces fibroblasts. When this occurs, collagen loses its strength and becomes fragile. The more fragile the tissue, the easier it is to injure and break down. The body then responds by forming thickened scar tissue in the tendon. Although it is not readily known what causes tendinosis, it is believed that the forearm tendon develops small tears with repetitive activity. The body attempts to heal the tears, but constant strain and overuse keep re-injuring the tendon. Eventually, the tendons stop trying to heal. Scar tissue never matures, leaving the injured areas weakened and painful. (HandUniversity, 2001).
I like the first part of your excerpt, but I think the second paragraph could use a bit of work in terms of being more precise with your language (I don't know if you're planning on submitting this paper of yours for format publication, but just in case you are):
1) Fibroblasts are not "produced" by the body. They can migrate from other sites; they can proliferate from existing fibroblasts at the site; or they can be activated if quiescent at the site.
2) The strength of collagen has nothing to do with the migration of fibroblasts to an injured site. Albeit, for the most part, the initial collagen secreted by fibroblasts is not of the native 'tendon' type (you are correct in stating that fibroblasts lay down 'scar' type collagen), the loss in tensile strength of a tendon is caused by collagen loss/disruption, which is not fibroblast mediated.
3) While popular theory does reside in the cumulative micro-trauma theory, more recent work (albeit not in lateral epicondylitis specifically, but in the Achilles tendon) suggests that tendon-related pain may be caused by the formation of new blood vessels (and the nerves that are formed alongside them). In fact, it may be that there are millions of people who have ultrasonographically 'injured' tendons who do not have pain at all, and thus, never present with 'tennis elbow'; thus creating a very large gap in the cumulative microtrauma theory.
Thanks for the response. Very informative and you seem to know quite a bit on the subject. Always nice to learn more about things, especially when I'm still relatively new (still have to take my reg exam next month).
The paper, wasn't actually a "paper" perse, but a presentation I had to do for the hand clinic I did my clinicals at. The fibroblast info, etc. I got from a website http://www.handuniversity.com/ topics.asp?Topic_ID=5. I may very well have misquoted it and thereby misexplained. I hate to propogate misinformation, so appreciate the additional insights.
Elbow Tendonitis
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