45 subscribers








  |  Software Dev  |  Science Stuff  |  Travel  |  Golf  |  Entertainment  |  Mindfulness  |  Finance and Investing  |  Austin  |  India  |  Diet, Health  |  Petitions, Causes  |  Miscellaneous  |  SaaS  |  Technology  |  

Posted on by Anuj Varma
Recovering from a (baaaaaaad) tennis elbow

All content on this site is original and owned by anujvarma.com.
Specializing in high volume web applications, Anuj Varma has helped architect, re-architect and troubleshoot some of the largest web applications out there.
His customer base includes Fortune 100 companies ( British Petroleum, dell.com, Schlumberger) as well as smaller to mid size firms within the United States. For Anuj’s specialized one-on-one executive seminars, visit ExecutiveTechnologySeminars

Anuj Varma – who has written posts on Anuj Varma, Technical Architect.


Tennis Elbow (severe) – is something I would not wish on anyone. It is one of the hardest things I have had to recover from. While the site of injury is obviously the elbow, the loss of strength one experiences is throughout the hands and forearms. One may find it difficult to even open a door. In my case, I was unable to even type at a keyboard – or shake hands – or open doors. This complete ‘hand-strength’ loss baffled me at first. After all – it was my elbow  – not my hands that were injured. Nevertheless, as a little research will uncover, tennis elbow causes complete loss of strength in various parts of the hands, shoulders and arms.

This was the second time I got tennis elbow. The first time, like others out there – I tried everything from physiotherapy to miracle ointments to pain killers  (including cortisone injections) – and learnt the hard way what works and what doesn’t. The first time – it took me 12 months – including LOTS of physical therapy to get over it. The second time, it took me less than 4 weeks – and zero physical therapy. I just knew what exercises to do – and what things to avoid. This article summarizes everything I did during those 4 weeks – and also everything that I continue to do on a preventative basis.  If you also have finger pain alongside the tennis elbow, you may want to read this post on how I overcame my finger tendinitis.

Intuitive Recovery Time

At an intuitive level, when one is unable to even pick up small objects (or open doors), one feels that one may never recover (or at least, that it is going be a super slow process). This is exactly how I felt.

Actual Recovery Time

I was able to work on my computer within a couple of weeks – and actually made a somewhat full recovery in less than 4 weeks – but I had to do a LOT of things right. Had I not done any of these things, I doubt if my recovery would be as quick.

Where is the pain coming from?

‘Tendon’-itis. A tendon is simply the ‘ending’ of a muscle. It is where the muscle attaches to the bone. Understandably, it is a ‘thinner’ strand of muscle fiber than the rest of the muscle.    When your forearm muscles contract (for various reasons), this ‘ending’ of the muscle gets stretched. This is what the pain in tendonitis is – the stretching of the tendons due to contracting muscles. Why do the muscles contract? Any repetitive motion would cause the muscles to get ‘overused’ – and overuse causes a ‘permanent contraction’ of sorts.

Step 1 – Bring down the inflammation. (You are injured – Limit your movements)

When you are down with something bad – like the flu – do you think about going to work? Or sitting on your computer? Or doing anything except lying down? Well – that is how you must treat your tennis elbow. Except – you do not have to be bed confined. But you do have to limit your movements – especially movements that involve your hands. I cut down on my driving – and only drove short distances (that too with elbow braces (see below) always around my forearms). Goes without saying that – tennis, golf etc. are all taboo. Lifting anything remotely heavy is out of the question. You have a serious ailment – and you need to treat it as such. This is one of those obstinate things that will just not go away if you do not give it complete rest (see step 2 below).

Bringing down the inflammation is tricky in tennis elbow. OTC medicines, pain killers etc. seem to have little or no effect. Topical ointments provide little comfort. The few things that helped bring down inflammation for me were (in order of effectiveness)

  • a) Aggressive icing
  • b) DMSO with Aloe Vera Gel – Very strong and effective, though with a nasty side effect (itchiness). Aloe Vera combined DSMO is slightly better. Alternate with vitamin E oil over the skin to mitigate the ‘itchiness’ side effect.
  • c) Cod Liver Oil (fresh, not capsules) and MSM powder – These were the only ‘supplements’ that showed instant results.
  • d) Electrotherapy and Ultrasound  –  Ultrasound is great for DEEP inflammation, Electro for more outer, broader scoped inflammation. For Electrotherapy, I recommend getting a HOME TENS unit. This is very effective – and you can effectively WORK with this UNIT ON.

tensunit3000

  • e) Aleve (Naproxen) – This did not relieve my elbow pain as much – but did work on my hand and finger pain (I took 1000 mg daily for 2 weeks). Check with your doctor before you start on this.
  • f)  Prescription Topical Gel (Very effective – more so than any other gel/ointment) – In the U.S., doctors may prescribe a compounded topical gel – containing ketamine, bupiv, cyclo,keto , gaba mixture. I tried this ‘compounded gel’ – and it seemed to instantly provide relief. Apparently, the combination contains pain killers used against neuropathic pain – as well as muscle relaxants. And since ‘tendonitis’ muscles are in a permanently ‘stretched’ state, muscle relaxants go a long way to helping the condition. Also ‘Blue Emu’ ointment – seemed to relieve the pain – although only temporarily.

DMSO

NOTE on a) Aggressive Icing – Ice the affected area for 10-15 minutes – every couple of hours. Using raw ice worked better than icepacks – if your skin can handle it.

NOTE on c) Cod Liver Oil – I tried various supplements (see supplements section below). The only one that I felt helped in reducing inflammation was cod liver oil (fresh). MSM powder is good for recovery from muscle fatigue – and in relaxing muscles in general. Relaxation of muscles is a good thing – since part of the source of the pain is a severely contracted (tightened) muscle. MSM does have side effects – and may cause bloating if taken in excess.

NOTE on d) Ultrasound and Electrotherapy treatment – These absolutely helped lessen the pain – especially along my forearm. Right at the spot of the injury (elbow), they were less effective. The HOME tens unit is absolutely miraculous. Once I learnt how to use it, I would actually work WITH the unit on. The biggest advantage of having the unit on was that it a) Kept the pain from interfering with my work  b) provided some level of healing while I worked.

Inflammation – and Cortisone Steroid Shots

Cortisone shots – These are popular in treating inflammation. I did not take a shot when I had the incident – but much, much later – when I had already tried a variety of things – but still had almost 80% of my initial pain present. It did absolutely nothing for me (ideally, it should have reduced the pain somewhat, even if not fully). Additionally, the shot hurts A LOT (for 24-48 hours after the shot).

Inflammation Summary

All I can say is that it (bringing down inflammation) is a process – not an event. You have to keep at it – and try a few things to see what works. Ice worked for me as did DMSO with aloe vera (though with a nasty skin itchiness side effect). Cod liver oil and fresh Vitamin C are good supplements – while DSMO gel and compounded topical gels are very effective as well. Ultrasound and Electrotherapy are also extremely effective – providing you with the option of working with a TENS unit on – which keeps the pain at bay and actually heals while you work.

Unfortunately, not any of my orthopedics (6 all in all) that I met could explain why it is so difficult to reduce inflammation in tennis elbow. Why tried and tested pain killers (including strong, prescription strength anti-inflammatories), had little effect? I was understandably mystified – but I didn’t realize that the experts were equally mystified at this condition. What I realized is that the inflammation never fully goes down (I had elbow MRIs done 8 months into my condition – and they still showed inflammation). One must proceed with the strengthening exercises in spite of the inflammation.

Rating – Top Inflammation Reducers (for me)

  1. Devices – TENS Unit – constant usage with a home tens unit. 30 minute sessions 2 to 3 times a day.
  2. Gel – DSMO gel – Though it has a nasty side effect (itchiness), I got this recommendation originally from Dr. Weil’s website. This stuff is very very powerful – but use in moderation. It will instantly bring your pain levels down (and keep them down). BUT be warned – it itches! Like Crazy. Which is why I went with  the Aloe Vera mixture with DSMO. Even that is itchy – but less so. Use it in moderation – apply it directly over your most tender spots (after wiping the area clean with water) – and let it sit for as long as you want (minimum 20 minutes to seep in). If it bothers your skin too much, you can alternate with Vitamin E oil applied over the skin – this soothes the itchiness – and has also been linked to  relieving tendon pain.
  3. Supplements – Fresh Orange Juice, Fresh Cod Liver oil, MSM Powder
  4. Ice

Step 2 – Wear an elbow brace 24/7 (except while sleeping) – (Update: can use a Kinesio Tape or crepe bandage instead)

kinesio_tape

My orthopedic explained the importance of this brace. Anything that you do with your hands – is connected to the same, common tendons in your elbow. This is why even a small action such as opening a door – hurts like hell. The idea is to arrest all hand motion from reaching the elbow – and the brace helps do just that. Without it – your elbow never really gets rested – and even the slightest hand motion keeps injuring it further.

These braces need to be worn even after your elbow starts improving. For a period of at least 6 months. Let the brace become part of your fashion statement – don’t worry about how it looks or whether it feels warm etc. Just wear it – otherwise chances are you will end up with a relapse (in my case, I believe this WAS a cause of the relapse – I started feeling better – and started doing things without the brace. Bad idea – just wear the brace at all times).

UPDATE note : Purely by accident, I discovered that a crepe bandage – tied over the entire elbow – and extending a bit on the biceps (above the elbow) and a bit on the lower arm (below the elbow) – kept the elbow in place much more effectively than even the braces I was used to. The only downside is the time it takes to put the bandage on. Also, the skin under the bandage may experience dryness. I simply applied some moisturizing crème to deal with that. The bandage was so effective that even at my worst pain levels, I could operate a keyboard with the bandage around my elbow. It absorbed the bulk of the impact – and worked better than the brace even.

UPDATE note 2: Crepe bandage seemed to work better than elbow bands. However, Kinesio ( aka Athletic tape) tape – works even better than Crepe bandage. You simply need to tape over the entire muscle as shown in the image above. It is a good idea to learn the taping technique from any physical therapist – once you see them tape you – you can do it yourself at home.

  1. Imak Elbow

    Band

2. Medspec Tennis Elbow Support

Step 3 – Do Forearm/Elbow stretching exercises – At least TWICE a day

Once your pain is somewhat reduced (aggressive icing, ultrasound , laser and active release are all good for this), you can begin the strengthening process. As mentioned before, your inflammation will never go down much (all the icing etc. only helped maybe 20-30% in bringing down pain levels), so it is a judgment call as to when you start these exercises. Obviously, if your pain is a 10 on 10 (btw…I hate this 1 to 10 scale– when I am in pain – there is just a two point scale – excruciating and bearable), you want to ice, ice and ice some more. In my case, all the icing and all the ultrasound never got the pain below a 7 at best (got it from ‘excruciating’ to just bearable). I wish I had the compounded topical gel earlier on – I think it certainly helps in relaxing the muscles and reducing the ‘stretching’ of the tendons.

To summarize, you need to start the strengthening exercises as soon as the pain is somewhat bearable enough for you to do the stretches.

If you want your elbows, hands and forearms to get strong – you must do a specific set of exercises. And do these as often as you can. The three sets of exercises that I did religiously included:

  1. Resistance Band (Stretch Band) Exercises – This was recommended to me by a top physiotherapist (this guy treats some of the top athletes – tennis players, soccer players etc.).  Just tie one end to a staircase knob or any other solid support – and grasp the other end in your affected hand.

Stretch 1 – Straight Back elbow stretches – holding your end of the band at about belly-button height – AS IF YOU ARE SHAKING HANDS WITH IT. Stretch it straight back – so your elbow moves past your hip – and hold for at least 10 seconds. Keep increasing the time you can hold it.

Stretch 2 – Diagonally across elbow stretches. Hold your end again at belly button height. Now try and stretch it diagonally across your chest towards your opposite shoulder (if you are holding it in your right hand – move towards your left shoulder).

Stretches 3,4 and 5 (once you are strong enough) – These are stretches that almost every physical therapist you go to will recommend. They bring strength back to the fingers and the forearm. These are recommended once the inflammation is down substantially (but you know my theory on that – my inflammation never went down more than 30% – and even elbow MRIs 8 months into the tendonitis revealed significant inflammation). Personally, I thought I did these (3,4 and 5) diligently, but for whatever reason, the above two stretches (1 and 2) worked best. However, I would suggest you at least try these (3,4 and 5)  – and see if they help you more than they helped me. The best place to see them in action is in this youtube video.

How often should you do them? At a minimum – twice a day – but as often as you can is ok. My physiotherapist (who taught me these stretching exercise) – said you cannot do enough of these.

 

2.  Finger stretches –  Place a rubber band around the tips of your fingers (as shown below) – and try to OPEN your fingers. This is a GREAT stretch for the entire muscles that stretch from your fingers all the way to the elbow. While you can use a regular rubber band, I did find these specific resistance bands very useful. They offer differing resistances – and do not slip off like rubber bands do.  Try and stretch the rubber band as shown in this youtube video.

finger_rubber_band

 

3.  Theraband Twisting – This was something I tried on my own (as opposed to the resistance band which my physiotherapist recommended). The theraband comes in various ‘flexes’ – I got the ‘light’ – and that was good enough. I have heard the medium can be a little hard for seriously affected elbows. There are several youtube videos on tennis elbow theraband exercises. Here’s an image showing the primary tennis elbow exercise (called a Tyler Twist) that you can do with the Theraband.

tennis-elbow-eccentric-twist-exercise-the-tyler-twist

How often should you do them? At a minimum – twice a day – but I did these more than twice – based on the advice of my physio about the stretch band exercises.

4.   Tennis Ball Squeezing

In an ironic twist, the thing that causes tennis elbow (tennis) – can also help in the recovery process. Just hold a regular tennis ball held in your palm – and squeeze it as hard as you can. Initially, you will find this to be difficult – since your hand will have very little strength. As you do this more and more – you will find your grip getting stronger. This is the simplest and one of the more effective exercises that I did. I carried that ball everywhere (I didn’t care if other lunch folks saw me squeezing a tennis ball while waiting for my food..). Again – like the rest of the exercises – there is no limit to how often you do this. As much as possible!

5.  Nerve Compression? (TOS, Carpal Tunnel, Cubital Tunnel etc.) 

It is possible that part of your ELBOW and FINGER pain is related to nerves being compressed somewhere between the SPINE and the hands. There are so many possibilities here – but I’ll list the top two.

  1. Carpal Tunnel (median nerve compression) at base of hand.   There are several self tests available online to determine if you have this. Notably, you will LOSE pincer strength (thumb and index finger in a pinching formation) – among other symptoms.
  2. Thoracic Outlet Syndrome – Neck and Shoulder area in front of body  – another common, yet overlooked cause of finger and ELBOW pain. While a full TOS diagnosis requires lots of tests, a quick way to determine this is :
    • Ring and Pinkie finger weakness and pain – also possibly numbness and tingling. These two fingers are usually involved in TOS.
    • Holding your arms above your head – with elbows at 90 degrees – palms facing forward -  is difficult for a long period of time. Hold them this way – and try to open and close your palms quickly – for about 2 to 3 minutes. If you feel pain, fatigue in your arms and hands, you may have some level of TOS going on.

Stretches for TOS and Carpal Tunnel or ANY NERVE Compression – This YOUTUBE video – with the THREE stretches covers ALL the three main nerves – median, radial and ulnar – that can be problematic. These stretches take less than 2 minutes. While the video is titled ‘Thoracic Outlet Syndrome Exercises’, the same exercises help with ANY nerve compression (cubital tunnel etc.) in the arm, shoulder and neck area.

Postural Braces – A POSTURE BRACE also helps in recovering from conditions such as these. These are especially useful in desk jobs (mainly computer related desk jobs) – where the neck, shoulders get out of good posture easily. I used these temporarily – but eventually, realized that I would have to strenghen my upper body – to where it could tolerate such postural contortions without breaking down! The exercise regimen (gym, weight training) that I describe below, helped me strengthen my upper body (I did not even realize how weak my entire upper body had become).

Exercises Summary

I am sure there are dozens of other recommended exercises (wrist flex with small weights, hold out your palm and flex it upwards/downwards). These are all worth doing – in addition to the ones above. The ones I have listed above (the stretch band exercises especially) – were shown to me by a really good physiotherapist (some famous sportspeople go this guy for their injuries). I take these exercises to be the most important of the lot. The theraband was something I tried on my own – and it seemed to help as well (it comes with its own instructions – but you can youtube theraband exercises for tennis elbow).  I actually went to 4 different physical therapy places – and tried a variety of acupressure and alternative modes of therapy. The sheer number of ‘stretches’ and exercises in my experience is ridiculous – some work the neck and shoulder area, others work the fingers, wrist area and so on. I would try and list all of them – but I feel the ones listed here are the ones that made the biggest difference.

How often should you do them? At a minimum – twice a day – but as often as you can is ok. My physiotherapist (who taught me the stretching exercise) – said you cannot do enough of these. In case you are worried that you may be ‘over working’ an already inflamed elbow – you would be wrong. These stretches actually help the elbow recover. Something as simple as trying to squeeze a tennis ball builds hand strength and wrist strength. These exercises were the centerpiece of my recovery program – and I am convinced that without these – my recovery would have taken longer.

Some general principles about STRENGTHENING joints:

  1. JOINT STRENGTHENING is VERY different from muscle strengthening. Muscles need to be fatigued by reaching higher and higher weights – before they break and rebuild new fibers. For JOINTS, this recipe is disastrous. What you want is smaller weights – and more reps. I learned this from a physical therapist that I worked with – and it has been a game changer in my recovery process. The ELBOW JOINTS (and finger joints) are no exception. It is the JOINTS that hurt – because that’s where the TENDONS are attached. The exercises below must be done with increasing REPS – not increasing weights.
  2. STRETCHES as opposed to WEIGHTS – In general, STRETCHING will help your tendons recover more than weights will. The stretches can be simple hand flexion or involve the use of an elastic (resistance band). In my experience, resistance band stretches are the BEST thing you can do for joint /tendon strengthening.

Step 4 – Change your keyboard, mouse (The keyboard and mouse below are MY MOST RECENT recommendations – Oct 2013)

Tennis elbow is caused by repetitive stress. Computer typing is one of the most common forms of this type of stress. In my case, it was at least partly responsible for my tennis elbow (besides actual tennis and golf). Once you have regained some strength – consider getting a keyboard and mouse that is as ‘soft’ as possible.Through my 1.5 years of experimentation, I honestly spent over $2000 just on keyboards and mice. Anything that promised to be gentle on RSI, was purchased. It was a matter of my livelihood for me.

Mechanical Keyboards (Oct 2013)

The most important discovery I made was regarding the TYPE of keys. Mechanical keys are the only keys that actually provide any  decent level of SHOCK ABSORPTION. With a gentle pressure from your finger tips, the key continues its depression on its own without any further pressure from your fingers. This makes it exceptionally gentle on the fingers. Once you get used to these keys, you will discover that regular keyboards (rubber keys) are just not the same. They let your fingers absorb the bulk of the shock instead of the key switch itself. While ANY mechanical keyboard will offer superior finger protection compared to non-mechanical, there was one that stood out in my experience. The TECK keyboard listed below. However, there are SEVERAL good mechanical keyboards on the market. These are mainly popular with GAMERS – but they are suitable for regular use as well. The CORSAIR mechanical keyboard was one that I tried – and had a good experience with.

Staggered versus Non staggered keys

Any keyboard you look at will have its keys NOT LINED UP. That is, the Q is not directly above the A and the A is not directly above the Z. This design (called STAGGERED keys) is HORRIBLE on the fingers – since they have to constantly stay non-lined up – as they move from key to key. A better design would be to have all the keys along a column – directly above /below each other. This is called a NON-staggered design. Again, once you try it out, there will be no going back. I can type for hours on a non-staggered keyboard without any pain – but move me to a regular keyboard – and after a couple of hours, my fingers feel stressed out. (btw– I have tried all the Kinesis keyboards as well – and while they offer the split keyboard design, most of them DO NOT have mechanical keys).

Kinesis Keyboard (with VIP accessory kit)

While it doesn’t offer mechanical keys, the keys are extremely soft. And while it doesn’t offer a non-staggered layout, the separation of the halves (split keyboard – with 20 inch separation) is a real asset. This is especially good if you have shoulder pain while typing – or if you tend to ‘crouch’ your upper body while typing. The keys are the softest of all the keyboards I tried, which is the main reason I recommend this keyboard. I would not recommend it WITHOUT the VIP kit – the kit makes it highly customizable.

kinesis_keyboard

Totally Ergonomic TECK Keyboard

The TECK keyboard listed below combines both of the above finger friendly features – mechanical keys and lined-up (non staggered) keys. There are other keyboards that offer mechanical keys as well as NON Staggered layouts. This one has met my needs for the past year or so. Apart from their slightly (actually COMPLETELY) unresponsive customer service (in case you have to do a return or something), the product itself is solid. Again, I must emphasize that their customer service is non-existent – no telephone number on their website. An email contact form – which never gets an actual response. But I give the product points for combining the two most finger-friendly features – non-staggered layout and mechanical keys. The learning curve?  Online reviews will scare you with a huge learning curve – in reality, it took me less than a week to get used to the slightly off ENTER and DELETE and SHIFT keys. Once I got the hang of these, the rest of the keys are standard (QWERTY…). Their logic behind relocating the ENTER and SHIFT keys is sound  – these are the most oft used keys and deserve to be in a CENTRAL location – where the THUMB (your most powerful digit)  – can access them.

mouse

Light-IO Touch Free Keyboard

lightIO_touchless-keyboard

This keyboard has laser activated keys. You DON’T touch the keys -  they SENSE the incoming depression from your fingers  – and the key gets activated (no touch involved). This is a great keyboard if you are willing to spend some time building up your typing speed. Since there is NO touch involved, it provides no pressure on your fingers. For me, initially, I felt this was the perfect solution. However, my typing speed on this was very slow. A suggestion offered by other users was to buy TWO such keyboards – one for the left and one for the right. Again, I just couldn’t type at any reasonable speed here – maybe I did not spend enough time with it.

Mouse (Oct 2013)  -

The mouse that I still continue to use is the 3M vertical mouse listed below. It is lightweight – and most of all, places your wrist in a neutral position – which causes no stress even after long periods of usage. The 3M Ergonomic mouse  ( get the large, the small is too small ) is the one that I use on a regular basis.

Older Recommendations (March 2013)

This is an older keyboard recommendation – the Microsoft Natural 4000 keyboard – which is a cost-effective option. However, it DOES NOT have mechanical keys and it DOES NOT have the column (non staggered) design. However, it is gentle on the fingers and especially on the shoulders due to its split keyboard design. As for the mouse , a vertical mouse is the way to go.  The 3M Ergonomic mouse  ( get the large, the small is too small ) is the one that I use on a regular basis.

Supplements

Thanks to the internet, I got to try virtually every “miracle-cure” that my friend, Google could suggest. I was desperate to get better fast – and while I did eventually get better, I learnt a lot about what worked for me and what did not.  Of all the supplements that I tried (Wobenzyme, Creatine, GLUCOSAMINE, CHONDROITIN & MSM, L Theanine, Magnesium, L Tyrosine…), there are only two that somewhat worked – and that I continue to use on a preventative basis.

  1. Cod Liver Oil – Not capsules – but fresh oil. I am sure all brands are ok – the one I use regularly is shown below. This is a natural anti-inflammatory – and in addition to icing, this helped me bring the pain down considerably. It is also great for overall joint health – and especially helps keep the pain down during cold, winter months.
  2. MSM Powder

3. Fresh Vitamin C – I eat whole oranges – but any form is good for you. Again, fresh is better than any capsule/tablet. Vitamin C is known to be effective in maintaining tendon health.

Prescription Anti Inflammatories

I do want to give honorable mention to Naproxen (same as Alleve) – taken in 500 mg doses TWICE daily (with a full meal). While they did not relieve my elbow pain much, they did wonders for my associated finger and hand pain. This is a quick and inexpensive thing to try. It does have its own side effects (for example, if you take acid blockers – you may want to up your dosage during the naproxen treatment). Of course, go through your doctor before you take this.

Ointments (mainly to reduce pain and bring inflammation down)

  1. DMSO Gel – with Aloe Vera. As mentioned above, this IS super effective, but with a stinging, itching side effect. The aloe vera mitigates the side effect somewhat. Vitamin E oil (just slice open a vitamin E capsule) rubbed over the skin (after the DMSO has soaked in), can relieve the itchiness. This is my all time favorite topical ointment for a simple reason. When it brings down inflammation, the effect is PERMANENT. The pain is reduced – and stays reduced. For best results, I would apply this every night (after showering) – and leave it on while I slept. In the morning, the pain would be magically MUCH MUCH less. This works on ANY joint – I used it on my fingers , wrists – along with the painful elbows.  If the itchiness gets too much, give it a break for a day or two (and apply Vitamin E oil generously).

2  Off the shelf – try Capsicain . Use the low concentration – 0.035 – to begin with. Or Blue Emu – this also helps with any muscular pain.

 

3 . Prescription Only Compounded Gels – In the U.S., doctors may prescribe a compounded topical gel – containing ketamine, bupa, cyclo, , gaba mixture. I tried this ‘compounded gel’ – and it seemed to instantly provide relief. Apparently, the combination contains pain killers used against neuropathic pain – as well as muscle relaxants. And since ‘tendonitis’ muscles are in a permanently ‘stretched’ state, muscle relaxants go a long way to helping the condition.

Massages , Active Release, Acupressure

There’s something called the ‘active release’ technique – which I have become a fan of. Their whole approach to this condition is – ‘No amount of rest will fix it. Something is pushing against something. A nerve against a muscle  perhaps. Unless we ‘release’ that, there will be no relief. So – I tried it – and I have recounted my experience here (in short, I think it works great – and was the first thing that provided immediate lowering of pain – apart from the icing).

In India, where it is relatively easy to obtain acupressure, I would have a specialist come home and massage the ‘pressure points’ along my palm and forearm. This also helped a lot.

Homeopathic Remedies

I grew up in India where these little white pills are administered for just about every ailment. They work on a principle similar to vaccinations – infuse a small amount of something (typically plant extracts) that CAUSES the symptoms you see. Your body’s immune system kicks into gear – and starts fighting your main symptoms. There’s a lot more to it – and doctors actually spend years studying homeopathy. A good homeopath knows as much about the human body and western diagnoses as a regular MD.

Whether or not you believe in this system, it is true that about a dozen of my friends and family members ONLY found treatment through this route. Usually , it took less than 6 weeks for all their tendonitis symptoms to disappear. Homeopathic remedies are VERY specific – in that – they are different if you

a) had the pain for a few months VERSUS just developed the pain

b) Got it from repetitive stress VERSUS got it from lifting something heavy one time

c) Does the pain feel better lying down – or get worse – does it feel better with movement or worse….etc.

These are some of the questions a good homeopath will ask before prescribing a remedy.

I DID consult a few homeopaths (some of them are good acquaintances of mine).  While there were a few discrepancies amongst what was prescribed (there are LOTS of treatments for tendonitis in homeopathy), there was also some agreement. Best of all, these medicines have no side effects.

RHUS TOX, for me,  was the one that delivered.  It especially helped with my finger pain (which was related to the tennis elbow -  and exacerbated with all the typing I did for my job).

  1. Try RHUS TOX 30 (twice a day) for a week. If even slight improvement is noticed, continue for another 2 weeks.
  2. If no improvement, up it to RHUS TOX 200 – for a week. If improvement, continue for another 2 weeks. If no improvement after a week, this is not the remedy for you.

However, rather than rely on MY diagnosis, I would strongly recommend consulting an actual homeopath for your specific symptoms.

Diet, Digestive Ailments and Chronic Tendonitis

Could poor diet be  at the root of chronic tendonitis? This question has been asked and addressed here (among other places). I will only make this observation – I had poor digestion for several years – before I got tendonitis. However, I did feel the weakening of my elbows (mild, gnawing pains) around the same time as my digestive issues started.

Book Recommendation – While I was merely conjecturing the relationship between digestion and chronic tendonitis, this lady seems to have really done her homework. A professional clarinist, she suffered from severe tendonitis along with digestive ailments. Not only did she uncover the connection between DIET and CHRONIC INJURIES, but has written an informative account of her journey.

Things that did not work (I tried all the items in this list)

NOTE: The two things that I would absolutely never try again are ‘Cortisone shots’ and ‘Acupuncture’. I am sure they work for some people (otherwise why would so many yelpers recommend acupuncture for tendonitis?) – but for me  – they actually worsened my existing condition. The other supplements just failed to work – but did not worsen my condition further.

Cortisone ( Steroid ) Shot

Most doctors / orthopedics will want you to consider these if full rest does not lessen the inflammation. I can see where it may help – right when you actually have the incident and the inflammation is at its worst. I DID NOT get the shot at the time of injury occurrence (got it MUCH later) – so my perspective may be slightly off. However, my pain when I got the shot was about as bad as when the incident occurred – so it should still have provided relief. It did not. Plus – it hurt like hell. There were some doctors who later told me that it has to be JUST right for it to work (neither a bit here nor there). Well – I got it from a very competent orthopedic – and I am not worried about whether he ‘got the spot right’ or not. I think he got it right – but it still did nothing to improve my elbow pain. In fact,  I am convinced it weakened my left elbow more (previously, my left was the ‘better’ of the two – after the shot and ever since, it has been the weaker of the two).

Acupuncture

I tried this with a lot of hope (several yelpers claimed to have fixed their tennis elbow with this). This is one of those things that I insist did nothing to help my condition – and possibly worsened it. This is in complete contrast to acupressure – which really helped. Again, I have nothing personal against acupuncture – it just did nothing for me – and for some reason, I felt much worse after it. Again, I don’t doubt the qualifications of the person who administered it – just its effectiveness in treating my specific condition.

Prolotherapy

There is a lot of discussion about the effectiveness of this for tennis elbow. I tried it – it did not work. This was the most expensive thing I tried (cost $500) – but it did nothing to relieve my pain. It did not worsen matters – but did nothing to relieve the pain or improve the condition.

Supplements, Over the counter meds and ointments that did not work (I tried all the items in this list – I am one of Jeff Bezos’ favorite customers)

  1. Penetrex  – Penetrex is the highest rated product on amazon.com for treating tennis elbow. I must have rubbed four jars full. Did not make the slightest difference as far as I could tell. Not saying it does not work for others – just did not work for me. Also – as an alternative, I tried Capsaicin – WHICH ACTUALLY HELPED (but not as effective as DMSO, which I discovered a little later on). I would apply it at least twice a day on both my elbows. Be sure to start with a small concentration (0.035) – this small dosage burnt a bit – so I can only imagine how much the 0.1 (high potency) would burn. Good news is that I found the small concentration (0.035) to be very effective – so did not have to try the higher concentration.
  2. Advil, Tylenol etc. – These had the least effect in terms of actually helping the tennis elbow pain. However, Alleve (naproxen), when taken at maximum dosage (1000 mg daily, for 2 weeks) , did help with my finger and hand pain. Take these only if approved by your doctor.
  3. Wobenzym – Again, I took a lot of it – no noticeable improvement.
  4. Creatine Protein Powder – I was most psyched about this one – but as far as I can tell, it had no effect on my condition
  5. Glucosamine , Chondroitin, MSM – I tried a powder that contained all 3 ingredients – and while it tasted great, I’m not convinced it helped my tendonitis any. However, JUST MSM powder by itself, worked great at relaxing my tense muscles.
  6. L-Theanine and L-Tyrosine – I tried these supplements based on some internet testimonials. Not sure they did anything.
  7. Magnesium Citrate – Although my serum Mg levels were normal, a lot of people seemed to recommend these for various muscular conditions. I did try them – but again – any effect they might have had was hard to discern. Magnesium OIL – when rubbed over an entire muscle area, has a relaxing effect on the muscle. It is worth a try – for some people the Magnesium oil works as well or better than MSM powder.
  8. Vitamin D Shots – Firstly, if you are Vitamin D deficient, be sure to take these shots (or oral capsules). Secondly, cod liver oil gives you Vitamin D as well. And cod liver oil is one of the few things that instantly relieved the elbow pain that showed no signs of subsiding. I don’t think the shots themselves made much difference – but I can readily vouch for the cod liver oil (fresh, not capsules).
  9. Vitamin B12 shots – I was slightly on the lower side on B12 – so I took these just to be safe. This is one of those important Vitamins that can cause all kinds of mysterious ailments if you are seriously deficient. And you MUST try and take a shot as opposed to oral ingestion.  The reason you may be B12 deficient may have to do with poor intestinal absorption of this vitamin (and in B12’s case this is a fairly common underlying cause) – so it is best to get it injected into your bloodstream (bypass the digestive system altogether). Again, not sure it had any effect on my tendonitis – just a generally good thing to have in the normal range.

Long Term – Continued Prevention

Steps 2 (wearing elbow braces),  3 (stretching exercises, especially the finger stretches) – and 5 (use ‘wrist-friendly’ keyboards, mice) – are a must on an ongoing basis – if you want to avoid a relapse of the condition. Also, cod liver oil (fresh, not capsules) and Vitamin C (also fresh), are important components of keeping joints and tendons healthy.

Massages, Acupressure etc.

A regular massage may not get you much relief. However, there are RSI massage specialists now – who specialize in repetitive stress injuries. I started trying some of these out – and had a decent experience – and then I found a technique which let me do the massage at home myself. This youtube video clearly shows how you can use your own knees to apply pressure on your elbows. This is truly a remarkable technique in my opinion – and even now – after heavy typing, I simply use my knees to ‘walk’ over my forearms. It works!  The underlying concept is acupressure – however, it is simply not possible to apply enough pressure with an acupressure ball/massager on your own. Using your own body weight (and knees) solves that problem.

DMSO Gel

To this day, if I feel the slightest start of pain in any joint, I reach for the DMSO gel. One small application (just a dab -  but rubbed in thoroughly) – and it disappears (by the next day).

Exercise Regimen

Tennis elbow is usually accompanied by a weakened upper body. Once I was able to lift light to medium weights, I started on a ‘strengthening’ regimen that included weight training. Prior to this, I had only being doing stretching (resistance bands) – no weights. Once I could, I worked on strengthening my upper body with weights. I was surprised to discover how weak my neck, shoulder and other upper body muscles were. My elbow was understandably weak – but, for a lot of tennis elbow sufferers , the problem may be their entire upper body. Recent RSI research confirms that RSI is a comprehensive upper body problem – and not just isolated to single joints.

I joined a gym that had WEIGHT TRAINING group classes (one can adjust the amounts of weight – you don’t have to lift the same amount as others in the class). A 1-hour session of non-stop lifting of weights sounds rough – but again, go at your own pace – and use only the weights that you can manage. Do this a few weeks (I did only ONE class a week) – and your upper body will start finding long forgotten muscles.  Once you reach this stage, you can have some peace of mind – you will not be afraid of lifting something (and injuring your elbow in the process). I went from not being able to lift a glass of water to where I can lift heavy groceries again.  But it took me a WHILE to get there!

Summary

As I mentioned before, everyone’s experience of what works and what doesn’t may differ. This is just my own experience. Having suffered from tennis elbow TWICE (in quick succession) – and having tried everything from ointments, pills, lots of physical therapy, electrotherapy, ultrasound, prolotherapy, home exercises to homeopathic medicine, I have learnt what works for me. If you are suffering from this serious condition, I feel for you – and wish you a quick recovery. Hopefully, something from this post would be helpful to you.  While I have listed these sequentially (Step 1….6), obviously, they all need to be done in parallel. Each step is an important part of the recovery process – and trust me, if you take this condition lightly, it WILL get the better of you.

Here is a quick recap of the ‘goodie bag’ (of things that worked).

icecubes Ice is the only thing that actually helped instantly bring down the inflammation. Pain killers and anti-inflammatories (including prescription strength) – and cortisone steroid shots, did nothing to relieve my elbow pain.  The TENS unit was especially helpful. Ultrasound and laser treatments helped somewhat – especially on the forearm – but not as much on the epicenter (the elbow).
TENS Unit (I used the TENS 3000 , but any unit will work) .  Instant pain relief – and I could actually work with the unit attached. tensunit3000

DMSO reduces pain within a span of a few hours. It must be applied on clean skin (wash and dry the area before applying) – and allowed to soak in. It is best to MASSAGE it in to the painful points. The more you massage it in – the better it works. I guarantee you , your skin WILL itch – for a good 30-60 minutes after application. But if you can survive that, you will have overcome the biggest hurdle – and PERMANENTLY reduced your pain.

Within TWO Weeks of following this regimen, chances are good that your pain levels will be well below 50% of the original levels. I do not know of anything that works this fast on severe tendonitis (with the possible exception of a TENS unit – but I am not sure how PERMANENT the pain reduction is there).

If TWO weeks sounds too rough for your skin, you can always ALTERNATE with Vitamin E oil (apply Vitamin E oil on alternate days – and DMSO on the other days). The Vitamin E soothes the skin and allows it to recover for the next session. Some research also suggests that Vitamin E , by itself, is beneficial in reducing inflammation.

DMSO_gel
Continue to wear throughout the day  – even after your elbow starts to recover. Wear for at least 6 months (advice of my ortho and my physiotherapist).
NOTE: Crepe bandages work very well  – IMO somewhat better than these wrist bands. Plus, with crepe bandages you can cover more area as well as provide ‘customized’ pressure.
Do the ‘straight back’ and ‘diagonally across’ stretches every day – as often as you can (minimum twice a day). Continue doing even after your elbow recovers.
This helped bring down the inflammation considerably (along with religious icing). It was one of those things that I could feel working right away (unlike a lot of other supplements). I still take it regularly – a teaspoon in warm milk – for maintenance once a day. If you have tennis elbow, three times a day  is recommended.
Aleve (naproxen) . You want to take 1000 mg daily (on a full stomach). Ask your doctor before you take this. This helped with my finger and hand pain – not as much with the elbow pain.
HOME tens unit. Any home tens unit will work. Learn the correct application points (for the pads) from your physiotherapist, if possible. Youtube has some decent videos on this as well.Buy high quality electrode pads, as the cheap ones tend to wear off fast.
Get rid of your old mouse – and use this or something similar which has a neutral wrist position – is super light (something that tendonitis sufferers need). Get the LARGE size of this 3M mouse – as the small is too small for most hands. I also tried EVOLUENT’s vertical mouse – which has the same features – but found it to be too heavy (something that is a no-no for severe tendonitis sufferers). This mouse will help prevent RSI due to computer (over) use.
mouse This keyboard has COLUMN aligned keys (non staggered keys) AND mechanical keys (that absorb the impact of striking down).https://www.trulyergonomic.com/store/index.php
tennisballfinger_rubber_band

Finger and Wrist Strengthening -Hold a tennis ball in your palm – and squeeze as hard as you can. Slowly, as you regain strength, you will be able to squeeze harder.

A simple stretch – involving a rubberband around your fingers can also work wonders at rebuilding finger strength .

Appendix A – Nerve Compression, Thoracic Outlet Syndrome

It is possible that part of your ELBOW and FINGER pain is related to nerves being compressed somewhere between the SPINE and the hands. There are so many possibilities here – but I’ll list the top two.

  1. Carpal Tunnel (median nerve compression) at base of hand.   There are several self tests available online to determine if you have this. Notably, you will LOSE pincer strength (thumb and index finger in a pinching formation) – among other symptoms.
  2. Thoracic Outlet Syndrome – Neck and Shoulder area in front of body  – another common, yet overlooked cause of finger and ELBOW pain. While a full TOS diagnosis requires lots of tests, a quick way to determine this is :
    • Ring and Pinkie finger weakness and pain – also possibly numbness and tingling. These two fingers are usually involved in TOS.
    • Holding your arms above your head – with elbows at 90 degrees – palms facing forward -  is difficult for a long period of time. Hold them this way – and try to open and close your palms quickly – for about 2 to 3 minutes. If you feel pain, fatigue in your arms and hands, you most likely have some level of TOS going on.
  3. Stretches for TOS and Carpal Tunnel or ANY NERVE Compression – I was REALLY impressed to find this YOUTUBE video – the THREE stretches in here cover ALL the three main nerves – median, radial and ulnar – that can be problematic. These stretches take less than 2 minutes.
  • Pingback: Finger tendonitis, Recovering from finger pain from typing | Anuj Varma, Technical Architect

    December 12, 2012 at 5:37 pm
    David Sandford says:

    I’m a little confused about the Straight Back elbow stretch. Is my arm supposed to be straight or at 90 degrees, palm up or down or facing inwards?
    Thanks for the great posting, I’m following as close as I can!
    cheers,
    David Sandford

    December 14, 2012 at 7:49 am
    Anuj Varma says:

    Forearm 90 degrees ( bent at elbow) and palm facing inside ( shake hands with the band). I should have clarified. Pull the band straight back ( towards your hip joint). Thanks

    January 31, 2013 at 5:49 pm
    Gary says:

    You did these exercises even while your elbow was inflamed?

    February 6, 2013 at 2:28 pm
    Anuj Varma says:

    Some amount of electro therapy ( to bring down the inflammation ) is a good idea before starting on the exercises. Maybe two weeks of ultrasound, laser and electrotherapy. Alternatively, aggressive icing and DMSO gel can bring down the inflammation. Every two hours, rub plain ice ( more effective than ice packs if your skin doesn’t mind) all over the elbow. This was my second bout of tEndonitis – so I skipped the physio, just did a little icing and went ahead with the strengthening exercises. The first time around, I did two weeks of ultrasound and electrotherapy before starting the stretching exercises.

    January 31, 2013 at 5:51 pm
    Gary says:

    and did you do these exercises while wearing your
    brace?

    February 1, 2013 at 11:24 am
    Anuj Varma says:

    Yes. The brace is to be worn at all times -especially during exercise. Some people even recommend wearing the brace at night while sleeping. I don’t have any opinion on that – I took it off before sleeping. You could tie a ‘crepe bandage’ around the elbow at night. This minimizes the impact on the elbow while sleeping on your arm etc.

    February 1, 2013 at 7:35 pm
    Gary says:

    thanks

    December 2, 2013 at 5:45 pm
    Jean says:

    Hi! Thank you so much for this post! Do this streches also help with golfers elbow?

    December 2, 2013 at 7:09 pm
    Anuj Varma says:

    The ‘straight back ‘ stretch works both golfer’s and tennis elbow. The other one works just the tennis elbow.
    If you’ve seen the ‘hammer’ exercise (keeping your elbow steady, use your wrist to lift and slowly lower a hammer, repeat), that works both as well. Hope that makes sense.

    March 28, 2013 at 6:09 am
    Vijay Pawar says:

    Hi Anuj,

    First of all, thanks for posting your recovery experience in so much detail. Reading this gives me some hope. I still regret the day I tried to change the exhaust/silencer of my Enfield Bullet. As the nut-bolt was very tight I exerted extra pressure on the spanner and it has been 3 months now and I am still in lot of pain. My left elbow hurts like hell even for the smallest action such as lifting my cell phone. I have had few weeks of physiotherapy – ultrasound, longwave and cold laser. I was not regular though. I used to skip some sessions. I was also lazy with the ice-pack thing. My physio advised me to apply ice-pack frequently, however i felt it boring so did not pay much attention. My ortho gave me pain killers for a week and suggested that I should take a cortisol injection in the left elbow, however my physio is against the advise of injecting cortisol.

    I am sincerly going to try all that you have mentioned in your post. I live in India and have access to homeopathic medicines, so will get those as well. I can just hope that some day I will get cured of this debilitating condition.

    The worst of my nightmares is: Will I ever be able to play golf again? I had joined a Golf club and was half way through the lessons when this happened. Since then I haven’t visited the greens. I am in love with Golf and it would be a disaster if I will not be able to hit the iron.

    Were you able to play golf again ?

    Thanks
    Vijay

    March 28, 2013 at 3:21 pm
    Anuj Varma says:

    Vijay:
    Firstly, the motorcycle incident was not the cause of your tennis elbow – it was simply the last step in a condition that had been building up for a while. ( elbow overuse).
    As for golf, while you can return to most normal activities after the elbow heals, I’ll give you the same advice my orthopedic gave me ( you’ll like it as little as I did) – stay away from golf for 12 months after it has healed.

    My main objective was to return to computer work – and I could hold off on the golf and tennis.

    While you might be one of the lucky ones and never have a reoccurrence , people tend to become ‘prone’ to this condition ( mainly because it is impossible to completely rest the involved muscles – anything you do with your hands, fingers involves the same muscles connected at the elbow).

    To avoid recurrence:
    1) continue with the stretching exercises – and wear the elbow band – even after your elbow heals
    2) take fresh cod liver oil ( good for overall joint maintenance) and fresh vitamin C ( very good for tendonitis) on a regular basis. The capsule form of these is not as effective in my experience.

    Also, invest in a good keyboard and mouse. Microsoft’s natural 4000 keyboard ( even better than the HP keyboard I recommended earlier) and a 3M vertical mouse – provide you with zero strain on your wrists and elbow.

    As for the injection, I actually got one in my left elbow. I cannot say that it helped in bringing down the inflammation. Some people claim to have had success with it – I just didn’t. IMO ice, and natural anti inflammatories ( like cod liver oil) were more effective in bringing down inflammation. Some US docs prescribe a topical compounded gel – ketamine, bupi, GABA mixture – which is very effective.

    In India, I would also get an acupressure guy to come to my house and do ‘pressure point’ ( called trigger point therapy in the US) massage. This , I found to be very useful as well.

    Hope that helps.

    April 2, 2013 at 8:56 pm
    Vijay Pawar says:

    Hi Anuj,

    Thanks for your detailed response. I am following your instructions and it is helping.

    On another note, I would like to share my recent experience. I read about your note on the Active Release Therapy. Incidentally I found a specialist who just treats joint pains, back aches and knee pain etc. He is not a regular doctor but from the field of Alternate Medicine. A Chiropractor precisely. He checked my elbow and to my supervise, he said the problem is not in the elbow but in the back. He pressed 2 points – one in the scapular region and the other near the L4 and L5 vertebrae. As soon as he pressed with his thumb, I almost shouted in pain. What he did next was interesting. He did some warmup of my back and neck and then he twisted my neck, shoulders and back. There was a series of cracking sounds and then the pain had magically disappeared. He then taught me 3 exercises for the shoulders and elbow and 3 for my lower back. He has given me some green colored oil made from herbs that I have to apply twice daily for 15 days and some multivitamin tablets. It has been 4 days now and I can say that my pain has reduced by 80%

    I will continue following you tips on using ice, natural vitamin C and stretches.

    Thanks for your time. It has been very helpful.

    April 2, 2013 at 9:01 pm
    Vijay Pawar says:

    Hi Anuj,

    I forgot to mention about the Keyboard and Mouse tip that you gave. I fully agree that keyboard and mouse play a significant role in these occupational disorders. I explored ergonomic keyboards and mouse and have finally concluded on these 2,

    1) http://www.kinesis-ergo.com/advantage_pro.htm

    2) http://www.evoluent.com/vm4rb.htm

    Before ordering them, I though I would share my findings and check with you on or your opinion about them.

    April 3, 2013 at 12:37 pm
    Anuj Varma says:

    Those are both popular choices. The kinesis keyboard has a slight learning curve – and, in my opinion, involves too much thumb usage. Some people prefer this. For me, with my tennis elbow, the thumb was somewhat weakened – and an overuse of the thumb did not suit me. I still prefer the microsoft natural 4000 over the kinesis – although for serious RSI users, Kinesis seems to be a popular choice.
    As for the mouse, the vertical mouse is the way to go. I tried evoluent and 3M’s vertical mouse. THey are both very similar – the only thing that won over 3M for me was the super light weight of the mouse. It shouldn’t matter to a normal user – but again – for severe tendonitis (a weak wrist), the evoluent mouse is just a bit too heavy to push around.
    This is just my experience – obviously, several people are happy with both these products – which is why they are popular.

    August 9, 2013 at 5:36 pm
    Chinmoyee says:

    Thank you, for such a nice information in such a great detail. I have this Tennis elbow (very severe, where on 1st few days I couldn’t even move the arm a inch) now for more than 2 months (though quiet bearable) but I still continue to lack strength in that arm, mostly forearm. Any further tips. I do not like to take medicines, I don’t want to take Cod-liver oil fresh, I take fresh fruits, vegetables, Oilve oil and Milk. which might have sufficient Omega – fatty acid and Vit-A & D. I will try to do these exercise now on, which I wasn’t regularly doing, but it hurts. I am mainly having difficulty to lift anything and even a slightest weight makes my arm feel like a weak piece. Thanks in advance
    & God Bless

    August 9, 2013 at 5:39 pm
    Chinmoyee says:

    Forgot to mention that I got this Tennis elbow, on my 1st time Squash session, which was intense, and probably and mostly I didn’t used the correct technique to grip and throw shots. later I learned but my arm isn’t anymore in form to play the next session.

    August 9, 2013 at 6:07 pm
    Anuj Varma says:

    Yes – I feel your pain. I was unable to lift a glass of water.
    Just keep doing what you can to a) lower the inflammation (all the inflammation fighters you can find) b) Strengthen the joint. Avoid the activities (tennis, golf etc.) that brought it on.
    The only long term fix for this problem – once you recover some strength – is to build up joint strength so that this does not occur again. In my case, I joined a gym and stuck to a workout regimen (arms and upper body).
    I would also recommend a consultation with an actual homeopathic doctor – as of this writing I know of 8 friends/relatives – all of whom have gone through a bout of tendinitis – that was finally fully cured through homeopathic doses. The exact medicine and dosage is very individual – depending on how the problem was brought on – and how long it has persisted. So – I would avoid any ‘internet searches’ and speak directly with a homeopath if you can.
    For some reason, western medicine is at a loss to cure tendinitis – beyond offering pain killers and prolonged physical therapy. I learnt this after speaking with several good orthopedics – one of whom himself suffered for 2 years from tennis elbow.
    Good luck – and speedy recovery.

    August 12, 2013 at 11:30 am
    Chinmoyee says:

    Thank you :)

    October 23, 2013 at 1:32 am
    neophytos savvides says:

    i will appreciate if you can video record the resistance band exercise and post in somewhere so i can understand it better
    thank you very much for what you are doing to us

    October 23, 2013 at 6:27 pm
    Anuj Varma says:

    Good point. I’ve been meaning to do so. Meanwhile you can see the images here - Fig 6 is almost identical to the ‘straight back’ stretch – and the other one simply stretches the band ACROSS your chest to the opposite shoulder (instead of straight back as in Fig 6). I will try and have the video up sometime. Also , check out this pdf – I think these exercises are all helpful.
    https://www.orthocenterillinois.com/pdfs/Tennis-Elbow.pdf

    October 25, 2013 at 5:13 pm
    carmel from Dublin says:

    Thank you so much for the unselfish sharing of advice and experience. I had severe tennis elbow for 3 years, nothing worked but time and some exercise. Unfortunately my other arm has now begun to show signs which is why I looked on line for information. I will follow your advice and hope I can catch it before it becomes unbearable. It is a very misunderstood and painful condition.

    November 7, 2013 at 11:35 pm
    Viveck says:

    Dear Anuj ur article was really helpful to understand the therapy the conclusion drawn by you is almost alike to me the only diff bet is in India i dont know how all things are available or cna u provide me the brand names of the same

    January 2, 2014 at 2:11 pm
    evey says:

    Hi thank you for your fab info but i have been doing the exercises 1 and 2 and now my upper arm above elbow hurts, is this normal? Thanks

    January 2, 2014 at 7:50 pm
    Anuj Varma says:

    I don’t recall that happening to me – but in my case it was my fingers and hands and other parts of the arm that would hurt.
    I am convinced that tennis elbow is as much due to a weakened upper body (upper arms, shoulders, neck..) as a weakened elbow.
    At some point, when you are able to lift light weights , I would encourage a ‘strengthening’ regimen. Multiple reps with light weights – for all your upper body muscles (biceps, triceps, lower, upper back , neck) . This strengthening should help avoid future relapses.
    If you can feel the elbow strengthening with the stretches, you can continue the stretches . If your pain is unbearable, try and go back to reducing inflammation first .

    January 5, 2014 at 7:34 pm
    Kay says:

    Your web page has been so helpful. Thanks. The question I have is can you use a home ultrasound? If so, do you have recommendation on treatment?

    January 5, 2014 at 10:47 pm
    Anuj Varma says:

    Yes – I did use a home ultrasound for about two months. I used the US 1000. I would set it to the highest setting (it has low, med and high) – and perform a circular motion over the painful area. It did help. 10-15 minutes per session – and two sessions per day. If you can get a home electrotherapy (TENS unit) alongside the ultrasound, you will have much better results. The ultrasound is more penetrating and has depth – whereas the TENS unit is more broad based and covers more surface area. Also, buy plenty of extra GEL for the home ultrasound – it runs out fast if you use it twice a day.

    February 7, 2014 at 5:32 am
    NotConvinced says:

    This website is a joke. your sole intention is to try to get us to buy the products you are recommending so that Amazon can pay you for redirecting us there. How can you recommend several products to do the same job? Ridiculous!!

    February 7, 2014 at 11:30 am
    Anuj Varma says:

    I appreciate your feedback. The ‘so many different products’ listed on my blog post represent about 25% of what I tried.
    Had I listed every product I had tried, I would have ALL tendinitis related products on amazon and other online health stores.
    You are under no obligation to buY Or try ANY thing listed on this blog. And if you had had the same condition as myself (bilateral tennis and golfer’s elbow), you would have been virtually handicapped – and tried just as many things.

    The intent of this post is to save sufferers time and money – I spent over 30k on my own treatments – including special trips to healing centers in India.

    There is NO intent on my part to make any money or get anything out of this post except provide relief to tennis elbow sufferers!

    February 8, 2014 at 10:24 pm
    Siddhesh says:

    I m only just into my teens, however i play a lot of tennis and very active into sports… i m feeling slight pain in my right elbow, and the pain continues in my arm… it is not so severe that i cant open a door or shake hands etc… i can play tennis as normal but my arm hurts… i have International tournaments coming up… How can i recover from this injury/reduce the pain ASAP… Is it possible to play without pain for next 1 month or so… Since i have a tournament? Thanks for the help

    February 8, 2014 at 11:07 pm
    Anuj Varma says:

    I would see an orthopedic or a good physical therapist. He/she will tell you whether you are in any condition to continue playing or you should avoid play at this time.
    Based on what little you have told me, if you avoid playing and ice aggressively, your pain should go away within 2-4 weeks. You have to then STRENGTHEN the elbow to avoid recurrence. That involves stretching and light weights.
    About 2-3 months of strengthening – and you should be able to resume play (again , I would recommend seeing an orthopedic to be sure about the level of your tendinitis).

    February 8, 2014 at 10:39 pm
    Siddhesh says:

    Adding to my above comment, you can tell i m very young… so total rest may not be possible, is there a way to recover/decrease the pain with ice and exercises that you can tell me… I will greatly apprieciate the help as i m not so comfortable with telling my parents yet, trying to do what can be done by me before they step in… I would really apprieciate if u could guide me through avoiding this pain and recovering with ice and exercises as i dont have ultrasound and high tech gadgets etc… Maybe after my tournament i will complain to my parents about this pain and then see the doc. Thanks… Hope to recieve a reply ASAP

    February 8, 2014 at 10:54 pm
    Anuj Varma says:

    Ask your doc to give you a strong anti inflammatory – like naproxen. 1000 mg per day – for 7 days should bring down your inflammation substantially.
    Check with your doc as these meds have side effects (mainly restlessness and excessive dry mouth).
    And wear an elbow brace during play – to absorb part of the shock. And keep icing immediately after playing.

    February 8, 2014 at 11:05 pm
    Siddhesh says:

    Is there anything i can do for a few weeks without consulting a doc, because then i wont be able to participate in the tournament

    February 11, 2014 at 4:22 pm
    Amy C. says:

    Thank you Anuj, for all of the great information you provide about this very painful condition. All of your information is very accurate. I just received my second cortisone injection – you’re right, VERY PAINFUL for 24-36 hours. After that, I am one of the lucky ones…total pain relief for 3 months but then it came back with a vengeance. Next I am going to try some of the treatments listed on your site before looking into surgical procedures.

    February 25, 2014 at 7:37 pm
    Lisa Coker says:

    Your post has been a lifesaver. Have been suffering 2-3 weeks now. Icing, resting, NSAIDs, stretches, and massage. Just found keyboard amd roller mouse that goes on wrist pad before seeing your post. The TENS unit is the lifesaver. My husband had one from a back injury. I type for a living, so today I was actually able to type without pain wearing the TENS. Going to do all your other recommendations as well. Thank you, thank you!!!

    April 2, 2014 at 10:05 am
    John says:

    Thank you Anuj for all your advise, I have just started to follow your advise.I have been off work for 5 weeks and only very little improvement…I understand that you had this for about 6 months when your first had it.Did you go to work then?How long were you off sick?Did you face any issues with your employers.How did you deal with that.Please advise.I hope it will help if you spare your time to share a little bit more of your experience. Thanks in advance

    April 2, 2014 at 1:52 pm
    Anuj Varma says:

    Some people are able to convince their employers that this is a disability of sorts (esp. if they are unable to type at all).
    I was able to take time off (being self employed helped me) until I healed to a point where I could type. I would say I was off for the most part of 6 months (my problem was multiplied by 2 – since I developed tennis elbow in my other arm even as the first one was still recovering).

    Some things that have helped others:
    1)TENS Unit – This provides instant relief – and many people (including myself) were able to continue typing with this unit attached.

    2) DMSO Gel – Although this itches like crazy, it also provides instant (as in next day) relief. And the best part is that this relief is permanent – it actually reduces inflammation faster than anything else I have tried. Even now, if I have the slightest start of a twinge, I apply this Gel – and I am good to go within the next day or two. Again, keep the skin reaction in mind – there is no bypassing that (you can apply vitamin E oil to soothe the skin after the DMSO has soaked in).

    3) PRP (Platelet rich plasma) therapy – This is something I haven’t tried. But I know, if I ever had to do it all over again, I would start with this. Although the jury is still out, there is mounting evidence that this provides fast and permanent healing of most tendinitis conditions.

    April 3, 2014 at 5:20 am
    John says:

    Thank you so much Anuj for your kind and prompt reply..The tens unit has just arrived.I have started using the elbow brace and it is definitely making a difference.I am going to the homeopath today….I shall keep this forum updated with my progress and god bless you for sharing all these information.

    April 3, 2014 at 6:02 pm
    Soo says:

    Thank you SO much!This is the most useful site I have seen. I am a weaver/harvester/artist, so I guess you could say I have weaver’s elbow. Absolute misery and fear.Both arms are in physio. At least my legs are getting a great workout pushing doors open. You give me hope to face the slow battle of recovery. Information IS power!

    May 7, 2014 at 12:43 pm
    Tess says:

    Anuj, Thank God for you! I, like many, stumbled on your site and gained the best insight available. I ordered everything. First came the DMSO, which doesn’t itch, it burns! Feels like my flesh is being eaten. However, a couple hours after using it, I felt so much better. After 2 days, I went from 10% usage of my hand to about 60%. Just doing that. Now, about the TENS unit. I’d love your insight on placement and intensity. I’ve tried a bunch of combos and can’t perform work with any of them! It’s not critical but I’d love to know exactly how you used it. At present, I’m holding steady at about 60%. I put Kinesio tape on for a couple days, then do 2 days of aggressive ultrasound/TENS/DMSO. Ice, stretching and exercises throughout. I seem to be holding steady with no progress but at least the pain/function is livable now. Also, I find that if I wrap or put a brace on my wrist while working (typing), it’s a huge help. You don’t want to engage the wrist muscles AND the finger muscles that all lead to the elbow. Thanks again!

    May 8, 2014 at 5:37 pm
    Anuj Varma says:

    Tess:

    While there is a standard TENS placement chart (google TENS placement chart elbow), I tried a few variations.

    Basically, the forearm extensor muscle runs from the elbow to the hand (just do a google search for a picture of the muscle, but if you follow the pain from your elbow, it will track along this muscle). Pick ANY two separated points on this muscle – I would pick one close to the elbow – and another one closer to the hand (wrist area).

    Another thing that helped me was picking BOTH – the inner and outer joints of the elbow. I picked the Golfer’s elbow as well as the Tennis elbow points – and that seemed to really work the entire forearm.

    Basically, where ever you feel pain and/or lack of circulation, is a good candidate for an electrode placement. For e.g. – I would feel poor circulation on the back of my hand – and would sometimes place an electrode there (at a lower current than for the forearm).

    The intensity – is a personal preference. For the hands, fingers – a low, pulsing treatment gets the blood flowing. For the forearm muscle close to the elbow, a higher setting works better. I would increase the current until I could feel the muscle start to throb. Most physical therapy places will tell you to stop JUST short of the throbbing point – and that is fine too. I felt it did more good AT the throbbing point – especially on the forearm.

    On the fingers/hands – you want to keep the current low – a small current is enough to get the blood flow going.

    That was how I worked it for the healing phase. For the ‘working with the unit attached’, it is best to keep the intensity LOW – since you will be keeping it on for a prolonged period of time.

    September 10, 2014 at 6:20 am
    chris says:

    Hello Anuj and thanks a lot for sharing your story. i got a bad tennis elbow from working out + playing ping pong. For 2 months i was very bad and i have tried a lot of things and nothing helped.After that i did some physioherapy ( 10 days ) and the pain started to go away and now i’m fine…the pain is totaly gone.The question is what to do now because i’m scared that the pain to not come back..Should i do some exercises ? i wait your answer and thanks again . :)

    September 13, 2014 at 12:54 pm
    Anuj Varma says:

    Chris: I have become a big fan of STRENGTH TRAINING. I joined a gym – where they have strength training classes (the class format ensures that I get through 1 hour, if you are disciplined enough on your own, you can do without the class). TWICE a week – but at the minimum – at least ONCE a week, STRENGTH TRAINING – will ensure that your episode never recurs. It will strengthen a) MUSCLES b) TENDONS .
    WEIGHT Training that focuses on upper body – especially wrists, elbows, biceps, triceps, shoulders – are all great. To me, there is nothing that is more effective than this for avoiding any future recurrence (I never realized how weak muscles get left to themselves, and simple cardio like running etc. does NOTHING to BUILD muscle strength!)
    In addition, if you are into supplements, a combination of GLUCOSAMINE, MSM and CHONDROITIN keeps joints healthy. If you haven’t already, you can research the various brands that sell this particular combo. Several people report that their joints feel ‘younger’ as long as they take this supplement.


    Leave a Reply

    Your email address will not be published. Required fields are marked *