TargetTalk

As you might have guessed from the subject line, I'm fighting recurring tennis elbow. I've had it checked, and the Dr. says no surgery is required. Just rehab. But, every time I work these muscles, via *any* gripping motion, the tennis elbow pain returns.

Here's the question. If usage of these muscles causes the pain to return, how do you ever solve tennis elbow? Do I just keep working them and hope that the pain will disappear one day? Or is this a lost cause?

Merry Christmas to all.

Stan

Every case is different Stan.

I developed really bad tendonitis in the early 1990s, I couldn't even lift a cup of coffee at arm's length.. After trying all sorts of treatment and excercises, the doctors from the British Olyimpic Association medical centre gave me two options; have an operation or stop shooting for a year. They were wrong, it was nearly 2 years before I could lift a pistol again.

Tendonitis is nasty. I had it in my fingers, and it still flares up occasionally. One thing to keep in mind: it has a positive feedback property. Once you tick it off beyond a certain level, the more you annoy it, the worse it will get, and the easier it will be to annoy it.

The first thing you have to do is to get it below that threshold. That usually means not doing a lot of things you enjoy & love for a considerable period of time. Anti-inflammatories like ibuprofen can help a lot. Vigorous exercise with other parts of your body will help. Basically, anything that improves your circulation to help drawn down the fluids swelling your tendon sheaths is a good thing.

Then, you need to be very careful reintroducing the activities that inflamed it in the first place. My doctor recommended heat before hand and ice afterward to help to keep things from spiraling out of control again, and I think that has helped me a lot.

Good luck.

Curious, what gun/s are you shooting? It never bothered me a bit until I moved to my first pistol with a raked grip (Benelli MP95). It quickly got quite bothersome. I ended up selling the Benelli for that reason - only to find out shortly thereafter that I was gripping it much harder than necessary. With the raked grip and a good-fitting set of anatomical grips, you can get by with a pretty light grip. I now shoot a Pardini, which is probably one of the steeper grip angles out there, and will feel a hint of it on occasion, but for the most part it's gone.
Also, getting back in to weightlifting seems to have helped it. No specific exercises for it. But I think just stressing/building the area indirectly with weights is a good thing.

I've been dealing with tendonitis since 2004. It happened while playing basketball with my son 2 weeks after I ordered my Match guns, I wasn't able to hold a gun for one year to much pain. Still today by the time rapid fire come up my elbow is getting sore.I need to do the stretching exercises the Dr. geve me to loosen up the muscles so the tendon isnt always tight and pulling against the bone.

You have my sympathy, I have experienced tennis elbow and the euphemistic name just does not convey the misery of the complaint.

My condition had developed from an initial acute episode to a recurring chronic condition over a period of about 3 years. I had most of the conventional treatment, from wait and see, exercise and then a series of cortisone injenctions. When nothing seemed to prevent another episode my doctor announced that the only recourse was surgery and proceeded to describe in detail the procedure and its implications. I was not impressed! A work colleague had suffered similarly many years before and he had resorted to acupuncture to find relief, so I put this suggestion to my doctor. His response was, "Give it a try. we can always cut you up if it doesn't work".

So, I gave it a try. I found a doctor who provided acupuncture and consulted him. He was very open about the treatment and his main points were:

1. There are no guarantees that it will work.

2. He was doctor and would examine me as such. If he felt that my condition was more properly suited to treatment by conventional methods then that would be what he would advise. He would not offer acupuncture.

3. He suggested a course of 5 sessions. About 50% of those that it would help would experience an improvement after the first session and this pattern would be repeated until the last session.

4. If it had not worked after 5 sessions it was not going to work.

5. If at any point I felt that it had achieved the desired result then that was the time to stop, there was nothing to gain by going on.

6. If at any time I felt that nothing was being achieved then that to was the time to stop.

and finally, again

7. There are no guarantees.

I opted to try acupuncture and off we went. he stuck the needles in and also gave me a few simple exercises to complement the therapy. The most important one was a transverse massage of the tendon attachment point. I had 4 sessions and decided that I had achieved sufficient improvement and did not need to continue. I carried on with the exercises and within 6 months my symptoms had completely gone and have never returned.

That was my experience.

You may also wish to consider that, clinical trials have shown that tennis elbow is one of the conditions that does not respond to acupuncture!

Good luck.

Rutty

Stan, you're killing me. We talked about this many times. You want to shoot again, you have to start a physical therapy program, committed and long term, as important as any work with the pistol.

In the case of somebody with the elbow and shoulder problems you have had; the creditability, the success, the glory is not measured by the scores you shoot, but by the simple fact that you compete again and promote the sport.

You have to strengthen your entire body and all the arm muscles. By having a stronger overall arm, you reduce the load on the specific muscles that are pulling on the tendon. You improve the blood flow etc.

You have to apply some heat to the elbow before you start training and ice as soon as you finish any training.

After I put in my hard wood floors, I could not pick up a a fork. And I had already had the symptoms of chronic problems. I no longer have any problems but work out very hard, a complete upper body work out. And I ice the elbow most of the drive home after any significant training or match event.

You can do it, with the long term determination and commitment, no short cuts.

Everybody's definition of success is different. What is yours? Now what do you have to do to achieve that success?

Tendonitis is inflammation of tendon.

I hosted a #1 US girl 16's player at my house when she was playing in the Orange Bowl tennis tournament two weeks ago. She developed a case of acute tennis elbow when serving too hard during her previous tournament 4 days ago. Her mother was quite distraught about her prospect of playing in this and subsequent tournaments. I examined her, she has a very discrete tender spot on her tendon. I think she either has a tendon strain or microtear.

I offered my diagnosis and treatment. They agreed. So I injected the area with 0.25 bupivacaine (local anesthetic) and Depomedrol/ decadron (long acting steroid, short acting steroid) with 24g needle (very small diameter, would not aggravate the tendon microtear). I gave her Tylenol and Motrin every 8 hours, staggered by 4 hours, so Tylenol / 4 hours later Motrin/ 4 hours later Tylenol/ 4 hours later Motrin. She is a very coachable player, followed my instruction to the T.

I thought she should let the arm rest. But the girl thought they have come a long distance at a great expense, so she wanted to continue playing on the proviso if she feels pain, she would stop immediately.

To her amazement, she was able to keep on playing at full throttle during the entire tournament.

So for me, the best acute treatment is local anesthetic/ steroid injection, pain med Tylenol acetominophen/ anti-inflammatory Motrin ibuprofen. And rest, unless if it unavoidable as is the case of this #1 ranked girl player who is very competitive.

Seamaster wrote:. . . . . . So for me, the best acute treatment is local anesthetic/ steroid injection, pain med Tylenol acetominophen/ anti-inflammatory Motrin ibuprofen. And rest, unless if it unavoidable as is the case of this #1 ranked girl player who is very competitive.

I always thought that an anesthetic would cover the pain so one would not know of additional injury that could be caused by playing "through the pain" which no longer can be felt.
Thanks for your view.
Ben

bupivacaine is a local anesthetic. It has a duration of 4-6 hours. It is used in injection to provide immediate pain relief. Hopefully the steroid (used for its anti-inflammatory property) would start to take effect by the time local anesthetic wear off.

Everyone,

Thanks for the replies.

I forgot to mention that I have had this injected once. It helped for a while, but as soon as I worked it much, the tennis elbow (TE) pain came back. Also, when nothing worked early in the process, I took Doc Sexton's advice and immobilized the wrist involved using a brace. I wore it for about two months and then the pain went away.

Several things have been mentioned that I will give a try:

1) Overall physical conditioning, including specific exercises for the arm and shoulder. This should make Pete happy. ;-)

2) For my rehab after both shoulder surgeries, the rehab folks applied heat, the rehab was done, then followed by ice. I must confess that I have not tried heat on the tennis elbow site before working it. So, the heat-work-ice routine I will try.

3) I've tried oral anti-inflammatory meds with no real results.

4) MSC asked if I had changed pistols. No, but you reminded me of one change. Sometime before the TE showed up, I started using a much harder grip pressure for AP and FP. I suppose the increased gripping strain might be the "tipping point" for the TE, but I can't say that for sure.

I have been using a TE band to protect it whenever I am doing something to work it. But, the band is not legal in a ISSF match.

If all else fails, I may try becoming just a FP shooter. For FP, I used to use moderate grip pressure ("caress" describes it well) before going to a hard pressure. I'm now thinking about trying the very light grip pressure technique that I've read and heard others talk about. I suppose that would involve hanging the FP out there, comfortably resting the fingers on the grip, and also using a much lighter trigger pull weight. It would seem that this technique requires little, if any, actual gripping of the pistol. If anyone with TE has made this change, I would like to hear your results.

Thanks to everyone for your replies. My training/competition schedule starts next week and runs through late June/early July. So, we'll see what happens.

Stan

Stan,

I would look at other things you are doing that could be also causing the issue. I have the same thing start to happen every year when I start to shoot bulls-eye. It also flairs up when I work a lot. The majority of my day is spent on the computer and if I have some long weeks and I am shooting a lot I notice it.

I think the root cause for me is extended time on the computer. I have a very good set up when I am working in the office but not at home. When I train for any pistol I wear the brace and also for all BE matches. The only time I do not wear it is when I shoot free or air pistol matches.

Hope it helps.

Like most soldiers in the US Army, I started off with the 1911 shooting 230 grain hard ball. My shooting hand became a bloody mess when the web between the thumb and trigger finger was pinched by the hammer when it cocked. Next my elbow started hurting so bad I could not lift the pistol to firing position. Out of a combination of frustration, pain , and anger I dropped down and did 20 one armed pushups. There was less pain. The next day I did 30 of the same pushups and there was still less pain. I had been babying my shooting arm and muscle strength had deterioted to the point that the recoil of the heavy loads were probably slaming the elbow joint togeather on every shot. I do not want to reccomend to any one that they should try this. I did it out of stupidity and desperation and got away with something that could have been a disaster. Good Shooting Bill HOrton

Chris wrote:. . . . I think the root cause for me is extended time on the computer. I have a very good set up when I am working in the office but not at home. . . . . . .
Hope it helps.

I agree, Chris, my elbow pain came from the computer and excercise helped cure the problem.
Ben

My wife suffered from the same symptoms,bought on ,in her non-dominant left elbow,by some extraneous activity.I might add that she is an enthusiatic vacuumer,so her right arm is in top condition.. After three cortisone treatments,which provided some positive, ableit temporary, relief,she underwent a small surgery which involved a tiny bolt to strengthen and reattach the tendon. While still an enthusiatic vacuumer,she has been pain-free for several years . This might also support the strength and exercise regime theory...perhaps a sound pre- season ,pre-emptive conditioning program is the real answer...

Hello Stan.

I have had these problems too, and they are frustrating and serious, if you don´t listen to your body you could be forced to rest from shooting 1-2 years.

My general advice:

Rest from shooting at least 3 months. Massage of the sore muscles every day, you can do it yourself and light stretching especially bend the hand carefully down to the maximum point and stay there for 30 sec and repeat this 3 times. That helped me a lot!

Use this long break to build up strength and stamina in your entire body. And exercise with light loads about 20 repetitions/exercise and different angles to build up all muscles. Don`t overdo it, 3 days a week and a day off between every session.

When you go back to shooting always warm up and light stretching of your muscles. Shoot shorter sessions, but instead more often, take short breaks in your session and stretch afterwards too maintain flexibility.

And when the pain comes back sometimes quit what your doing and stretch your mucles.

Use a grip that supports the hand, but a grip could never replace fitness. My experience is that freepistol is the hardest discipline for this painful condition, so you could consider to shoot more airpistol for a period of time.

I've got some arthritic condition in many joints. Naturally, the ones I aggravate become inflammed. Shooting sets my elbow off. I agree with all that has been said in this chain. It's a matter of overall conditioning as well as joint health. I've found swimming to be a good way of circulation without beating the joints. Always warm joints up before using them, then ice them afterwards. I used to watch Karl Malone play basketball. When he'd finish the game, ice bags went on his knees.

Diet is important as well. For me, more omega 3s and less of the pro-inflammatory fats.

Stretching (press closed fist straight down on table, roll forward over knuckles until top of hand approaches table. Grip forearm below elbow and stroke tendons downward. Release and place open hand on table. Rotate arm forward until you feel a stretch up fingers to arm muscle. Stroke tendons again. Finally, with your arm extended in front of you, squeeze top and bottom of arm below elbow area and flop arm up and down. Your hand will flop and this will work those TE tendons loose.

These things are good to do daily. But, especially in a match or training, loosen the grip once in a while, shake things out, stretch as necessary.

I practice pellet in my basement. I rotate and shoot left handed as well. This gives my RH a break, and builds the shoulders more evenly. And, I'm still improving my shooting as it requires the mind to focus on trigger, grip, sight. Sort of like cross (hemisphere) training.

I've got some arthritic condition in many joints. Naturally, the ones I aggravate become inflammed. Shooting sets my elbow off. I agree with all that has been said in this chain. It's a matter of overall conditioning as well as joint health. I've found swimming to be a good way of circulation without beating the joints. Always warm joints up before using them, then ice them afterwards. I used to watch Karl Malone play basketball. When he'd finish the game, ice bags went on his knees.

Diet is important as well. For me, more omega 3s and less of the pro-inflammatory fats.

Stretching (press closed fist straight down on table, roll forward over knuckles until top of hand approaches table. Grip forearm below elbow and stroke tendons downward. Release and place open hand on table. Rotate arm forward until you feel a stretch up fingers to arm muscle. Stroke tendons again. Finally, with your arm extended in front of you, squeeze top and bottom of arm below elbow area and flop arm up and down. Your hand will flop and this will work those TE tendons loose.

These things are good to do daily. But, especially in a match or training, loosen the grip once in a while, shake things out, stretch as necessary.

I practice pellet in my basement. I rotate and shoot left handed as well. This gives my RH a break, and builds the shoulders more evenly. And, I'm still improving my shooting as it requires the mind to focus on trigger, grip, sight. Sort of like cross (hemisphere) training.

Hello Stan and everyone

I've been suffering from severe tennis elbow as well. Tried physio for 6 months and resting for 2 months and lots of ice and cortisone too (wore off just before the my big match overseas). All of it helped to a certain extent but nothing fixed it.
One thing I tried, with my LP10 in particular, is change my grip angle. I’d been shooting with a nearly square or straight up and down grip for a while (most of the year). I changed to a rather aggressive rake where the knuckle on my little finger is nearly pointing down.
I’m not an expert, but this has made a dramatic difference for me. I can easily shoot 70 or 80 good shots in a session before getting too tired to continue. It almost seems to disengage the tendons on the top of the forearm since they don’t have to hold up the weight. I’ve also had to increase my grip pressure a bit to keep the front site from drooping. I do still have to work on strengthening and I still ice after I shoot to be safe. But, from being 2 weeks away from selling it all and giving up, I have hope again.

Hope this helps.

Pat

I've found some of the aikido wrist exercises to be good for tennis elbow. Try http://www.aikido-world.com/highlights/ ... t-list.htm