Recalcitrant form of tennis elbow

[taoist]

HI RJ

Having trained in Chinese acupuncture, the application of Cold is seen to restrict the flow of that which is needed to promote healing, in their terms "Qi and Blood". The normal treatment method is to improve local flow using heat (either Moxa or heat lamps) and needles, probably with electro-stimulation. Ice may be useful in the acute and sub-acute stages, but chronic injury seems to respond better to heat. Injuries such as TE are seen as "Overwork" which tends to cause a local "deficit" of Qi and Blood, leading to "Stagnation" that causes pain and inflammation, so stimulating the area would be the normal approach, depending on the type and age of the person involved. It's a fuzzy kind of logic, but certainly one that is based in years of continuous observation and refining.

I'n my clinic, I'd probably use a combination of heat, massage, needles and electro, and expect to see a positive result in around 6-8 treatments

[mcasus]

I agree that ice in acute and sub-acute stages, and heat in chronic is helpful for most people. But to be clear for the questioner, prior to returning to the activities that caused the TE in the first place, you want to be sure that elasticity has returned to the tissues, which means having some appropriate stretching exercises to do on a regular basis, and some strengthening exercises of the muscles which have no doubt lost some strength after months of inflammation. If you are being followed by a Physio, presumably these techniques have been suggested. If you aren't then I strongly suggest you consult a Physio for a home program of strategies to get you past this.

[RiderJen]

Thank you for your comments; I'll address each topic in a separate paragraph:

CHANGE OF LIFESTYLE:
Aside from my full-time job, my lifestyle activities (prior to onset of this problem) primarily involved cycling and gardening, amateur photography (using a DSLR), baking/cooking, and knitting. I also enjoy (er, enjoyed) fitness walking and trips to the gym to work out on the spin bikes, eliptical machine and/or treadmill, along with some of the arm and leg machines (NO barbells). I took rest days --- I'm NOT an exercise/activity fanatic, just try to have some exercise most days of the week. I haven't ridden my bike since last December when my doctor restricted me from riding, gardening, and every other fun activity that might cause pain in my shoulder (until February, I was getting PT for rotator cuff tendinosis/tears). I also stopped gardening and knitting and rarely took pictures of the garden since the garden was going to pot anyway. After months away from our cycling group (a MAJOR source of social activity and sunlight) and gardening, I was starting to feel depressed. Desperate, I started doing some "light" gardening, taking care to use good body mechanics, wear my elbow band, and use my left hand whenever possible. I've also been taking some garden pictures which I share and keep to record progress -- a hobby that brings me great pleasure. I stopped baking and knitting because they aggravate my shoulder and elbow -- but, so does taking pictures and gardening. Meanwhile, I caught a bad cold in late March, then Shingles in early April; sick for 5 weeks, I didn't do any exercise which led me further down the slippery slope of mental depression. I'm recovered from those now, but there are other signs of a weakened immune system. I have ALWAYS been a very healthy person and wasn't often sick. I had an ergonomic evalauation of my workspace, which seems to be fine (I also sit in an ergonomic chair which I love).

ONSET/TREATMENT
The tennis elbow pain began in early January while I was under the care of a physiotherapist and sports orthopedic surgeon for the treatment of rotator cuff tendinosis/tears. Shoulder PT began last November, and the pain only worsened each week while I obediently and religiously followed their instructions to the letter doing the exercises and stretches at the PT appts. and at home. They finally decided that PT wasn't really helping my shoudler and that things looked very likely I'd need surgery, so we stopped shoulder exercises until my next doctor appointment in mid-Feb. Meanwhile, the tennis elbow pain began in early January and by mid-February was much more painful than my shoulder; my doctor wanted to focus on healing the elbow before resuming treatment of the shoulder, so he sent me back to PT for new stretches/exercises as well as ultrasound, massage, and and the elbow band --- however, like the shoulder, the elbow continued to worsen. Perplexed, my doctor (a very reputable sports orthopedist who specializes in elbow/shoulder injury) ordered an MRI which I had to postpone 2x due to Shingles, and seemed ready to advise that the next step is surgery (he is not a proponent of cortisone shots and didn't seem to think it would help in my case). I stopped seeing the PT until the MRI to determine how to proceed, and the MRI is still pending while I decide what to do next.

ACUPUNCTURE
Funny you should mention that --- a member of our bike group asked if I've tried acupuncture. What do I look for in a good acupuncturist to treat tennis elbow?

OTHER
I am doing some stretching and mild strengthening exercises at home, using the book "Fixing You: Elbow and Shoulder Pain" (by Rick Olderman), to keep my shoulder flexible and improve scapular strength. I do them with care, following his instructions, to stay within the boundaries of pain. Pain has not improved (yet) but my shoulder ROM seems excellent. This Friday, I have an appointment to consult with a DO who performs Prolotherapy treatments. She is highly trained in the field. On the first visit, she will spend an hour assessing me which will include an ultrasound test of my elbow; if I qualify for Prolotherapy, she can do a treatment on that day. I need to get verification that my insurance will help pay for Prolotherapy; if not, I may seek another type of treatment.

Am I frustrated? Very much so. Every physical activity that I enjoy causes pain, including walking (due to the natural arm-swinging motion... nothing vigorous, just the natural movement causes intense pain in my elbow). One activity that also causes a lot of pain is getting ready for work in the morning --- it's impossible to put on make-up and style my hair with one hand. I vanpool to save gas $$$$$$$ and to also avoid stress on my elbow while driving (my car has a manual transmission); the van leaves at 5:35 AM, so my morning routine is rushed starting when I hurl myself out of bed after a poor night's sleep. By the time I'm on the van, my elbow is a wreck and doesn't settle down until a few hours later. So, I could say that the activity that causes the MOST pain is getting ready for work, but that's one activity I cannot curtail. :-(