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Injuries of the elbow usually begins in the forearm muscles and move up to the tendons where they attach to the elbow. When the muscles get overused from tennis our bodies naturally lay down scar tissue (which is like paste) to quickly "glue" the damaged areas back together so they heal. Unfortunately, scar tissue can stay around much longer than necessary, making muscles tight and weak as well as gluing them to neighboring muscles. Worst of all, scar tissue can make muscles or tendons very pain sensitive. With scar tissue, the muscles can be pre-loaded with tension and will start pulling on and irritating the tendons at the elbow whenever you use your arm. Thus, additional scar tissue will form at the tendons. This can make playing tennis or even simple tasks like picking up a glass of water painful.
From the Marin Independent Journal about tennis elbow and Dr. Fung...
THE PAIN OF TENNIS ELBOW: ATHLETES TRY TO FIND RELIEF FROM CHRONIC INJURY
Holly Woolard, Marin Independent Journal
THEY ARE the two most dreaded words in tennis, carrying such negative connotations that players would rather be diagnosed with the plague.
It's easy to blow off initial soreness, but as pain gravitates to the outside middle of the playing arm, discomfort makes it nearly impossible to, say, grab a half gallon of milk out of the refrigerator. Tennis is basically out of the question, rendering a pastime to a past life.
The biggest bummer about tennis elbow is that you typically don't think about it until after it strikes.
"Tennis elbow will find itself in the age group between 40 and 60," says Sharon Skylor, a Corte Madera physical therapist who specializes in chronic pain relief. "People wait until they get it. They don't think about it."
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Although there are a few preventive steps one can take to thwart tennis elbow, the nature of the injury is a result of repetition, which is tough to evade. Due to overuse, micro tears form on the tendon that attaches muscle to bone. Scar tissue builds up to repair the tiny tears, making muscles and tendons sensitive to pain in the form of tendinitis.
Home remedies such as icing and anti-inflammatories may work on some people. Unless scar tissue is eliminated, however, tennis elbow could be a recurring problem the rest of a player's life, according to San Rafael chiropractor Daniel Fung.
"If you keep playing through it, you could risk permanent damage to the tendon," Fung says. "You have to release scar tissue that builds up on muscle, tendons and ligaments. It makes those muscles tight and short. Tight short muscles create abnormal tension on tendons."
Fung, a former teaching pro and 4.5 player (on a zero-to-7 skills scale), employs the Active Release Technique, or ART, to treat tennis elbow. Developed by Michael Leahy, a Colorado chiropractor, ART extends well beyond tennis to the NFL, NBA and Hawaii Ironman Triathlon. Fung has worked as official trainer at the Ironman, will compete and be a trainer for the Gay Games this summer in Chicago, and works with Dominican University athletes.
"In comparison to massage, ART is much more specific," Fung says. "ART isolates individual muscles to reduce scar tissue.
"The great thing is that there is very little damage to healthy tissue," he says. "In these injuries, I'm over 90 percent successful. It's pretty amazing."
Because only 5 percent of those who suffer from tennis elbow require surgery, according to WebMD, Marin's aging tennis community is fighting back thanks to local experts. Fung sees as many as 30 clients a week, while 20 to 25 percent of Skylor's business specifically is related to tennis elbow.
"I thought I would always have to nurse it," says Paula Sauv}, a Marin league player who praises Fung's handiwork. "I noticed improvement after three treatments. Little by little, it just went away.
"I had tried staying off it, which I couldn't stand," Sauv} says. "I got a cortisone shot and I had to quit playing for another month. Dan let me play through the treatment."
The first thing Fung and Skylor do when they are treating clients with tennis elbow is ask questions:
1. Has there been an increase in playing, especially if you've recently retired or cut back on working hours?
2. Have you changed rackets?
3. Are you using different strings?
4. Are you hitting with new players who have more pace on the ball?
"Most often there is an aging," says Skylor, who uses deep friction massage to treat tennis elbow. "They are hitting a little bit behind the ball. As aging is an issue you have to get a racket that is more forgiving."
Noah Kerwin, racket master technician at Golden Gate Golf and Tennis in San Rafael, says players come in all the time looking for a racket that is gentle on the old arm. He says that heavyweight, flexible, oversized rackets absorb more of the ball's impact, thus reducing shock to the elbow.
"Imagine a big truck hitting a small car," Kerwin says. "Avoid stiff, lightweight rackets."
Rackets that Kerwin says may prevent or help alleviate tennis elbow include the Prince 03 Tour, Volkl Catapult, Wilson N Blade and Wilson N3. Although natural gut strings are expensive, they can help absorb shock. Another tip is to use a larger grip so you don't have to squeeze the handle as hard during contact.
"We have a lot of people with arm problems," Kerwin says.
Besides a change in rackets or strings, players suffering from tennis elbow should consider wearing a forearm band, designed to aid in the relief and prevention of pain. Such discomfort can also be associated with golf, bowling, weight lifting and workplace injuries. Kerwin says carpenters turn to forearm bands to help cope with carpal tunnel syndrome and repetitive stress injuries.
Skylor, one of the top 4.0 women's doubles players in Marin, says a player suffering from tennis elbow could benefit from lessons to reform biomechanics. And definitely cut back on frequency of play.
Regardless of the type of therapy you choose to get back on the court as soon as possible, it's important to seek treatment.
"You have to get that scar tissue out," Skylor says. "As long as scar tissue is there you'll have continual problems."
IF YOUR ELBOW HURTS
-- Definition: Tennis elbow is a condition in which tendon damage causes pain or soreness around the outside part of the elbow known as the lateral epicondyle. Symptoms are especially noticeable when the palm is turned up.
-- Symptoms: The main symptom is pain, which may begin with a dull aching or soreness on the outer part of the elbow that goes away within 24 hours after an activity. As time goes on, it may take longer for the pain to go away or progress to pain with any movement, such as lifting a jug of milk.
-- Cause: Overuse or stress can cause micro tears in the tendon. This usually occurs because of repetitive motions of the arm or wrist. These movements are sometimes a part of everyday activities, such as using a screwdriver. Overuse can also result from playing sports, such as tennis or golf.
-- Treatment: Home treatments may include icing in 10-minute intervals several times a day and anti-inflammatory drugs. Stopping or changing activities that may irritate the tendon. Call your health professional if you have severe pain, cannot move your elbow normally, your elbow looks deformed or begins to swell, or has pale or bluish skin. Professional treatments may include massage, corticosteroid injection, and in rare cases, surgery.