Yet Another Cycling Forum
General Category => The Knowledge => Health & Fitness => Topic started by: andyoxon on 05 January, 2018, 03:45:31 pm
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Anyone know about elbows? I did something to my right elbow last year while lifting/trying to break-up some heavy rubble. I've been hoping it would just get better, but there's still an issue.
Basically, I can make a tight fist/hard grip with my arm bent (right angle) with no pain/ache, but, if I stretch my arm out straight and try to do the same, I get significant ache/'pain' at the elbow. Sometimes repetitive finger movement can cause ache at the elbow. If I knock my elbow on something it seems far more tender than the left elbow. Forearm movement is Ok, without ache, but I begin to get an ache when riding (on hoods) probably because my arm is outstretched, and fingers operating shifter.
Hopefully my GP will shed some light eventually re physio etc... 3wks for appmt!
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The elbow's a big and complex beastie and you haven't really specified where on the elbow you are having your pain.
It's necessary to cock the wrist back (extend it) to make a good grip, as well as to curl up (flex) the fingers.
The extensor muscles attach to a 'common extensor origin' on the outside (lateral aspect) of the humerus. Pain at this point is commonly known as 'tennis elbow' and I guess this might be your problem.
The flexor muscles attach to a 'common flexor origin' on the inside (medial aspect) of the humerus at the elbow. Pain here is known as 'golfers' elbow' but people who suffer these woes do not necessarily partake of these (or any) sports.
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As Helly says , not really enough info but my 10pence would be on laterl epicondylitis (TE). This is a middle aged degenerative condition that occurs spontaneously and is not caused by work or activities.
Physio or stretches on google will help but it generally settles over 12-18 months. Patient who have steroid injections are more likely to have long term severe problems so avoid the steroid injections!
Remember your GP gets paid extra for every steroid injection. If he offers you one ask them to share the profit with you and let us know their response!
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Thanks helly & chris. If I outstretch my right arm and make a fist, in a kind of superman pose, so that the back of my hand is pointing up - the ache is in outside area of the elbow to the right and below the muscle (nr elbow) on top off my arm. If I put my forearm at right angles to my bicep (with no ache when I make fist), this would be around the boney top, outer 'corner' of the elbow. Someone at work suggested I could try doing orange squeezing (/stress ball) exercises?? Thanks for the info on steroids. Is it reasonable for GP to send me for x-ray, and or physio?
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I don't think X-rays are helpful. Physio might be.
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Sounds like tennis elbow. I would find an epicondylitis clasp on amazon as a start and then look for stretches to relax the area.
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Thanks, now trying a counterforce elbow brace and some exercises (without brace)...
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I saw the GP, and then the surgery's physio. Tennis elbow. Basically treatment regime suggested is - massage ibuprofen gel into area morning & evening, also ice pack (peas) each day 2x10mins, and these exercises https://www.arthritisresearchuk.org/arthritis-information/exercises-to-manage-pain/tennis-elbow-exercises.aspx with the wrist flex every 1-2hrs. Also, wear the 'elbow' brace at work/when using PC mouse, and cycling etc.
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There is absolutely no evidence that Physio is of any benefit in altering the rate of recovery.
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Ok, interesting.
Found this from World J Orthop
Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation.
Perhaps ice packs, support braces, and massaging NSAIDs count as other 'modalities'... I guess this is not exactly difficult to do, so if the TE is not serious, and if there's a chance it helps on top of simply time elapsed and resting...
I did wonder on the best order to do neurofen/exercises/ice pack - perhaps it makes no diffs then.
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I *believe* the Chinese name for tennis elbow is "fifty year old elbow" (can a Mandarin speaker here confirm that?) And coincidentally (or not) I had TE at around that age. It disappeared spontaneously after about twelve months or so ...
Does your age profile match the Chinese name Andy?
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I *believe* the Chinese name for tennis elbow is "fifty year old elbow" (can a Mandarin speaker here confirm that?) And coincidentally (or not) I had TE at around that age. It disappeared spontaneously after about twelve months or so ...
Does your age profile match the Chinese name Andy?
Partner had golfer's elbow at 51...
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Re Chinese for Tennis elbow, I looked it up, the Mandarin version is 肱骨外上髁炎, something like outer humerus inflammation, or 网球肘 which is a literal translation of tennis elbow.
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There is absolutely no evidence that Physio is of any benefit in altering the rate of recovery.
Huh? Granted a biased source. but still
https://torontophysiotherapy.ca/physiotherapy-for-tennis-elbow/
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Ok we need to look at the quality of the evidence. Level one evidence shows no benefit to therapy.
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I'm of that age... In hindsight I would probably have come away with TE even at 10-20 years younger, given the number of times I lifted the heavy concrete block above my shoulder height, to break large slab of concrete (raised at each end) - which I didn't realise was reinforced. Wrong tool for the job. :-\
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Ok we need to look at the quality of the evidence. Level one evidence shows no benefit to therapy.
What evidence?
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There is absolutely no evidence that Physio is of any benefit in altering the rate of recovery.
Sources and citations to back this claim up? And don't say "Google it" in a typical Flat Earther's response.... 😋
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I believe, although I could be wrong, that this is chrisbainbridge's area of professional expertise.
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This was probably the first to show no real difference in the long term
http://www.bmj.com/content/333/7575/939
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This was probably the first to show no real difference in the long term
http://www.bmj.com/content/333/7575/939
That study doesn't back up your first statement, Chris.
Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.
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Charly, I am on holiday so posting on a phone so the posts are relatively short. The benefit at 52 weeks was zero. The reduction in use of NSAIDS, etc by the Physio group was small and probably a placebo effect from having hands laid on you.
The evidence from the placebo effect is strongly suggested by the evidence that there is no difference between any of the exercise regimes. These include neck manipulation!!
I will rephrase the statement to “there is no evidence that any particular set of exercises has any beneficial effect in the long term and that the short term benefit is almost certainly placebo.”
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Ok, I accept that this is your area of expertise, but the study does not agree with your statements
The study's conclusion was:
Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term.
I agree that the study is flawed in that it did not exclude pure placebo effect (there should have been a fourth group, where the participants received 'treatment' that amounted to consultation time and someone inspecting and touching their elbow).
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Re Chinese for Tennis elbow, I looked it up, the Mandarin version is 肱骨外上髁炎, something like outer humerus inflammation, or 网球肘 which is a literal translation of tennis elbow.
Thanks Gerald.
I have to own up to spreading fake news ... in fact I've no idea about the Chinese for tennis elbow, my post above was faulty recollection of "fifty year old shoulder" as the Chinese for "frozen shoulder" ... which leads us off-topic. :facepalm:
I don't know the Chinese for "muddled memory" either.
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Charly, I am on holiday so posting on a phone so the posts are relatively short. The benefit at 52 weeks was zero. The reduction in use of NSAIDS, etc by the Physio group was small and probably a placebo effect from having hands laid on you.
The evidence from the placebo effect is strongly suggested by the evidence that there is no difference between any of the exercise regimes. These include neck manipulation!!
I will rephrase the statement to “there is no evidence that any particular set of exercises has any beneficial effect in the long term and that the short term benefit is almost certainly placebo.”
That study was referenced in the article I posted earlier.
I'm curious...have you ever been injured?. Because I would much rather get treated and back to training quicker, than wait an undetermined amount of time. I've had plenty of minor injuries that would most likely have healed on their own, but have used physio to speed up and monitor the healing process.
Had the study been on say, 2 months, it might have been valid, but a year?
The only real conclusion from the study is that corticosteroid works but causes people to re-injure themselves.
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The conclusion of the study is not what the study results say. The study results say no benefit at 1 year So how can they conclude that physio is better?
The conclusion was written to continue to allow Physio’s to treat tennis elbow despite the results. This is the problem when you want the study to support you in doing what you enjoy but the results are negative. You find a pseudo endpoint and change your final outcome.
Jakob, tennis elbow is not due to injury. Steroid injections reduce the pain but leave you on average worse off at 1 year. I am almost at a situation where I would call a steroid or njrction for tennis elbow within 9 months of onset negligent. I no many GPs do it and are paid for it but the evidence is no longer there for any treatment.
This is true for almost all Physio actually. When you carry out good quality trials Physio is no better than placebo. Surgery for tennis elbow is almost certainly the same and for knee arthroscopy for arthritis and some shoulder conditions.
We are now looking at sham operations for many musculoskeletal conditions and I suspect we will stop a lot of operating.
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I'm either not being clear enough or you're deliberately misreading me.
Phsyio will make you return to activity earlier than doing nothing.
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I would suggest that physio MAY allow you to return to activity earlier than doing nothing.
And yes, I have had injuries and physio as well as injuriez and no physio but I am a sample of 1 and statistically irrelevant. Each incidence will be unique, obviously, including placebo reaction.
There is little substitute for properly independent peer reviewed research.
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Jakob. I am not deliberately misreading you. Any physiotherapy exercise of any type will speed up your recovery. It is called the placebo effect. Our own trial which was adequately powered, and met its defined endpoints showed no difference between placebo and active treatment. At the time of inclusion they were all awaiting surgery and 50% of them in both groups at 1 year no longer wanted surgery suggesting that tennis elbow is a self limiting/healing condition.
If you want to speed up pain relief of your tennis elbow I would suggest seeing the most highly priced therapist that you can find, who will promise to realign your chakras, stick needles in parts of your body linked to your elbow and chant mystical healing songs over you. The cost of the therapy is very important.
Does physiotherapy make your tennis elbow better - No. Does a powerful placebo effect make your tennis elbow less painful - YES!
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If you want to speed up pain relief of your tennis elbow I would suggest seeing the most highly priced therapist that you can find, who will promise to realign your chakras, stick needles in parts of your body linked to your elbow and chant mystical healing songs over you. The cost of the therapy is very important.
Erhh, that does not sound anything like any physio I've ever met.
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If you want to speed up pain relief of your tennis elbow I would suggest seeing the most highly priced therapist that you can find, who will promise to realign your chakras, stick needles in parts of your body linked to your elbow and chant mystical healing songs over you. The cost of the therapy is very important.
Erhh, that does not sound anything like any physio I've ever met.
But then you don’t have the advantage of being a practicing surgeon who deals with such things - or not as would seem to be the current thinking. Chris does.
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Quote from: chrisbainbridge on Today at 12:51:48 pm
If you want to speed up pain relief of your tennis elbow I would suggest seeing the most highly priced therapist that you can find, who will promise to realign your chakras, stick needles in parts of your body linked to your elbow and chant mystical healing songs over you. The cost of the therapy is very important.
Erhh, that does not sound anything like any physio I've ever met.
That would be because it is not the exercises that make the difference but the placebo effect. The more impressive the placebo the better the effect.
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Quote from: chrisbainbridge on Today at 12:51:48 pm
If you want to speed up pain relief of your tennis elbow I would suggest seeing the most highly priced therapist that you can find, who will promise to realign your chakras, stick needles in parts of your body linked to your elbow and chant mystical healing songs over you. The cost of the therapy is very important.
Erhh, that does not sound anything like any physio I've ever met.
That would be because it is not the exercises that make the difference but the placebo effect. The more impressive the placebo the better the effect.
Again, are you really sure you are talking about physio therapist and not chiropractors? Never had a physio even hint about 'chakras' or 'healing'.
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You misunderstand me, I suspect deliberately. The placebo effect I am suggesting, somewhat tongue in cheek, will be greater with my therapist.
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Should we form a club? I'm just back from my GP who has confirmed tennis elbow. Yet another reason not to like tennis! >:(
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Should we form a club? I'm just back from my GP who has confirmed tennis elbow. Yet another reason not to like tennis! >:(
I'm not doing that well with the exercises for my rubble elbow, but managing to wear a 'counterforce' brace at work and cycling - which seems to help, but may not... :)
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Is 'rubble' elbow an AutoCorrect/Complete/predictive text 'feature'?
Would nonn know?
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'Rubble elbow' is my concreting-breaking, DIY-fail elbow injury... :)
Still doing little in the way of specific exercises, however I am consistently wearing the brace. Possibly some improvement seen, and riding the bike is fine now (200km untested yet).