Tendinitis - advice?

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Jonathan.
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Tendinitis - advice?

Post by Jonathan. » Wed Dec 27, 2017 10:29 pm

Early in September I tried paddling round the Isle of Wight but our trip plan was too ambitious and I’m left with two painful elbows.

Since then a physio has given me excercises which seem to make no difference, and a GP-friend suggested rest is the only cure. I’d love to get back in my boat but at this rate it’s going to take years rather than months.

If anyone knows a shortcut I’d be hugely grateful.
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Re: Tendinitis - advice?

Post by Ken_T » Thu Dec 28, 2017 7:46 am

Hi Jonathan,
I suffered from tendinitis once after racing the DW. I found once it had settled down that changing to cranked paddles I could paddle all day with no problems, but with straight shafts I would get trouble after about 1 hour. The problem seems to have completely resolved itself now & I can paddle with straight shafts indefinitely (although I still prefer cranks). I do not know exactly how long it took to recover to the state where I could use straight shafts indefinitely as I continued to use cranks & only found the problem had gone when I had to let someone else use my cranks.
Ken

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Re: Tendinitis - advice?

Post by Graham T » Thu Dec 28, 2017 8:43 am

If it is tendinitis that is inflammation of the tendon. Basically inflamation is a healing process as the body tries to resolve the injury. Sometimes this resolution does not take place in a speedy fashion and resolution never seems to happen. I view this as now being a situation whereby the inflamation needs to be quelled.
This is what steroids do although that is not a route i would go down to begin with. My advise is to ice the area vigorously.
I have had the following
Biceps tendonitis
Suprspinatus tendinitis which took two steroid injections to resolve
Note i had physio therapy in a hospitals specialist department for sports injuries which had taken place within 24 hours, 9 months of treatment made absolutely zero difference until the first injection.
I have also had golfers AND tennis elbow in both elbows all at the same time, the worst of these was golfers elbow in my right arm and i got rid of that only having chosen to rotate three cold gel packs so basically iced it for several hours non stop one evening and that stopped the problem. This was with the gel pack directly on the site of inflammation with no covering layer to ensure i got it as cold as i could manage
Is the above protocol no so proceed at your own discretion, but it worked for me.
Note the left biceps tendon which had no injection can still let me know it is not 100% 25 years approx on since the injury i I ice any time i think it is becoming sore again

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Re: Tendinitis - advice?

Post by number10ox » Thu Dec 28, 2017 10:34 am

Hi Jonathan, I'd suggest finding a remedial and sports massage therapist or a physio who specifically deals in sports rehabilitation.

I'm a remedial and sports massage therapist myself. The trouble with many injuries is that although they often come to light during a sporting activity there is often a background issue, usually something we do at work or home that set the ground for the condition and likely slowing down it's recovery. So have a good look at other activities so you can reduce their effect. Also there may be adhesions, scar tissue or general thickening of tissues around the injury that may impede recovery that an appropriate therapist could help resolve.

Some general advice: Regularly use the pain free range of motion (ROM). Keep the joints mobile, however out of the pain. Working through a little stiffness is fine, however be careful not to re-injure. Every time you hit pain you are likely to have re-inflamed the problem starting the healing process from the start. If you do hit pain, ideally ice as soon as you can to reduce the inflammation. If you suspect an activity might have had a negative impact though it hasn't hurt yet, ice anyway. If you tend to hurt it in an environment where ice isn't available, keep a topical anti-inflammatory gel to hand, if you don't have problems with such items. In addition the tissues need rest and time to heal without re-injury, that's not just no paddling but reducing other activities that impact the area. Often clients don't do their exercises regular enough (best little but often) and also don't rest adequately, that may include changing your work routine.

When you do go back to paddling, Start small, progressively build duration and vigour of activity, if you find signs of trouble, ease back a level for a period. Get specific advice and training on technique, have someone observe with a critical eye, often we overlook things in ourselves that we would see in someone else. Warm up and cool down before and after. Allow extra time to warm up injury sites. Allow as much time to warm and mobilise an old injury site as you would for the rest of the body.

Lastly, repetitive injuries usually come about because the muscle is doing two activities at the same time. Usually there is a static component, often gripping, and a mobile component, articulation of the joint or resistance of an external force. A tight grip takes up most of the capacity of the muscle leaving little capacity for anything else, hence as light a grip as possible and also as wide a grip as is comfortable. Apparently there was a period in tennis when thin gripped tennis rackets became popular and tennis elbow incidences rose.

John

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Re: Tendinitis - advice?

Post by PlymouthDamo » Thu Dec 28, 2017 11:19 am

I got an elbow injury wiping out whilst surfing and it took more than a year to go away. I even had a steroid injection, which made it disappear for a few months but it came back after that. All this time, I wasn't paddling or doing anything else strenuous.

So it's possible you're in for a long recovery no matter what you do. If you don't want to give up kayaking in the meantime, perhaps try a paddle with smaller blades or a Greenland paddle? From what's written above, it sounds like paddling may be beneficial provided you can stay in the pain free range of motion.

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Re: Tendinitis - advice?

Post by davek » Thu Dec 28, 2017 3:24 pm

Therabar worked well for me (look for video on youtube) and finger extensors, e.g., powerfingers, for golfers elbow from climbing. Went to cranks some years ago to get over carpal tunnel pain.

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Re: Tendinitis - advice?

Post by Douglas Wilcox » Thu Dec 28, 2017 5:41 pm

Hi Jonathan, you have my sympathy. I wish you well.

I have suffered tendonitis for over 30 years and as John has suggested above, I had an underlying problem which was only recently diagnosed...haemochromatosis. Too much iron in my body was being deposited in tendons and tendon sheaths causing irritation and inflammation, leading to chronic tendonitis. I have required surgery to my left Achillies tendon, left shoulder and both knees, where long muscles in my thigh and calf were harvested for their tendons and these transplanted into my knees. My wrists and elbows have also both been affected. I need to be especially careful with my right elbow. My nadir occurred on a trip from Campbelltown round the Mull of Kintyre with a portage back into the Clyde at Tarbert and a return to Ardrossan. For most of the paddle I could only properly pull on one side and had to stop on Cara for two days to let it settle enough to continue. After that I had major shoulder surgery.

Too much paddling definitely brings tendonitis on, especially if you are pushing distance, battling against wind and tide and especially if there is any chink in your technique. As a doctor, I spent a working lifetime as a NHS consultant in neuromuscular medicine and during training spent 3 years doing a specific sports injury clinic. I agree with the excellent advice given above. I also agree that tight grip on the paddle makes tendonitis, especially in the wrists and elbows much worse. From a personal point of view I discovered that moving to zero feather angle on Euro paddles made the biggest improvement. Your body is not asymmetric so why torture yourself with an asymmetric paddle? The repeated feathering action is almost guaranteed to cause/aggravate tendonitis. The next improvement came with moving to smaller blades. I used to paddle with large Lendal Nordkapp blades and moving to smaller Kinetik touring blades helped for a couple of years. Moving to a light carbon paddle also helped but beware of Euro paddles with stiff carbon shafts. I loved my light Werner Cyprus cranks but had to sell them as they had such a stiff shaft that my wrists and elbows hurt within a couple of kilometres. Talking of cranks, I found they encourage a light grip as they have a sort of self castering action which helps the blade to find the best angle itself. I then moved to small wing paddles for touring though you might struggle to find wings on a cranked shaft.

Throughout my paddling career I intermittently tried Greenland paddles and even made several. I did not find they made a dramatic difference, compared with my later Euro Paddles, which were small carbon blades on a softer glass/carbon shaft. I also found that since I was using zero feather, having an ovalised grip on both sides was very helpful (your grip is not round). ( I found VE paddles are very flexible in their options list). I then tried a Blacklight carbon Greenland paddle, which I have found to be very gentle on my tendons and I can now paddle up to 50km a day with it. 80% of my paddling is now with it.

Lots of sports recommend warming up before starting. In truth, gentle paddling is itself a great warm up but beware of stressing your tendons from a cold start. I have burst my Achillies tendon trying to bump start my car on my own! I also burst two tendons in my shoulder trying to lift a kayak onto a car roof rack on my own in cold weather. Basically be sensible!

If you suffer from an acute tendonitis brought on by an activity, stop doing it and over the following three days:

1. rest the affected joint (tendonitis usually occurs near joints)
2. cool the affected area with a pack of frozen peas every 2-3 hours.
3. if you can, use a compression bandage like tubi-grip.
4. if you can, elevate the affected area.
5. after 48 hours take a non steroidal anti-inflammatory drug (NSAID) such a ibuprofen (read the pack for side effects and contra indications).
6. avoid further exercise, massages, hot baths and heat packs.

Once the acute attack has passed you can gradually reintroduce movement to the affected joint, I like swimming but avoid weights, jogging etc. Pain killers can be continued and massages gradually introduced. If it does not improve go and see your GP or self refer to an NHS physio. You can also go to see a private physio, some of whom specialise in sports physiotherapy. I have had a LOT of physiotherapy over the years and have always just used the NHS physios, with great success, I cannot praise their work too much. Physiotherapy exercises do not make the tendonitis itself go away but can greatly help rebuild muscle wasting, which can quickly develop secondary to lack of use, due to pain from tendonitis. Some physios might also use shock wave treatment, which can speed healing. Even when the area is still sore, light physiotherapy exercises are also very beneficial to maintain range of movement, especially in a joint like an affected shoulder. Except in very specific cases (such as following surgery).... if something hurts.... stop doing it. (Following surgery you may need to undergo a lot of painful rehabilitation but only under the direction of a physiotherapist.)

Once you think the tendonitis has gone you can gradually reintroduce the activity that brought it on but consider altering both technique and equipment and gradually build up your distance.

If you are left with chronic tendonitis then definitely consider changing technique, equipment or even giving up the activity for a considerable time or even permanently (I have had to give up several sports which I loved). As plymouthdamo has said steroid injections can make things feel better over the short term but they are not a cure, cannot be repeated too many times and are less suited for older people.

The good news is that.... despite a lack of shortcuts.... I have managed to adapt and continue sea kayaking. This is despite being pretty badly affected by tendonitis, (most people only get tendonitis at one or two joints). Quite often, if I know it is going to be a hard day I will take a NSAID before activity and I find this prophylactic use reduces the chance of a recurrence. I now make a point of not doing a big day unless I have had several successful shorter days over the preceding week or two. I make a point of swimming several times a week to maintain both my fitness but also flexibility and range of movement.

I wish you a successful (if not speedy) return to paddling,
Douglas

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Re: Tendinitis - advice?

Post by Jonathan. » Fri Dec 29, 2017 10:39 am

Wow! What great feedback - thanks to one and all.

Replies seem to agree on one point - that my injuries are likely to be a symptom of a broader problem. In my case, I suspect that’s to do with posture and a weak core - things I must work on. And once I’m back in a boat I’ll also get someone to have a look at my paddling technique; I recently joined a club that does a lot of K1 paddling and suspect this sea paddler can learn much from a racer.

Particular thanks to John and Douglas. To have such detailed replies from two experts in their fields is more than I could have hoped for. I fear I’m in for the long haul so those are two posts I shall read and keep reading; there’s a good deal of sound advice for me to put into practice.

And Douglas, can I please make sure I fully understand your sixth point? I can well appreciate the wisdom of not aggravating my injuries and avoiding further excercise. But massages, hot baths and heat packs? I’m intrigued to know that they, too, are bad news.
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Re: Tendinitis - advice?

Post by Douglas Wilcox » Fri Dec 29, 2017 1:42 pm

Hi Jonathan, you should avoid exercise, massages hot baths and heat packs of/on the affected area only in the first few days after an acute exacerbation. If you follow the 6 points (ice is better than heat) for the first few days then they are great afterwards.

Douglas :o)

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Re: Tendinitis - advice?

Post by dc9mm » Sat Dec 30, 2017 6:30 pm

These worked for me

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Re: Tendinitis - advice?

Post by Jonathan. » Sun Dec 31, 2017 4:37 am

A six-step recovery plan - that should keep me busy well into 2018. Very many thanks for your kindness, Douglas.

And thanks, too, for that strap recommendation, dc9mm. The physio recommended something similar and I tried it for a month or so, but it didn’t seem to make any difference. There isn’t an easy fix for whatever I have; the damage seems too severe.
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Re: Tendinitis - advice?

Post by richb250 » Mon Jan 01, 2018 10:16 pm

We're lucky to have such a range and depth of knowledge in the forum membership. I occasionally suffer from tendonitis, and will certainly be referring back to this thread if it recurs. Fortunately, mine tends to clear up after a week of rest - my sympathy to Jonathan and others who've had to endure longer periods of pain and immobility.

I echo the comments about paddles - moving to a small blade area and cranks made a big difference. Another observation is that I seemed to encounter most pain not from the forward stroke, but when using the affected hand as the offside hand to control the far blade and put pressure along the shaft. I need to think about this more, and probably correct defects in my technique. However, it leaves me wondering how much less regular but especially awkward motions cause or aggravate the condition compared to very repetitive motions?

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Re: Tendinitis - advice?

Post by Douglas Wilcox » Mon Jan 01, 2018 10:45 pm

Richb>
However, it leaves me wondering how much less regular but especially awkward motions cause or aggravate the condition compared to very repetitive motions?
A very good point Rich, I have had to stop using screwdrivers, even electric screwdrivers, as a few screws are now enough to bring on a recurrence of tendinitis in my elbow. I now use both hands (on an electric drill) if I have some screwing to do (as the bishop said to the actress).

Douglas

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Re: Tendinitis - advice?

Post by Daker » Mon Jan 08, 2018 11:27 am

I went through a spell of fairly bad 'tennis elbow' after a period of kayak surfing and a LOT of rolling without any prior conditioning.

The usual exercises and physio weren't having much effect and I had an event coming up so needed a quick fix. The one thing that really made a difference fairly quickly was dry needle acupuncture. I have to admit I was sceptical but it worked for me so definitely worth considering.

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Re: Tendinitis - advice?

Post by Psamathe » Mon Jan 08, 2018 11:45 am

I'm no expert so can only comment from personal experience and responses from questions I've asked the physio I occasionally see (which are obviously related to myself).

So many web sites/people say NSAIDs (e.g. Ibuprofen) but I've always found these have no effect on me. Even tried Naproxen and Diclofenac (prescribed by my GP) which also had no effect. Might be that my problems were too bad for them (but they were not really that bad). I asked the physio about this and they said that different people respond differently to NSAIDs - for some they help and for others they don't. Personal experience for me is that they don't so I don't bother with them any more.

Ian

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Re: Tendinitis - advice?

Post by JMarkW » Tue Jan 09, 2018 7:19 am

I have suffered with assorted tendinitis, both golfers and tennis for years. Off and on.

Usually brought on by doing too much. Mainly training at the climbing wall, sport climbing and going too hard, too quickly with out warming up properly in tide race paddling.

Warm up warm up warm up.

Stretch those tendons. But don't over do it with the wrist mobility.

Antagonistics. This for me is the golden egg. Press ups. Kayaking like climbing builds muscle for pulling mainly. I know we should be using our core but if we were....
For me press ups every day. After warming up....do some off your knees if you can't do many properly. I try 100 from my knees and and then built upto 100 standard ones. Protect your back neutral zone (Google this)

Also check out this:
https://www.ukclimbing.com/articles/page.php?id=3614
Can be used for both golfers and tennis. Also wrist curls up and down with a supported forearm with a can of baked beans.

I'm not convinced about the effects of vitamin i other than masking the pain?

Hope it helps
Cheers
Mark

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Re: Tendinitis - advice?

Post by adventureagent » Sat Jan 13, 2018 11:08 am

Douglas Wilcox wrote:
Mon Jan 01, 2018 10:45 pm
Richb>
However, it leaves me wondering how much less regular but especially awkward motions cause or aggravate the condition compared to very repetitive motions?
A very good point Rich, I have had to stop using screwdrivers, even electric screwdrivers, as a few screws are now enough to bring on a recurrence of tendinitis in my elbow. I now use both hands (on an electric drill) if I have some screwing to do (as the bishop said to the actress).

Douglas
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