My elbow hurts…but I need to race?

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So what do you do?

Lateral epicondylalgia? Lateral epicondylitis? Tennis elbow? Do any of these sound familiar?

They are synonymous terms that point to a common problem not only among tennis players, but paddlers as well. Lateral epicondylalgia is by definition: lateral elbow pain (pain on the outside of the elbow). It is caused by tiny little tears in the tendon where it inserts into the elbow bone. These tears can occur from abnormal or repetitive motions with the wrist, elbow and shoulder.

In order to understand how to manage lateral epicondylalgia, it is important to understand the difference between tendinitis and tendinosis. Tendinits is inflammation of the tendon, and tendinosis is degeneration of the tendon due to chronic inflammation. Tendinitis responds well to rest, light stretching, anti-inflammatory medications and ice therapy. It can usually be fixed easily if cared for correctly. Tendinosis is tendinitis that has been around for a long time, maybe even off and on for weeks or months. This chronic insult to the tendon prevents healing, which causes weakness and degeneration. At this point, the tendon does not respond well to ice or anti-inflammatory medications or stretching. The moral of the story is that it’s best to treat tendinitis before it turns into tendinosis.

So what do I do if I have tendinosis? Unfortunately there are no quick fixes, but there are things you can start immediately. Research suggests a model to address this type of injury called the EdUReP model. It stands for Education, Unloading, Re-loading, and Protection.

Education means it is important to understand what to avoid so your body can heal. Excessive typing at work with poor posture, gripping your paddle too hard, or not twisting enough to allow proper paddling mechanics are common causes.

Unloading means you need to stop stressing your arm out. Now I know you can’t just quit your job or stop paddling before the upcoming race or regatta. So what do you do? Studies show that elbow straps and braces decrease strain on the elbow enough to decrease pain and immediately improve grip strength. This may be a short-term solution but it may be the best option until you see a health care professional.

Re-loading consists of a systematic approach to strengthen the affected area after the pain has resolved. This stage consists of eccentric exercises.

Protection is a combination of the previous steps. You may need to educate yourself in different/corrected stroke mechanics, grips and postures to prevent reoccurrence. It is also important to maintain a steady flexibility and exercise program to keep tissue healthy, and use the brace or strap to take the stress off. This is usually a 12-16 week program.

This sounds like a long time, especially if your race may be in the next week or the season has just begun. So, I recommend that if you are absolutely unable to rest, try using an elbow tendinitis brace or strap. One can be purchased at a local drug or athletic sport supply store. This will help unload the damaged tissue while you seek medical care to diagnose exactly what you may be dealing with and get the best care. Good luck and healthy paddling.

Marco Adamé Jr., 
PT, DPT, OCS, ATC, CCCE

 

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