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PostPosted: 08 Aug 2014, 19:26 
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Old-Man-Southpaw wrote:
I need to rest it and strengthen it, but its not easy to take time off when its the only fun thing you do.

How do you strengthen it? Did he give some execises? Is the idea to build up the muscle so that they can protect the tendons?

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PostPosted: 09 Aug 2014, 13:39 
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Ok, for example, for the Achilles, its heel drops. See

For the outside of the foot its toe lifts. See

For the arm and tennis elbow its exercises to strengthen the muscles and stretches before playing. I'm not sure why they are doing the stretches afterwards in the video. I prefer a rod similar in diameter to a paddle handle.

The other thing I'm trying is to use a roller to massage the muscles of both the leg and arm http://www.youtube.com/watch?v=3oBLV-Na9vQ I've been using a rolling pin, but ordered a roller massage as mentioned in a post above.

I read somewhere that 3 groups of 15 repetitions each, done 3 times a day is good. If an exercise or stretch is causing pain you are pushing too hard and hurting the muscle instead of help. The Dr. gave me a handout for the elbow ones somewhat similar to the video exercises and told me about the heel drop and suggested a similar number of reps and frequency and a similar pain threshold warning.

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PostPosted: 09 Aug 2014, 20:12 
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Thanks Old-Man-Southpaw, very informative! :up: :up: :up:

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PostPosted: 09 Aug 2014, 22:49 
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What I really need to do is make myself a daily checklist so that I remember to do all the stretches and exercises each day. My biggest problem is that I have read, seen, and been told all this "stuff", but don't get myself to *DO* what I should be doing to improve the problem areas.

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PostPosted: 09 Aug 2014, 23:32 
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Old-Man-Southpaw wrote:
What I really need to do is make myself a daily checklist so that I remember to do all the stretches and exercises each day. My biggest problem is that I have read, seen, and been told all this "stuff", but don't get myself to *DO* what I should be doing to improve the problem areas.

I can certainly relate to that, and not just in table tennis! :lol: :lol: :lol:

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PostPosted: 05 Jan 2015, 15:26 
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Old-Man-Southpaw wrote:
Baal wrote:
The ice part is probably not particularly helpful for tendon problems (for the reasons given in those articles I cited) but it can't do any harm. Ice is used to reduce inflammation, but if the underlying condition is degenerative rather than inflammatory (as with most tendon problems), it won't help much. It might reduce pain a little for a short period of time.


I dunno if I agree there. I am sitting here after playing 3 hrs and a half dozen matches as well as a good bit of practice hitting, and was in pain when I got home, both arm and leg, and after icing the pain is gone, and there was and is no swelling. The icing took care of all that. BTW, I saw my MD today and he stressed again that I need to ice the problem areas after every time I play. He is over 1800 himself and has suffered the same injuries, and recovered from them, so I do trust his calls.

The pain will return when I play again, if I'm playing good players, I suppose.

I need to rest it and strengthen it, but its not easy to take time off when its the only fun thing you do.


I don't mean to be impolite, but whether you agree or not (or your doctor for that matter), this is what the scientific studies show about what is actually happening in most forms of sports-related tendonitis. (Unfortunately most primary care doctors are unaware of this literature). It's not controversial, and the work supporting this goes back nearly 20 years. The effect of ice on pain is temporary and will do no harm, but it's not going to prevent degeneration of tendons from continued overuse. It will have no effect. Degeneration and inflammation are not the same thing (which is why rheumatologists and sports medicine specialists are starting to use the term "tendonopathy" rather than "tendonitis". So if things start to get worse, you need to know that rest is the only thing that works to prevent further degeneration. (I study inflammatory and degenerative conditions for a living). People need to know this. So I have done my best.

I will post this here for people who want to see in more detail what the studies actually say. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

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Last edited by Baal on 05 Jan 2015, 15:47, edited 2 times in total.

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PostPosted: 05 Jan 2015, 15:39 
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haggisv wrote:
Old-Man-Southpaw wrote:
I need to rest it and strengthen it, but its not easy to take time off when its the only fun thing you do.

How do you strengthen it? Did he give some execises? Is the idea to build up the muscle so that they can protect the tendons?


Since the tendons are the structures that connect muscles to bone, there is no effective way to use increased muscle strength to protect many tendons (e.g. Achilles, rotator cuff).

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PostPosted: 05 Jan 2015, 17:02 
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Can tendons grow or strengthen through exercises like weight training?

The diagnoses of the tendons in my elbow was that there is lots of scar and damage that has likely accumulated over a long period. It seems to have settled now, about a year later. I've been doing strength excises over this period, but I'm not sure if this has helped in any way.

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PostPosted: 05 Jan 2015, 21:36 
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Baal wrote:
Old-Man-Southpaw wrote:
Baal wrote:
The ice part is probably not particularly helpful for tendon problems (for the reasons given in those articles I cited) but it can't do any harm. Ice is used to reduce inflammation, but if the underlying condition is degenerative rather than inflammatory (as with most tendon problems), it won't help much. It might reduce pain a little for a short period of time.


I dunno if I agree there. I am sitting here after playing 3 hrs and a half dozen matches as well as a good bit of practice hitting, and was in pain when I got home, both arm and leg, and after icing the pain is gone, and there was and is no swelling. The icing took care of all that. BTW, I saw my MD today and he stressed again that I need to ice the problem areas after every time I play. He is over 1800 himself and has suffered the same injuries, and recovered from them, so I do trust his calls.

The pain will return when I play again, if I'm playing good players, I suppose.

I need to rest it and strengthen it, but its not easy to take time off when its the only fun thing you do.


I don't mean to be impolite, but whether you agree or not (or your doctor for that matter), this is what the scientific studies show about what is actually happening in most forms of sports-related tendonitis. (Unfortunately most primary care doctors are unaware of this literature). It's not controversial, and the work supporting this goes back nearly 20 years. The effect of ice on pain is temporary and will do no harm, but it's not going to prevent degeneration of tendons from continued overuse. It will have no effect. Degeneration and inflammation are not the same thing (which is why rheumatologists and sports medicine specialists are starting to use the term "tendonopathy" rather than "tendonitis". So if things start to get worse, you need to know that rest is the only thing that works to prevent further degeneration. (I study inflammatory and degenerative conditions for a living). People need to know this. So I have done my best.

I will post this here for people who want to see in more detail what the studies actually say. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/


To be completely candid, my thoughts on it are just from personal experience, and I have no training on the subject, other than what I've read on the net or handouts I was given, or been told by my MD and physical therapists, all of which is within the past couple years. I will send your link to my MD. I trust the guy with my life, not just for tendon issues, and he's the best Dr I've ever had, and he seems quite knowledgeable on tendon problems.

I went and read the article you linked and agree with it that anti-inflammatory meds are not a solution. I don't have any disagreements with the article you posted. Rest and restrengthening are what allowed my arm to heal, not icing after playing or taking pills or rubs.

Ice packs help for me because they are completely topical, and as much as possible if there still is pain, I use topical pain relievers, typically the ones with MSM and glucosamine in them, not expecting them to heal or improve anything, just expecting them to keep it from hurting too much, but the main thing is to avoid making it hurt in the first place. Its been a year now since I hurt the achilles, and I am down to playing once or twice a week, just to get out of the house and be sociable, to play for 1 hr or less at maximum. I am avoiding playing the better players completely, and won't play any tough matches, and am trying to play a one step game where I take no more than one step to get to the ball (and no steps if at all possible), in order to avoid using the legs much while playing to avoid getting hurt again. I'm doing that in combination with daily gentle stretches and excercises, trying to get the calf muscles back to normal in order to try to recover from the achilles problem. My achilles is so bad that I reinjured it by walking up the stairs, taking a shower, and walking back down a couple weeks ago, so I really need to be careful. Evidently, I also have arthritis in the ankle as well. In the past 6 weeks or so, I've been doing physical therapy, and the range of movement has improved dramatically, like 20 or 25 degrees, but as your article suggests, these are not problems that are going to go away in weeks, and my conclusion is that every time I reinjure it, that just resets the clock on trying to heal it, so I'm really making a big effort not to reinjure it, and instead to restrengthen it. My arm is a good example that the tendon problem can be "cured" with ice, rest, massage, exercise, and avoiding reinury. With luck, a year from now I'll say the same about the achilles.

Basically, at my age, I'm done, and I don't ever expect to be able to be competitive vs the 25 or 30 yr old guys, or to ever play another tournament, because I'll just get hurt again if I do, just like last spring. I gained 126 points, but hurt myself again by playing too long and too hard. So it looks like I'll be 1831 till I die, and I'll be lucky if I can hit the ball with my robot or a practice partner.

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PostPosted: 06 Jan 2015, 01:18 
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Old-Man-Southpaw wrote:

To be completely candid, my thoughts on it are just from personal experience, and I have no training on the subject, other than what I've read on the net or handouts I was given, or been told by my MD and physical therapists, all of which is within the past couple years. I will send your link to my MD. I trust the guy with my life, not just for tendon issues, and he's the best Dr I've ever had, and he seems quite knowledgeable on tendon problems.

I went and read the article you linked and agree with it that anti-inflammatory meds are not a solution. I don't have any disagreements with the article you posted. Rest and restrengthening are what allowed my arm to heal, not icing after playing or taking pills or rubs.

Ice packs help for me because they are completely topical, and as much as possible if there still is pain, I use topical pain relievers, typically the ones with MSM and glucosamine in them, not expecting them to heal or improve anything, just expecting them to keep it from hurting too much, but the main thing is to avoid making it hurt in the first place. Its been a year now since I hurt the achilles, and I am down to playing once or twice a week, just to get out of the house and be sociable, to play for 1 hr or less at maximum. I am avoiding playing the better players completely, and won't play any tough matches, and am trying to play a one step game where I take no more than one step to get to the ball (and no steps if at all possible), in order to avoid using the legs much while playing to avoid getting hurt again. I'm doing that in combination with daily gentle stretches and excercises, trying to get the calf muscles back to normal in order to try to recover from the achilles problem. My achilles is so bad that I reinjured it by walking up the stairs, taking a shower, and walking back down a couple weeks ago, so I really need to be careful. Evidently, I also have arthritis in the ankle as well. In the past 6 weeks or so, I've been doing physical therapy, and the range of movement has improved dramatically, like 20 or 25 degrees, but as your article suggests, these are not problems that are going to go away in weeks, and my conclusion is that every time I reinjure it, that just resets the clock on trying to heal it, so I'm really making a big effort not to reinjure it, and instead to restrengthen it. My arm is a good example that the tendon problem can be "cured" with ice, rest, massage, exercise, and avoiding reinury. With luck, a year from now I'll say the same about the achilles.

Basically, at my age, I'm done, and I don't ever expect to be able to be competitive vs the 25 or 30 yr old guys, or to ever play another tournament, because I'll just get hurt again if I do, just like last spring. I gained 126 points, but hurt myself again by playing too long and too hard. So it looks like I'll be 1831 till I die, and I'll be lucky if I can hit the ball with my robot or a practice partner.


Yep. Achilles is a tough injury. However, it is not completely irreversible, so you are doing the right thing.

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PostPosted: 06 Jan 2015, 01:20 
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haggisv wrote:
Can tendons grow or strengthen through exercises like weight training?

The diagnoses of the tendons in my elbow was that there is lots of scar and damage that has likely accumulated over a long period. It seems to have settled now, about a year later. I've been doing strength excises over this period, but I'm not sure if this has helped in any way.


The answer is clearly yes, but it turns out to be incredibly complicated based on studies going back to the mid 1980s. There are a lot of studies that show that sustained training causes the tendons to essentially get larger, and interestingly the types of trying that cause that are not always the same ones that cause the attached muscles to get stronger. Also, as the tendons get larger, they often become less elastic (stiffer) and this can occur even without the tendon getting larger (increased cross-sectional area). This can be good or bad, depending on the sport you play and/or the tendon in question. Also, the types of loading history that cause increases in tendon size and increases in tendon stiffness are not always the same.

Here is an article showing how ridiculously complex this is.

http://jap.physiology.org/content/107/2/523

They conclude that the right kind of exercise could protect from future injury.

Also this one.

http://www-ncbi-nlm-nih-gov.ezproxyhost ... d/17524067

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PostPosted: 06 Jan 2015, 16:56 
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Thanks baal! :up: :up: :up:

I can read the first article, and I get the general gist, but the details are a little complex. :oops:

The 2nd article requires login details.

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PostPosted: 07 Jan 2015, 10:54 
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Sorry! I forgot I had used my login account. Here is the abstract of the second one. Fairly technical, but maybe you can just skip to the conclusion. The tendon does get larger with certain kinds of exercise.

Acta Physiol (Oxf). 2007 Oct;191(2):111-21. Epub 2007 May 25.
Region specific patellar tendon hypertrophy in humans following resistance training.
Kongsgaard M1, Reitelseder S, Pedersen TG, Holm L, Aagaard P, Kjaer M, Magnusson SP.
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Abstract
AIM:

To examine if cross-sectional area (CSA) differs along the length of the human patellar tendon (PT), and if there is PT hypertrophy in response to resistance training.
METHODS:

Twelve healthy young men underwent baseline and post-training assessments. Maximal isometric knee extension strength (MVC) was determined unilaterally in both legs. PT CSA was measured at the proximal-, mid- and distal PT level and quadriceps muscle CSA was measured at mid-thigh level using magnetic resonance imaging. Mechanical properties of the patellar tendons were determined using ultrasonography. Subsequently, subjects performed 12 weeks of heavy resistance knee extension training with one leg (Heavy-leg), and light resistance knee extension training with the other leg (Light-leg).
RESULTS:

The MVC increased for heavy-leg (15 +/- 4%, P < 0.05), but not for light-leg (6 +/- 4%). Quadriceps CSA increased in heavy-legs (6 +/- 1%, P < 0.05) while unchanged in light-legs. Proximal PT CSA (104 +/- 4 mm(2)) was smaller than the mid-tendon CSA (118 +/- 3 mm(2)), which again was smaller than distal tendon CSA (127 +/- 2 mm(2), P < 0.05). Light-leg PT CSA increased by 7 +/- 3% (P < 0.05) at the proximal tendon level, but was otherwise unchanged. Heavy-leg PT CSA increased at the proximal and distal tendon levels by 6 +/- 3% and 4 +/- 2% respectively (P < 0.05), but was unchanged at the mid tendon level. PT stiffness increased in heavy-legs (P < 0.05) but was unchanged in light-legs. Modulus remained unchanged in both legs.
CONCLUSIONS:

To our knowledge, this study is the first to report tendon hypertrophy following resistance training. Further, the data show that the human PT CSA varies along the length of the tendon.

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Last edited by Baal on 07 Jan 2015, 10:59, edited 1 time in total.

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PostPosted: 07 Jan 2015, 10:59 
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The issue of ice is fairly complex. Here is a study showing that icing can reduce effects of conditioning that challenges some of the conventional wisdom. A fairly small study, it needs to be repeated.

J Strength Cond Res. 2013 May;27(5):1354-61. doi: 10.1519/JSC.0b013e318267a22c.
Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage.
Tseng CY1, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai C, Harris MB, Kuo CH.
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Abstract

It is generally thought that topical cooling can interfere with blood perfusion and may have positive effects on recovery from a traumatic challenge. This study examined the influence of topical cooling on muscle damage markers and hemodynamic changes during recovery from eccentric exercise. Eleven male subjects (age 20.2 ± 0.3 years) performed 6 sets of elbow extension at 85% maximum voluntary load and randomly assigned to topical cooling or sham groups during recovery in a randomized crossover fashion. Cold packs were applied to exercised muscle for 15 minutes at 0, 3, 24, 48, and 72 hours after exercise. The exercise significantly elevated circulating creatine kinase-MB isoform (CK-MB) and myoglobin levels. Unexpectedly, greater elevations in circulating CK-MB and myoglobin above the control level were noted in the cooling trial during 48-72 hours of the post-exercise recovery period. Subjective fatigue feeling was greater at 72 hours after topical cooling compared with controls. Removal of the cold pack also led to a protracted rebound in muscle hemoglobin concentration compared with controls. Measures of interleukin (IL)-8, IL-10, IL-1β, and muscle strength during recovery were not influenced by cooling. A peak shift in IL-12p70 was noted during recovery with topical cooling. These data suggest that topical cooling, a commonly used clinical intervention, seems to not improve but rather delay recovery from eccentric exercise-induced muscle damage.

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PostPosted: 07 Jan 2015, 11:03 
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Here is a very nice explanation for laymen on how to use ice to deal with different kinds of sports related pain. The person who curates this website is an excellent writer and the things he writes are invariably evidence based. He also provides references to original studies for people who want to check them out. I highly recommend the site in general for everything you might want to know about sports-related pain (and other pain too) and how to deal with it. When things are simply not known, he lets you know, and he is also very good at pointing out when conventional wisdom is simply not supported or even contradicted by controlled studies. (A big problem in physiotherapy and sports medicine in general).

https://www.painscience.com/articles/icing.php

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