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PostPosted: 05 Aug 2014, 13:32 
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Some of the recent research on these conditions indicates that they are really degenerative over-use injuries. Somewhat surprisingly, there is less inflammation than people used to think (meaning there is not a lot of infiltration of circulating immune cells such as macrophages etc.). However there are profound structural changes in the tendons and connective tissues. There are several implications of this. One is that icing, non-steroidal anti-inflammatory drugs and even cortisone may not really have that much effect (they may relieve some of the pain but not the underlying degenerative changes). The bad news is that really the only way to keep the degenerative changes from progressing is to cease the repetitive use and resulting wear and tear and allow time for healing to take place. This is not really good news for most athletes, especially as we age, especially if we love our sport. This applies to things like tennis elbow, Achilles tendonosis, plantar fasciitis, also rotator cuff problems, and also some of the degenerative bone changes that may occur.

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PostPosted: 05 Aug 2014, 13:55 
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Great thread, Baal.
I work with my fingers and wrist a lot as a dentist. I also play CPen. Like TableTennisDoc but not as severe, I do have some pain in my thumb recently. I think the pain (inflammation) is from cell. phone use.
Take a look at "smartphone thumb": http://advancingyourhealth.org/orthoped ... revention/
I am changing my smartphone habit. Now, I try to hold it in the left hand, and use my right index finger to operate.


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PostPosted: 06 Aug 2014, 19:19 
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I have wrist pain in the tendons running up from the palm side of the hand ,this was after around 5 or 6 hours with the computer mouse at work,I iced it for 20 mins then when I touched it there were spasms in my palm with tingling down the tendon :sweat: ,this went away after a short time ,was due to play tt the dayafter and thought I`d risk it and surprisingly it feels better today,using my left hand on the mouse today to rest it

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PostPosted: 06 Aug 2014, 23:52 
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Perhaps that explains why the Armaid worked so well for my tennis elbow when several other approaches failed. I became pain-free after less than 10 uses, and that was after several years of typical table tennis-induced epicondylitis. I feel it succeeded in breaking up scar tissue nodes in my forearm that were causing the pain.


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PostPosted: 07 Aug 2014, 03:33 
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Baal wrote:
Some of the recent research on these conditions indicates that they are really degenerative over-use injuries. Somewhat surprisingly, there is less inflammation than people used to think (meaning there is not a lot of infiltration of circulating immune cells such as macrophages etc.). However there are profound structural changes in the tendons and connective tissues. There are several implications of this. One is that icing, non-steroidal anti-inflammatory drugs and even cortisone may not really have that much effect (they may relieve some of the pain but not the underlying degenerative changes). The bad news is that really the only way to keep the degenerative changes from progressing is to cease the repetitive use and resulting wear and tear and allow time for healing to take place. This is not really good news for most athletes, especially as we age, especially if we love our sport. This applies to things like tennis elbow, Achilles tendonosis, plantar fasciitis, also rotator cuff problems, and also some of the degenerative bone changes that may occur.


Baal, can you provide a link to your sources? I'd like to discuss this with my doctor. I've suffered for years with pain in my right hip that is aggravated when I play TT. I've gone to scores of specialists with no firm diagnosis yet. The best they've been able to tell me is severe tendonitis of the hip. And like you indicate, ice, NSAID's and cortisone have had no impact on my pain level or improving my condition. I've even lain off TT and most other activities that might stress the hip for 3 months, 6 months, and even a year without any real improvement. I personally believe that it is from years and years of footwork exercises. It's really limited how much I can play and when it starts acting up, TT is no fun. I wonder how long they recommend laying off an aggravating activity before improvement typically occurs. Thanks.

Larry


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PostPosted: 07 Aug 2014, 14:11 
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Larry

You can start with these:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

http://www.ncbi.nlm.nih.gov/pubmed/10418074

http://www.ncbi.nlm.nih.gov/pubmed/16156339

http://www.ncbi.nlm.nih.gov/pubmed/14560543

http://www.ncbi.nlm.nih.gov/pubmed/11899264

http://www.ncbi.nlm.nih.gov/pubmed/9848596

http://www.ncbi.nlm.nih.gov/pubmed/24923269

I will try to dig up some more recent work.

The current treatment options supported by quality clinical trials are pretty limited, although this may change in in the not two distant future if some ideas people are testing pan out. These include various forms of shock wave therapy, and injections of platelet-rich plasma directly into the tendon.

The important conclusion of the studies above (and many others) is that most (but not all) tendon problems caused by repetitive use and sports are not really inflammatory. That explains the limited success of using anti-inflammatory therapies (such as cortisone, or NSAIDs). IN fact, cortisone can actually increase the likelihood that a tendon will rupture. Unfortunately, all that shows is what doesn't work. It doesn't help you figure out what does work. The one thing that most generally does work is prolonged rest. Unfortunately, that is not what most of us want to hear.

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PostPosted: 07 Aug 2014, 20:10 
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I has some recent scans done with my tennis elbow (which has slowly improved over the last few months), which ties up with what you said. The scans showed lots of scar tissue that would have accumulated over many years, and this really can't heal very well.

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PostPosted: 08 Aug 2014, 00:57 
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Hmmmm, the way I read it, rest, ice, till no pain, then eccentric exercise 3 x 15 twice a day (below pain threshhold to strengthen) is best course of action.

Rest is of course the problem. Nobody wants to rest. Everyone wants to play.

They don't seem to talk much about massage helping, but muscles seem to be knotted up and taut, and it does seem to help that for me. I think it needs to be in conjunction with the others above.

My arm is much better than it was, but now have foot/leg troubles with achilles and extensor muscles that I need to improve.

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PostPosted: 08 Aug 2014, 01:00 
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nathanso wrote:
Perhaps that explains why the Armaid worked so well for my tennis elbow when several other approaches failed. I became pain-free after less than 10 uses, and that was after several years of typical table tennis-induced epicondylitis. I feel it succeeded in breaking up scar tissue nodes in my forearm that were causing the pain.


I wish that wasn't such an expensive gismo (ie $100). I have been using a rolling pin, which isnt "optimal", but does help. I'm going to try a couple other cheaper, similar acting devices to see if I can get anything to work for both the arm and legs.

http://www.ebay.com.au/itm/Body-Shape-R ... AQ:AU:1123

http://www.amazon.com/dp/B00525X8ZW/ref ... 00_TE_item

And might order something like this as well...
http://www.amazon.com/dp/B00CBNDNOO?psc=1

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Last edited by Old-Man-Southpaw on 08 Aug 2014, 01:23, edited 2 times in total.

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PostPosted: 08 Aug 2014, 01:07 
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I've had quite the journey with knee pain over the last 2 months. It's something that effected me 2 years ago, seemed to go away then came back at the end of a tournament after playing all day.

After jumping through a lot of hoops (was very close to having a scope done as the doc initially thought it was a torn meniscus. Glad I dodged that bullet.), we settled on that I have a knee tendinitis issue.

I went to see a physical therapist. The therapist me told me 80% of the people he sees is due to poor flexibility. So we worked on stretching that session where I failed pretty much every test.

After working & stretching on my own, I've come to the conclusion that I either have a knee tendinitis issue or what I think is more likely IT Band syndrome (which is this tight band along the side of your leg that feels like outer knee pain). In either case, I have to stretch more to make it better and I have been feeling better & better. I can only hope it'll stay that way now.

So if anybody here is dealing with these kind of issues, I'd urge you to stretch more if you don't. My TP told me to get me where I need to be, I'll have to stretch 3-4 times a day just to start. After which that point, stretching should be done at least once a day. That part I found surprising as honestly I probably stretched half @$$ed for about 5 minutes once a week just before I start playing.

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PostPosted: 08 Aug 2014, 05:05 
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suds79 wrote:
I went to see a physical therapist. The therapist me told me 80% of the people he sees is due to poor flexibility. So we worked on stretching that session where I failed pretty much every test.

After working & stretching on my own, I've come to the conclusion that I either have a knee tendinitis issue or what I think is more likely IT Band syndrome (which is this tight band along the side of your leg that feels like outer knee pain). In either case, I have to stretch more to make it better and I have been feeling better & better. I can only hope it'll stay that way now.

So if anybody here is dealing with these kind of issues, I'd urge you to stretch more if you don't. My TP told me to get me where I need to be, I'll have to stretch 3-4 times a day just to start. After which that point, stretching should be done at least once a day. That part I found surprising as honestly I probably stretched half @$$ed for about 5 minutes once a week just before I start playing.

In my own case, I went through 6 months of physical therapy 3 times a week with additional rebuilding exercises and stretching at home. I then played in a tournament in which my right leg gave out at my bad right hip and I ended up on the floor several times and having to stop outright because of severe pain during a point many additional times. I've always considered myself a fairly flexible person and rarely feel "tight". At least in my case, I feel that all that stretching and exercising didn't do me any good as far as correcting the problem or easing the pain (however, I did feel in great shape, other than the hip problem, for that tournament). So perhaps I was just in the other 20% that your therapist's prescription doesn't apply.

Larry


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PostPosted: 08 Aug 2014, 07:17 
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Seriously Larry, that sounds like you are headed to an artificial hip. You need to take some time.

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PostPosted: 08 Aug 2014, 07:19 
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Old-Man-Southpaw wrote:
Hmmmm, the way I read it, rest, ice, till no pain, then eccentric exercise 3 x 15 twice a day (below pain threshhold to strengthen) is best course of action.

Rest is of course the problem. Nobody wants to rest. Everyone wants to play.

They don't seem to talk much about massage helping, but muscles seem to be knotted up and taut, and it does seem to help that for me. I think it needs to be in conjunction with the others above.

My arm is much better than it was, but now have foot/leg troubles with achilles and extensor muscles that I need to improve.


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.

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PostPosted: 08 Aug 2014, 07:48 
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Baal wrote:
Seriously Larry, that sounds like you are headed to an artificial hip. You need to take some time.

No, I've had 3 X-rays done and they all show very good bone and cartilage at the hip joint. It seems to be related to tendons, ligaments, or possibly muscles.

Larry


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PostPosted: 08 Aug 2014, 13:45 
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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.

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