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 Post subject: Biceps tendinopathy etc
PostPosted: 27 Feb 2016, 10:00 
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Since around October / November last year I have had vague twingeing on the inside of my elbow, feelings that the biceps was weak and pain when I rotated my wrist outwards. I cannot point to a specific incident that may have brought this on.

At one table tennis session, I played a reaction shot and a pain shot up from the inside of my elbow almost to my shoulder. I also found it painful to do a pendulum serve, which for me involves the outward rotation of the wrist. I have been a lot more careful playing backhands as that seems to be when I rotate my wrist more, and I am a backhand dominant player.

The next day I booked in to see a physio who thought that I had tendinopathy of the biceps tendon and had me do reverse curls and resistance work turning my wrist outwards. She thought that the tendinopathy would clear up in around 3 months.

In January I decide that I had had enough, having progressed to straight curls and twisting curls with a 5 pound weight and rotating an umbrella, but with the symptoms remaining much the same.

I then went to a sports physician who thought the tendinopathy may have been in the brachio-radial tendon, but sent me off for an MRI of my elbow. The MRI showed that the brachio-radialis tendon was normal, but
Quote:
"Moderate distal biceps tendinopathy with a partial thickness deep surface tear of the more posterior tendon insertion at the radial tuberosity involving up to 50% of the thickness of the tendon with underlying bone marrow oedema but no boney avulsion"


The tear is apparently 10mm in length.

I found that out yesterday and have been told that clearing up the symptomatic pain could take up to 2 years, but to continue playing table tennis (use it or lose it!) and that the pain involved in the tendon was not a warning of danger. I have also been told to go back to the physio for more exercises.

The only other intervention the sports physician was considering was PRP injection, which involves taking my own blood, centrifuging out the red blood cells and injecting it in the region of the tendon, to help it heal. I am not keen on doing this until the strengthening and time thing has played out.

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PostPosted: 27 Feb 2016, 15:15 
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So a brace around the forearm doesn't ease the pain? Have you tried it at least? The aircast brace has helped me and everyone I know who has tried it. Might be worth a shot...search ebay for one. ;)

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PostPosted: 29 Feb 2016, 02:41 
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Ouch, double ouch. I feel you as I am in recovery (prolly 75-80% there) of a real bad grade 2 tear of a rotator cuff tendon. I had similar difficulties in lifting the arm level with shoulder and even worse difficulties rotating it. Gave me excruciating pain trying that. Like you, I have no idea of which exact thing did it. I did an even where I had to stand at parade rest for 3 hrs, which strained my right arm by shoulder, also had to help push 10 people's car stuck in snow, had to extend arm and swing shovel with force to loosen up packed snow under car when it got high centered, had to pull start cords on many snow blowers, and who knows what other lifting chores could have done it. When we are over 40, it is so much easier to tear a tendon, rotator cuff in particular.

Tendons are tough to deal with as they do not get as much blood flow as muscles, so healing takes what seems like forever. Then, you/we want to keep playing or doing physical stuff, and it is real easy to aggravate it all over again. Still, doing totally nothing for months on end is a good way to get the surrounding weak and when the pain goes away enough, we start back up again and it is so much easier to make the injury more serious.

The body has its own mechanisms to heal itself given the chance, but again, tendons are something that do not heal totally in a short time frame. Sounds like you had a grade 2 tear and it can be painful and make you want to get surgery. I think you made a good decision to get it to heal without surgery, which really wont do much except for help it re-attach to an end (which in this case sounds like it is in middle?) and you still have the same or worse challenges getting it to heal.

Another thing you did which I think is uber good is you tried to strengthen the surrounding muscles and work the injury site just enough to make it grow.

If the procedure of the blood centrifuge is reasonable in expense I would say go for it. This is a very effective treatment that top athletes have done to help them heal joint injuries with tendon damage in a short time frame with excellent results. It is not nearly as risky and problematic as a scope procedure. Scopes are notoriously difficult to completely clean. The chems used to clean these instruments kill 99.99% of bad bacteria, but over time harbor and grow resistant bacteria. In USA, many top athletes get a scope procedure done, then they get a bacteria infection that is very resistant to the normal and reserved anti-boitics. In Particular, athletes of Cleveland Browns American Football team have had issues in this area.

Another thing to consider (to help the healing faster) is doing things to increase the blood flow, which is what is bringing in the building blocks to restore the damage. Heat does this, and direct heat pressed against the injury site to a reasonable temp for 30 minute intervals is something to consider if the injury site is no more than a cm deep. (like say if it is one of the tendons attaching right at the end of the elbow.) Any deeper than that and direct heat is not as effective in promoting extra blood flow to the injury.

For an injury that is deeper under the surface, like what your injury appears, Far Infared Heat is effective at getting the heat to penetrate deep into the tissue to stimulate increased blood flow. The wraps vary in price, but are reasonable in price. The one I got for my shoulder to help my grade 2 tear of my rotator cuff tendon cost around $100 USD on Amazon. Magnets also do this. There are many FDA approved back braces that have a series of magnets in the brace to perform the same function as FIH.

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PostPosted: 29 Feb 2016, 06:50 
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Hi Der_Echte,

Many thanks for your thoughts on my injury. You have said some of the same things as my physio and the sports physician.

I have been told that playing TT won't make it worse, and that the pain involved in some shots is not signalling any further damage. I agree that blood flow to the afflicted area should help fix it.

Fortunately most (all) of my table tennis is not competitive at my level so I have time to decide what shot I am going to play and plan for the lesser or no pain shot.

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PostPosted: 29 Feb 2016, 12:33 
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You might want to consider moving to a lighter paddle to reduce stress on your damaged tendon. You can get a double-inverted paddle into the 150-160g range provided you choose light rubber and a light blade. BBC has been making me ~70g blades for this very reason for years. The Rubber Mass Database will tell you which rubbers are light and which aren't (they range from 35g-55g cut per piece.. a huge difference).

If you go this route be sure to give the lightweight paddle a few sessions to get accustomed to the new weight. Initially your timing will be way off. Everyone I know who has gone this route at first hated the feel of the light paddle, claiming it was impossible to use. A few playing days later and they were converts, gushing at their new hand-speed and lack of fatigue.

Good luck with your recovery!


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