Tennis Elbow (severe) – is something I would not wish on anyone. It is one of the hardest things I have had to recover from. While the site of injury is obviously the elbow, the loss of strength one experiences is throughout the hands and forearms. One may find it difficult to even open a door. In my case, I was unable to even type at a keyboard – or shake hands – or open doors. This complete ‘hand-strength’ loss baffled me at first. After all – it was my elbow  – not my hands that were injured. Nevertheless, as a little research will uncover, tennis elbow causes complete loss of strength in various parts of the hands, shoulders and arms.

This was the second time I got tennis elbow. The first time, like others out there – I tried everything from physiotherapy to miracle ointments to pain killers  (including cortisone injections) – and learnt the hard way what works and what doesn’t. The first time – it took me 12 months – including LOTS of physical therapy to get over it. The second time, it took me less than 4 weeks – and zero physical therapy. I just knew what exercises to do – and what things to avoid. This article summarizes everything I did during those 4 weeks – and also everything that I continue to do on a preventative basis.  If you also have finger pain alongside the tennis elbow, you may want to read this post on how I overcame my finger tendinitis.

Intuitive Recovery Time

At an intuitive level, when one is unable to even pick up small objects (or open doors), one feels that one may never recover (or at least, that it is going be a super slow process). This is exactly how I felt.

Actual Recovery Time

I was able to work on my computer within a couple of weeks – and actually made a somewhat full recovery in less than 4 weeks – but I had to do a LOT of things right. Had I not done any of these things, I doubt if my recovery would be as quick.

Where is the pain coming from?

T
‘Tendon’-itis. A tendon is simply the ‘ending’ of a muscle. It is where the muscle attaches to the bone. Understandably, it is a ‘thinner’ strand of muscle fiber than the rest of the muscle.    When your forearm muscles contract (for various reasons), this ‘ending’ of the muscle gets stretched. This is what the pain in tendonitis is – the stretching of the tendons due to contracting muscles. Why do the muscles contract? Any repetitive motion would cause the muscles to get ‘overused’ – and overuse causes a ‘permanent contraction’ of sorts.

Step 1 – Bring down the inflammation. (You are injured – Limit your movements)

When you are down with something bad – like the flu – do you think about going to work? Or sitting on your computer? Or doing anything except lying down? Well – that is how you must treat your tennis elbow. Except – you do not have to be bed confined. But you do have to limit your movements – especially movements that involve your hands. I cut down on my driving – and only drove short distances (that too with elbow braces (see below) always around my forearms). Goes without saying that – tennis, golf etc. are all taboo. Lifting anything remotely heavy is out of the question. You have a serious ailment – and you need to treat it as such. This is one of those obstinate things that will just not go away if you do not give it complete rest (see step 2 below).

Bringing down the inflammation is tricky in tennis elbow. OTC medicines, pain killers etc. seem to have little or no effect. Topical ointments provide little comfort. The few things that helped bring down inflammation for me were (in order of effectiveness)

  • a) Aggressive icing
  • b) DMSO with Aloe Vera Gel – Very strong and effective, though with a nasty side effect (itchiness). Aloe Vera combined DSMO is slightly better. Alternate with vitamin E oil over the skin to mitigate the ‘itchiness’ side effect.
  • c) Cod Liver Oil (fresh, not capsules) and MSM powder – These were the only ‘supplements’ that showed instant results.
  • d) Electrotherapy and Ultrasound  –  Ultrasound is great for DEEP inflammation, Electro for more outer, broader scoped inflammation. For Electrotherapy, I recommend getting a HOME TENS unit. This is very effective – and you can effectively WORK with this UNIT ON.

  • e) Aleve (Naproxen) – This did not relieve my elbow pain as much – but did work on my hand and finger pain (I took 1000 mg daily for 2 weeks). Check with your doctor before you start on this.
  • f)  Prescription Topical Gel (Very effective – more so than any other gel/ointment) – In the U.S., doctors may prescribe a compounded topical gel – containing ketamine, bupiv, cyclo,keto , gaba mixture. I tried this ‘compounded gel’ – and it seemed to instantly provide relief. Apparently, the combination contains pain killers used against neuropathic pain – as well as muscle relaxants. And since ‘tendonitis’ muscles are in a permanently ‘stretched’ state, muscle relaxants go a long way to helping the condition. Also ‘Blue Emu’ ointment – seemed to relieve the pain – although only temporarily.

DMSO

NOTE on a) Aggressive Icing – Ice the affected area for 10-15 minutes – every couple of hours. Using raw ice worked better than icepacks – if your skin can handle it.

NOTE on c) Cod Liver Oil – I tried various supplements (see supplements section below). The only one that I felt helped in reducing inflammation was cod liver oil (fresh).
MSM powder and Magnesium Drops are both good for recovery from muscle fatigue – and in relaxing muscles in general. Relaxation of muscles is a good thing – since part of the source of the pain is a severely contracted (tightened) muscle. MSM does have side effects – and may cause bloating if taken in excess.

NOTE on d) Ultrasound and Electrotherapy treatment – These absolutely helped lessen the pain – especially along my forearm. Right at the spot of the injury (elbow), they were less effective. The HOME tens unit is absolutely miraculous. Once I learnt how to use it, I would actually work WITH the unit on. The biggest advantage of having the unit on was that it a) Kept the pain from interfering with my work  b) provided some level of healing while I worked.

Inflammation – and Cortisone Steroid Shots

Cortisone shots – These are popular in treating inflammation. I did not take a shot when I had the incident – but much, much later – when I had already tried a variety of things – but still had almost 80% of my initial pain present. It did absolutely nothing for me (ideally, it should have reduced the pain somewhat, even if not fully). Additionally, the shot hurts A LOT (for 24-48 hours after the shot).

Inflammation Summary

All I can say is that it (bringing down inflammation) is a process – not an event. You have to keep at it – and try a few things to see what works. Ice worked for me as did DMSO with aloe vera (though with a nasty skin itchiness side effect). Cod liver oil and fresh Vitamin C are good supplements – while DSMO gel and compounded topical gels are very effective as well. Ultrasound and Electrotherapy are also extremely effective – providing you with the option of working with a TENS unit on – which keeps the pain at bay and actually heals while you work.

Unfortunately, not any of my orthopedics (6 all in all) that I met could explain why it is so difficult to reduce inflammation in tennis elbow. Why tried and tested pain killers (including strong, prescription strength anti-inflammatories), had little effect? I was understandably mystified – but I didn’t realize that the experts were equally mystified at this condition. What I realized is that the inflammation never fully goes down (I had elbow MRIs done 8 months into my condition – and they still showed inflammation). One must proceed with the strengthening exercises in spite of the inflammation.

Rating – Top Inflammation Reducers (for me)

  1. Devices – TENS Unit – constant usage with a home tens unit. 30 minute sessions 2 to 3 times a day.
  2. Gel – DSMO gel – Though it has a nasty side effect (itchiness), I got this recommendation originally from Dr. Weil’s website. This stuff is very very powerful – but use in moderation. It will instantly bring your pain levels down (and keep them down). BUT be warned – it itches! Like Crazy. Which is why I went with  the Aloe Vera mixture with DSMO. Even that is itchy – but less so. Use it in moderation – apply it directly over your most tender spots (after wiping the area clean with water) – and let it sit for as long as you want (minimum 20 minutes to seep in). If it bothers your skin too much, you can alternate with Vitamin E oil applied over the skin – this soothes the itchiness – and has also been linked to  relieving tendon pain.
  3. Supplements – Fresh Orange Juice, Fresh Cod Liver oil, MSM Powder
  4. Ice

Step 2 – Wear an elbow brace 24/7 (except while sleeping) – (Update: can use a Kinesio Tape or crepe bandage instead)

kinesio_tape

My orthopedic explained the importance of this brace. Anything that you do with your hands – is connected to the same, common tendons in your elbow. This is why even a small action such as opening a door – hurts like hell. The idea is to arrest all hand motion from reaching the elbow – and the brace helps do just that. Without it – your elbow never really gets rested – and even the slightest hand motion keeps injuring it further.

These braces need to be worn even after your elbow starts improving. For a period of at least 6 months. Let the brace become part of your fashion statement – don’t worry about how it looks or whether it feels warm etc. Just wear it – otherwise chances are you will end up with a relapse (in my case, I believe this WAS a cause of the relapse – I started feeling better – and started doing things without the brace. Bad idea – just wear the brace at all times).

UPDATE note : Purely by accident, I discovered that a crepe bandage – tied over the entire elbow – and extending a bit on the biceps (above the elbow) and a bit on the lower arm (below the elbow) – kept the elbow in place much more effectively than even the braces I was used to. The only downside is the time it takes to put the bandage on. Also, the skin under the bandage may experience dryness. I simply applied some moisturizing crème to deal with that. The bandage was so effective that even at my worst pain levels, I could operate a keyboard with the bandage around my elbow. It absorbed the bulk of the impact – and worked better than the brace even.

UPDATE note 2: Crepe bandage seemed to work better than elbow bands. However, Kinesio ( aka Athletic tape) tape – works even better than Crepe bandage. You simply need to tape over the entire muscle as shown in the image above. It is a good idea to learn the taping technique from any physical therapist – once you see them tape you – you can do it yourself at home.

  1. Imak Elbow

    Band

2. Medspec Tennis Elbow Support

Step 3 – Do Forearm/Elbow stretching exercises – At least TWICE a day

Once your pain is somewhat reduced (aggressive icing, ultrasound , laser and active release are all good for this), you can begin the strengthening process. As mentioned before, your inflammation will never go down much (all the icing etc. only helped maybe 20-30% in bringing down pain levels), so it is a judgment call as to when you start these exercises. Obviously, if your pain is a 10 on 10 (btw…I hate this 1 to 10 scale– when I am in pain – there is just a two point scale – excruciating and bearable), you want to ice, ice and ice some more. In my case, all the icing and all the ultrasound never got the pain below a 7 at best (got it from ‘excruciating’ to just bearable). I wish I had the compounded topical gel earlier on – I think it certainly helps in relaxing the muscles and reducing the ‘stretching’ of the tendons.

To summarize, you need to start the strengthening exercises as soon as the pain is somewhat bearable enough for you to do the stretches.

If you want your elbows, hands and forearms to get strong – you must do a specific set of exercises. And do these as often as you can. The three sets of exercises that I did religiously included:

  1. Resistance Band (Stretch Band) Exercises – This was recommended to me by a top physiotherapist (this guy treats some of the top athletes – tennis players, soccer players etc.).  Just tie one end to a staircase knob or any other solid support – and grasp the other end in your affected hand.

Stretch 1 – Straight Back elbow stretches – holding your end of the band at about belly-button height – AS IF YOU ARE SHAKING HANDS WITH IT. Stretch it straight back – so your elbow moves past your hip – and hold for at least 10 seconds. Keep increasing the time you can hold it.

Stretch 2 – Diagonally across elbow stretches. Hold your end again at belly button height. Now try and stretch it diagonally across your chest towards your opposite shoulder (if you are holding it in your right hand – move towards your left shoulder).

Stretches 3,4 and 5 (once you are strong enough) – These are stretches that almost every physical therapist you go to will recommend. They bring strength back to the fingers and the forearm. These are recommended once the inflammation is down substantially (but you know my theory on that – my inflammation never went down more than 30% – and even elbow MRIs 8 months into the tendonitis revealed significant inflammation). Personally, I thought I did these (3,4 and 5) diligently, but for whatever reason, the above two stretches (1 and 2) worked best. However, I would suggest you at least try these (3,4 and 5)  – and see if they help you more than they helped me. The best place to see them in action is in this youtube video.

How often should you do them? At a minimum – twice a day – but as often as you can is ok. My physiotherapist (who taught me these stretching exercise) – said you cannot do enough of these.

 

2.  Finger stretches –  Place a rubber band around the tips of your fingers (as shown below) – and try to OPEN your fingers. This is a GREAT stretch for the entire muscles that stretch from your fingers all the way to the elbow. While you can use a regular rubber band, I did find these specific resistance bands very useful. They offer differing resistances – and do not slip off like rubber bands do.  Try and stretch the rubber band as shown in this youtube video.

finger_rubber_band

Trigger Point Massage Ball  – Another great, self service massage ball. Almost as good as getting a professional massage.

3.  Theraband Twisting – This was something I tried on my own (as opposed to the resistance band which my physiotherapist recommended). The theraband comes in various ‘flexes’ – I got the ‘light’ – and that was good enough. I have heard the medium can be a little hard for seriously affected elbows. There are several youtube videos on tennis elbow theraband exercises. Here’s an image showing the primary tennis elbow exercise (called a Tyler Twist) that you can do with the Theraband.

tennis-elbow-eccentric-twist-exercise-the-tyler-twist

How often should you do them? At a minimum – twice a day – but I did these more than twice – based on the advice of my physio about the stretch band exercises.

4.   Tennis Ball Squeezing

In an ironic twist, the thing that causes tennis elbow (tennis) – can also help in the recovery process. Just hold a regular tennis ball held in your palm – and squeeze it as hard as you can. Initially, you will find this to be difficult – since your hand will have very little strength. As you do this more and more – you will find your grip getting stronger. This is the simplest and one of the more effective exercises that I did. I carried that ball everywhere (I didn’t care if other lunch folks saw me squeezing a tennis ball while waiting for my food..). Again – like the rest of the exercises – there is no limit to how often you do this. As much as possible!

5.  Nerve Compression? (TOS, Carpal Tunnel, Cubital Tunnel etc.) 

It is possible that part of your ELBOW and FINGER pain is related to nerves being compressed somewhere between the SPINE and the hands. There are so many possibilities here – but I’ll list the top two.

  1. Carpal Tunnel (median nerve compression) at base of hand.   There are several self tests available online to determine if you have this. Notably, you will LOSE pincer strength (thumb and index finger in a pinching formation) – among other symptoms.
  2. Thoracic Outlet Syndrome – Neck and Shoulder area in front of body  – another common, yet overlooked cause of finger and ELBOW pain. While a full TOS diagnosis requires lots of tests, a quick way to determine this is :
    • Ring and Pinkie finger weakness and pain – also possibly numbness and tingling. These two fingers are usually involved in TOS.
    • Holding your arms above your head – with elbows at 90 degrees – palms facing forward –  is difficult for a long period of time. Hold them this way – and try to open and close your palms quickly – for about 2 to 3 minutes. If you feel pain, fatigue in your arms and hands, you may have some level of TOS going on.

Stretches for TOS and Carpal Tunnel or ANY NERVE Compression – This YOUTUBE video – with the THREE stretches covers ALL the three main nerves – median, radial and ulnar – that can be problematic. These stretches take less than 2 minutes. While the video is titled ‘Thoracic Outlet Syndrome Exercises’, the same exercises help with ANY nerve compression (cubital tunnel etc.) in the arm, shoulder and neck area.

Postural Braces – A POSTURE BRACE also helps in recovering from conditions such as these. These are especially useful in desk jobs (mainly computer related desk jobs) – where the neck, shoulders get out of good posture easily. I used these temporarily – but eventually, realized that I would have to strenghen my upper body – to where it could tolerate such postural contortions without breaking down! The exercise regimen (gym, weight training) that I describe below, helped me strengthen my upper body (I did not even realize how weak my entire upper body had become).

Exercises Summary

I am sure there are dozens of other recommended exercises (wrist flex with small weights, hold out your palm and flex it upwards/downwards). These are all worth doing – in addition to the ones above. The ones I have listed above (the stretch band exercises especially) – were shown to me by a really good physiotherapist (some famous sportspeople go this guy for their injuries). I take these exercises to be the most important of the lot. The theraband was something I tried on my own – and it seemed to help as well (it comes with its own instructions – but you can youtube theraband exercises for tennis elbow).  I actually went to 4 different physical therapy places – and tried a variety of acupressure and alternative modes of therapy. The sheer number of ‘stretches’ and exercises in my experience is ridiculous – some work the neck and shoulder area, others work the fingers, wrist area and so on. I would try and list all of them – but I feel the ones listed here are the ones that made the biggest difference.

How often should you do them? At a minimum – twice a day – but as often as you can is ok. My physiotherapist (who taught me the stretching exercise) – said you cannot do enough of these. In case you are worried that you may be ‘over working’ an already inflamed elbow – you would be wrong. These stretches actually help the elbow recover. Something as simple as trying to squeeze a tennis ball builds hand strength and wrist strength. These exercises were the centerpiece of my recovery program – and I am convinced that without these – my recovery would have taken longer.

Some general principles about STRENGTHENING joints:

  1. JOINT STRENGTHENING is VERY different from muscle strengthening. Muscles need to be fatigued by reaching higher and higher weights – before they break and rebuild new fibers. For JOINTS, this recipe is disastrous. What you want is smaller weights – and more reps. I learned this from a physical therapist that I worked with – and it has been a game changer in my recovery process. The ELBOW JOINTS (and finger joints) are no exception. It is the JOINTS that hurt – because that’s where the TENDONS are attached. The exercises below must be done with increasing REPS – not increasing weights.
  2. STRETCHES as opposed to WEIGHTS – In general, STRETCHING will help your tendons recover more than weights will. The stretches can be simple hand flexion or involve the use of an elastic (resistance band). In my experience, resistance band stretches are the BEST thing you can do for joint /tendon strengthening.

Step 4 – Change your keyboard, mouse (The keyboard and mouse below are MY MOST RECENT recommendations – Oct 2013)

Tennis elbow is caused by repetitive stress. Computer typing is one of the most common forms of this type of stress. In my case, it was at least partly responsible for my tennis elbow (besides actual tennis and golf). Once you have regained some strength – consider getting a keyboard and mouse that is as ‘soft’ as possible.Through my 1.5 years of experimentation, I honestly spent over $2000 just on keyboards and mice. Anything that promised to be gentle on RSI, was purchased. It was a matter of my livelihood for me.

Mechanical Keyboards (Oct 2013)

The most important discovery I made was regarding the TYPE of keys. Mechanical keys are the only keys that actually provide any  decent level of SHOCK ABSORPTION. With a gentle pressure from your finger tips, the key continues its depression on its own without any further pressure from your fingers. This makes it exceptionally gentle on the fingers. Once you get used to these keys, you will discover that regular keyboards (rubber keys) are just not the same. They let your fingers absorb the bulk of the shock instead of the key switch itself. While ANY mechanical keyboard will offer superior finger protection compared to non-mechanical, there was one that stood out in my experience. The TECK keyboard listed below. However, there are SEVERAL good mechanical keyboards on the market. These are mainly popular with GAMERS – but they are suitable for regular use as well. The CORSAIR mechanical keyboard was one that I tried – and had a good experience with.

Staggered versus Non staggered keys

Any keyboard you look at will have its keys NOT LINED UP. That is, the Q is not directly above the A and the A is not directly above the Z. This design (called STAGGERED keys) is HORRIBLE on the fingers – since they have to constantly stay non-lined up – as they move from key to key. A better design would be to have all the keys along a column – directly above /below each other. This is called a NON-staggered design. Again, once you try it out, there will be no going back. I can type for hours on a non-staggered keyboard without any pain – but move me to a regular keyboard – and after a couple of hours, my fingers feel stressed out. (btw– I have tried all the Kinesis keyboards as well – and while they offer the split keyboard design, most of them DO NOT have mechanical keys).

Kinesis Keyboard (with VIP accessory kit)

While it doesn’t offer mechanical keys, the keys are extremely soft. And while it doesn’t offer a non-staggered layout, the separation of the halves (split keyboard – with 20 inch separation) is a real asset. This is especially good if you have shoulder pain while typing – or if you tend to ‘crouch’ your upper body while typing. The keys are the softest of all the keyboards I tried, which is the main reason I recommend this keyboard. I would not recommend it WITHOUT the VIP kit – the kit makes it highly customizable.

kinesis_keyboard

Totally Ergonomic TECK Keyboard

The TECK keyboard listed below combines both of the above finger friendly features – mechanical keys and lined-up (non staggered) keys. There are other keyboards that offer mechanical keys as well as NON Staggered layouts. This one has met my needs for the past year or so. Apart from their slightly (actually COMPLETELY) unresponsive customer service (in case you have to do a return or something), the product itself is solid. Again, I must emphasize that their customer service is non-existent – no telephone number on their website. An email contact form – which never gets an actual response. But I give the product points for combining the two most finger-friendly features – non-staggered layout and mechanical keys. The learning curve?  Online reviews will scare you with a huge learning curve – in reality, it took me less than a week to get used to the slightly off ENTER and DELETE and SHIFT keys. Once I got the hang of these, the rest of the keys are standard (QWERTY…). Their logic behind relocating the ENTER and SHIFT keys is sound  – these are the most oft used keys and deserve to be in a CENTRAL location – where the THUMB (your most powerful digit)  – can access them.


Light-IO Touch Free Keyboard

lightIO_touchless-keyboard

This keyboard has laser activated keys. You DON’T touch the keys –  they SENSE the incoming depression from your fingers  – and the key gets activated (no touch involved). This is a great keyboard if you are willing to spend some time building up your typing speed. Since there is NO touch involved, it provides no pressure on your fingers. For me, initially, I felt this was the perfect solution. However, my typing speed on this was very slow. A suggestion offered by other users was to buy TWO such keyboards – one for the left and one for the right. Again, I just couldn’t type at any reasonable speed here – maybe I did not spend enough time with it.

Mouse (Oct 2013)  –

The mouse that I still continue to use is the 3M vertical mouse listed below. It is lightweight – and most of all, places your wrist in a neutral position – which causes no stress even after long periods of usage. The 3M Ergonomic mouse  ( get the large, the small is too small ) is the one that I use on a regular basis.

Older Recommendations (March 2013)

This is an older keyboard recommendation – the Microsoft Natural 4000 keyboard – which is a cost-effective option. However, it DOES NOT have mechanical keys and it DOES NOT have the column (non staggered) design. However, it is gentle on the fingers and especially on the shoulders due to its split keyboard design. As for the mouse , a vertical mouse is the way to go.  The 3M Ergonomic mouse  ( get the large, the small is too small ) is the one that I use on a regular basis.

Supplements

Thanks to the internet, I got to try virtually every “miracle-cure” that my friend, Google could suggest. I was desperate to get better fast – and while I did eventually get better, I learnt a lot about what worked for me and what did not.  Of all the supplements that I tried (Wobenzyme, Creatine, GLUCOSAMINE, CHONDROITIN & MSM, L Theanine, Magnesium, L Tyrosine…), there are only two that somewhat worked – and that I continue to use on a preventative basis.

  1. Cod Liver Oil – Not capsules – but fresh oil. I am sure all brands are ok – the one I use regularly is shown below. This is a natural anti-inflammatory – and in addition to icing, this helped me bring the pain down considerably. It is also great for overall joint health – and especially helps keep the pain down during cold, winter months.
  2. MSM Powder

3. Fresh Vitamin C – I eat whole oranges – but any form is good for you. Again, fresh is better than any capsule/tablet. Vitamin C is known to be effective in maintaining tendon health.

Prescription Anti Inflammatories

I do want to give honorable mention to Naproxen (same as Alleve) – taken in 500 mg doses TWICE daily (with a full meal). While they did not relieve my elbow pain much, they did wonders for my associated finger and hand pain. This is a quick and inexpensive thing to try. It does have its own side effects (for example, if you take acid blockers – you may want to up your dosage during the naproxen treatment). Of course, go through your doctor before you take this.

Ointments (mainly to reduce pain and bring inflammation down)

  1. DMSO Gel – with Aloe Vera. As mentioned above, this IS super effective, but with a stinging, itching side effect. The aloe vera mitigates the side effect somewhat. Vitamin E oil (just slice open a vitamin E capsule) rubbed over the skin (after the DMSO has soaked in), can relieve the itchiness. This is my all time favorite topical ointment for a simple reason. When it brings down inflammation, the effect is PERMANENT. The pain is reduced – and stays reduced. For best results, I would apply this every night (after showering) – and leave it on while I slept. In the morning, the pain would be magically MUCH MUCH less. This works on ANY joint – I used it on my fingers , wrists – along with the painful elbows.  If the itchiness gets too much, give it a break for a day or two (and apply Vitamin E oil generously).

2  Off the shelf – try Capsicain . Use the low concentration – 0.035 – to begin with. Or Blue Emu – this also helps with any muscular pain.

 

3 . Prescription Only Compounded Gels – In the U.S., doctors may prescribe a compounded topical gel – containing ketamine, bupa, cyclo, , gaba mixture. I tried this ‘compounded gel’ – and it seemed to instantly provide relief. Apparently, the combination contains pain killers used against neuropathic pain – as well as muscle relaxants. And since ‘tendonitis’ muscles are in a permanently ‘stretched’ state, muscle relaxants go a long way to helping the condition.

Massages , Active Release, Acupressure

There’s something called the ‘active release’ technique – which I have become a fan of. Their whole approach to this condition is – ‘No amount of rest will fix it. Something is pushing against something. A nerve against a muscle  perhaps. Unless we ‘release’ that, there will be no relief. So – I tried it – and I have recounted my experience here (in short, I think it works great – and was the first thing that provided immediate lowering of pain – apart from the icing).

In India, where it is relatively easy to obtain acupressure, I would have a specialist come home and massage the ‘pressure points’ along my palm and forearm. This also helped a lot.

Homeopathic Remedies

I grew up in India where these little white pills are administered for just about every ailment. They work on a principle similar to vaccinations – infuse a small amount of something (typically plant extracts) that CAUSES the symptoms you see. Your body’s immune system kicks into gear – and starts fighting your main symptoms. There’s a lot more to it – and doctors actually spend years studying homeopathy. A good homeopath knows as much about the human body and western diagnoses as a regular MD.

Whether or not you believe in this system, it is true that about a dozen of my friends and family members ONLY found treatment through this route. Usually , it took less than 6 weeks for all their tendonitis symptoms to disappear. Homeopathic remedies are VERY specific – in that – they are different if you

a) had the pain for a few months VERSUS just developed the pain

b) Got it from repetitive stress VERSUS got it from lifting something heavy one time

c) Does the pain feel better lying down – or get worse – does it feel better with movement or worse….etc.

These are some of the questions a good homeopath will ask before prescribing a remedy.

I DID consult a few homeopaths (some of them are good acquaintances of mine).  While there were a few discrepancies amongst what was prescribed (there are LOTS of treatments for tendonitis in homeopathy), there was also some agreement. Best of all, these medicines have no side effects.

RHUS TOX, for me,  was the one that delivered.  It especially helped with my finger pain (which was related to the tennis elbow –  and exacerbated with all the typing I did for my job).

  1. Try RHUS TOX 30 (twice a day) for a week. If even slight improvement is noticed, continue for another 2 weeks.
  2. If no improvement, up it to RHUS TOX 200 – for a week. If improvement, continue for another 2 weeks. If no improvement after a week, this is not the remedy for you.

However, rather than rely on MY diagnosis, I would strongly recommend consulting an actual homeopath for your specific symptoms.

Diet, Digestive Ailments and Chronic Tendonitis

Could poor diet be  at the root of chronic tendonitis? This question has been asked and addressed here (among other places). I will only make this observation – I had poor digestion for several years – before I got tendonitis. However, I did feel the weakening of my elbows (mild, gnawing pains) around the same time as my digestive issues started.

Book Recommendation – While I was merely conjecturing the relationship between digestion and chronic tendonitis, this lady seems to have really done her homework. A professional clarinist, she suffered from severe tendonitis along with digestive ailments. Not only did she uncover the connection between DIET and CHRONIC INJURIES, but has written an informative account of her journey.

Things that did not work (I tried all the items in this list)

NOTE: The two things that I would absolutely never try again are ‘Cortisone shots’ and ‘Acupuncture’. I am sure they work for some people (otherwise why would so many yelpers recommend acupuncture for tendonitis?) – but for me  – they actually worsened my existing condition. The other supplements just failed to work – but did not worsen my condition further.

Cortisone ( Steroid ) Shot

Most doctors / orthopedics will want you to consider these if full rest does not lessen the inflammation. I can see where it may help – right when you actually have the incident and the inflammation is at its worst. I DID NOT get the shot at the time of injury occurrence (got it MUCH later) – so my perspective may be slightly off. However, my pain when I got the shot was about as bad as when the incident occurred – so it should still have provided relief. It did not. Plus – it hurt like hell. There were some doctors who later told me that it has to be JUST right for it to work (neither a bit here nor there). Well – I got it from a very competent orthopedic – and I am not worried about whether he ‘got the spot right’ or not. I think he got it right – but it still did nothing to improve my elbow pain. In fact,  I am convinced it weakened my left elbow more (previously, my left was the ‘better’ of the two – after the shot and ever since, it has been the weaker of the two).

Acupuncture

I tried this with a lot of hope (several yelpers claimed to have fixed their tennis elbow with this). This is one of those things that I insist did nothing to help my condition – and possibly worsened it. This is in complete contrast to acupressure – which really helped. Again, I have nothing personal against acupuncture – it just did nothing for me – and for some reason, I felt much worse after it. Again, I don’t doubt the qualifications of the person who administered it – just its effectiveness in treating my specific condition.

Prolotherapy

There is a lot of discussion about the effectiveness of this for tennis elbow. I tried it – it did not work. This was the most expensive thing I tried (cost $500) – but it did nothing to relieve my pain. It did not worsen matters – but did nothing to relieve the pain or improve the condition.

Supplements, Over the counter meds and ointments that did not work (I tried all the items in this list – I am one of Jeff Bezos’ favorite customers)

  1. Penetrex  – Penetrex is the highest rated product on amazon.com for treating tennis elbow. I must have rubbed four jars full. Did not make the slightest difference as far as I could tell. Not saying it does not work for others – just did not work for me. Also – as an alternative, I tried Capsaicin – WHICH ACTUALLY HELPED (but not as effective as DMSO, which I discovered a little later on). I would apply it at least twice a day on both my elbows. Be sure to start with a small concentration (0.035) – this small dosage burnt a bit – so I can only imagine how much the 0.1 (high potency) would burn. Good news is that I found the small concentration (0.035) to be very effective – so did not have to try the higher concentration.
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  2. Advil, Tylenol etc. – These had the least effect in terms of actually helping the tennis elbow pain. However, Alleve (naproxen), when taken at maximum dosage (1000 mg daily, for 2 weeks) , did help with my finger and hand pain. Take these only if approved by your doctor.
  3. Wobenzym – Again, I took a lot of it – no noticeable improvement.
  4. Creatine Protein Powder – I was most psyched about this one – but as far as I can tell, it had no effect on my condition
  5. Glucosamine , Chondroitin, MSM (update – the combo supplement listed below is very effective for both, short term pain relief and long term joint maintenance).
  6.
  7. L-Theanine and L-Tyrosine – I tried these supplements based on some internet testimonials. Not sure they did anything.
  8. Magnesium Citrate – Although my serum Mg levels were normal, a lot of people seemed to recommend these for various muscular conditions. I did try them – but again – any effect they might have had was hard to discern. Magnesium OIL – when rubbed over an entire muscle area, has a relaxing effect on the muscle. It is worth a try – for some people the Magnesium oil works as well or better than MSM powder.
  9. Vitamin D Shots or Supplements – Firstly, if you are Vitamin D deficient, be sure to take these shots (or oral capsules). Secondly, cod liver oil gives you Vitamin D as well. And cod liver oil is one of the few things that instantly relieved the elbow pain that showed no signs of subsiding.
    • The type of Vitamin D supplement matters. You want quick and readily absorbable. Read Amazon reviews. The one I used was an Indian brand . After about 2 weeks of taking 2k / day, I noticed a drastic improvement in all joint pain. My stiff palm and fingers opened up.
    • The quantity – I took 2k/day. While 2k / day sounds like a lot – for actual repair purposes, that is what was prescribed for me.
  10. Vitamin B12 shots – I was slightly on the lower side on B12 – so I took these just to be safe. This is one of those important Vitamins that can cause all kinds of mysterious ailments if you are seriously deficient. And you MUST try and take a shot as opposed to oral ingestion.  The reason you may be B12 deficient may have to do with poor intestinal absorption of this vitamin (and in B12’s case this is a fairly common underlying cause) – so it is best to get it injected into your bloodstream (bypass the digestive system altogether). Again, not sure it had any effect on my tendonitis – just a generally good thing to have in the normal range.

Long Term – Continued Prevention

Steps 2 (wearing elbow braces),  3 (stretching exercises, especially the finger stretches) – and 5 (use ‘wrist-friendly’ keyboards, mice) – are a must on an ongoing basis – if you want to avoid a relapse of the condition. Also, cod liver oil (fresh, not capsules) and Vitamin C (also fresh), are important components of keeping joints and tendons healthy.

Massages, Acupressure etc.

A regular massage may not get you much relief. However, there are RSI massage specialists now – who specialize in repetitive stress injuries. I started trying some of these out – and had a decent experience – and then I found a technique which let me do the massage at home myself. This youtube video clearly shows how you can use your own knees to apply pressure on your elbows. This is truly a remarkable technique in my opinion – and even now – after heavy typing, I simply use my knees to ‘walk’ over my forearms. It works!  The underlying concept is acupressure – however, it is simply not possible to apply enough pressure with an acupressure ball/massager on your own. Using your own body weight (and knees) solves that problem.

DMSO Gel

To this day, if I feel the slightest start of pain in any joint, I reach for the DMSO gel. One small application (just a dab –  but rubbed in thoroughly) – and it disappears (by the next day).

Exercise Regimen

Tennis elbow is usually accompanied by a weakened upper body. Once I was able to lift light to medium weights, I started on a ‘strengthening’ regimen that included weight training. Prior to this, I had only being doing stretching (resistance bands) – no weights. Once I could, I worked on strengthening my upper body with weights. I was surprised to discover how weak my neck, shoulder and other upper body muscles were. My elbow was understandably weak – but, for a lot of tennis elbow sufferers , the problem may be their entire upper body. Recent RSI research confirms that RSI is a comprehensive upper body problem – and not just isolated to single joints.

I joined a gym that had WEIGHT TRAINING group classes (one can adjust the amounts of weight – you don’t have to lift the same amount as others in the class). A 1-hour session of non-stop lifting of weights sounds rough – but again, go at your own pace – and use only the weights that you can manage. Do this a few weeks (I did only ONE class a week) – and your upper body will start finding long forgotten muscles.  Once you reach this stage, you can have some peace of mind – you will not be afraid of lifting something (and injuring your elbow in the process). I went from not being able to lift a glass of water to where I can lift heavy groceries again.  But it took me a WHILE to get there!

Summary

As I mentioned before, everyone’s experience of what works and what doesn’t may differ. This is just my own experience. Having suffered from tennis elbow TWICE (in quick succession) – and having tried everything from ointments, pills, lots of physical therapy, electrotherapy, ultrasound, prolotherapy, home exercises to homeopathic medicine, I have learnt what works for me. If you are suffering from this serious condition, I feel for you – and wish you a quick recovery. Hopefully, something from this post would be helpful to you.  While I have listed these sequentially (Step 1….6), obviously, they all need to be done in parallel. Each step is an important part of the recovery process – and trust me, if you take this condition lightly, it WILL get the better of you.

Here is a quick recap of the ‘goodie bag’ (of things that worked).

icecubes Ice is the only thing that actually helped instantly bring down the inflammation. Pain killers and anti-inflammatories (including prescription strength) – and cortisone steroid shots, did nothing to relieve my elbow pain.  The TENS unit was especially helpful. Ultrasound and laser treatments helped somewhat – especially on the forearm – but not as much on the epicenter (the elbow).
TENS Unit (I used the TENS 3000 , but any unit will work) .  Instant pain relief – and I could actually work with the unit attached. tensunit3000

 

 

 

DMSO reduces pain within a span of a few hours. It must be applied on clean skin (wash and dry the area before applying) – and allowed to soak in. It is best to MASSAGE it in to the painful points. The more you massage it in – the better it works. I guarantee you , your skin WILL itch – for a good 30-60 minutes after application. But if you can survive that, you will have overcome the biggest hurdle – and PERMANENTLY reduced your pain.Within TWO Weeks of following this regimen, chances are good that your pain levels will be well below 50% of the original levels. I do not know of anything that works this fast on severe tendonitis (with the possible exception of a TENS unit – but I am not sure how PERMANENT the pain reduction is there).

If TWO weeks sounds too rough for your skin, you can always ALTERNATE with Vitamin E oil (apply Vitamin E oil on alternate days – and DMSO on the other days). The Vitamin E soothes the skin and allows it to recover for the next session. Some research also suggests that Vitamin E , by itself, is beneficial in reducing inflammation.
Continue to wear throughout the day  – even after your elbow starts to recover. Wear for at least 6 months (advice of my ortho and my physiotherapist).
NOTE: Crepe bandages work very well  – IMO somewhat better than these wrist bands. Plus, with crepe bandages you can cover more area as well as provide ‘customized’ pressure.
Do the ‘straight back’ and ‘diagonally across’ stretches every day – as often as you can (minimum twice a day). Continue doing even after your elbow recovers.
This helped bring down the inflammation considerably (along with religious icing). It was one of those things that I could feel working right away (unlike a lot of other supplements). I still take it regularly – a teaspoon in warm milk – for maintenance once a day. If you have tennis elbow, three times a day  is recommended.
Aleve (naproxen) . You want to take 1000 mg daily (on a full stomach). Ask your doctor before you take this. This helped with my finger and hand pain – not as much with the elbow pain.
HOME tens unit. Any home tens unit will work. Learn the correct application points (for the pads) from your physiotherapist, if possible. Youtube has some decent videos on this as well.Buy high quality electrode pads, as the cheap ones tend to wear off fast.
Get rid of your old mouse – and use this or something similar which has a neutral wrist position – is super light (something that tendonitis sufferers need). Get the LARGE size of this 3M mouse – as the small is too small for most hands. I also tried EVOLUENT’s vertical mouse – which has the same features – but found it to be too heavy (something that is a no-no for severe tendonitis sufferers). This mouse will help prevent RSI due to computer (over) use.
This keyboard has COLUMN aligned keys (non staggered keys) AND mechanical keys (that absorb the impact of striking down).https://www.trulyergonomic.com/store/index.php
tennisballfinger_rubber_band

 Finger and Wrist Strengthening -Hold a tennis ball in your palm – and squeeze as hard as you can. Slowly, as you regain strength, you will be able to squeeze harder.

A simple stretch – involving a rubberband around your fingers can also work wonders at rebuilding finger strength .

Appendix A – Nerve Compression, Thoracic Outlet Syndrome

It is possible that part of your ELBOW and FINGER pain is related to nerves being compressed somewhere between the SPINE and the hands. There are so many possibilities here – but I’ll list the top two.

  1. Carpal Tunnel (median nerve compression) at base of hand.   There are several self tests available online to determine if you have this. Notably, you will LOSE pincer strength (thumb and index finger in a pinching formation) – among other symptoms.
  2. Thoracic Outlet Syndrome – Neck and Shoulder area in front of body  – another common, yet overlooked cause of finger and ELBOW pain. While a full TOS diagnosis requires lots of tests, a quick way to determine this is :
    • Ring and Pinkie finger weakness and pain – also possibly numbness and tingling. These two fingers are usually involved in TOS.
    • Holding your arms above your head – with elbows at 90 degrees – palms facing forward –  is difficult for a long period of time. Hold them this way – and try to open and close your palms quickly – for about 2 to 3 minutes. If you feel pain, fatigue in your arms and hands, you most likely have some level of TOS going on.
  3. Stretches for TOS and Carpal Tunnel or ANY NERVE Compression – I was REALLY impressed to find this YOUTUBE video – the THREE stretches in here cover ALL the three main nerves – median, radial and ulnar – that can be problematic. These stretches take less than 2 minutes.

Anuj holds professional certifications in Google Cloud, AWS as well as certifications in Docker and App Performance Tools such as New Relic. He specializes in Cloud Security, Data Encryption and Container Technologies.

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Anuj Varma – who has written posts on Anuj Varma, Hands-On Technology Architect, Clean Air Activist.

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