Tennis Elbow

Ok I got the official diagnosis - tennis elbow or lateral epicondylitis - and the cortisone shot into selfsame common extensor tendon - painful!  After the pain of the injection subsided over a couple of days, the general pain subsided somewhat but more practice over the weekend for a performance at Chestertown guitar festival (great fun - workshops, concerts, fun with friends) put me right back at square one -   which is -  I can play just fine without pain, but gripping or twisting or even extending my left arm at all other times is quite painful, and the common extensor tendon and associated muscles down the forearm are sore when pressed.    So this is finally making me contemplate a serious change in my practice attitude - probably long overdue - only youngsters can go at something with abandon until they quit from mental and physical exhaustion and not suffer consequences!  Fortunately we have a month long break from orchestra rehearsals after this week, which will allow me to rest it pretty much entirely.  The question is, how can I accelerate recovery and change what I'm doing to prevent it happening again?

While waiting for medical, advice about what to do next I've been reading up on tennis elbow.  Yes Google to the rescue - however I'm only reading posts from physical therapists or MD's - so much misguided information out there, particularly on medical issues.  It seems the current thinking is that tennis elbow is not so much an "tendinitis" but more of an "tendinosis."    Tendinitis indicates inflammation (pain, swelling, redness, heat) whereas tendinosis just means there is something wrong with the tendon but we don't really know what it is.  Hmm.    The post by Paul Ingraham was the most informative I found - a list of therapies that have been found in some cases to work (or not), including the original study references.   I tried a bunch of them - I think in my case I have a bit of both tendinosis and myositis because the muscle hurts in addition to the tendon, so I have tried icing, and when it was particularly sore it did seem to settle it down.  However the 2 things to date I have found to be most beneficial are massage (both longitudinally along the muscle and the so-called "friction" massage across the tendon) and stretching or stretching with mobilization (read the article to find out what this is - but easy to do at your desk at work).  Plus rest of course.  This  means not using the left hand on the guitar.  Or does it?  I found out today that if I don't use the thumb (at all) finger pressure does not cause any pain, either on or off the guitar. Thus I have a potential way to practice finger placement without exacerbating the condition, with the added benefit that I will hopefully learn to lighten up with the left hand.  Also I fear if I just do right hand exercises, though I know they are good for me,  I will either die of boredom or mess up the right hand or both!

Accordingly, things will probably be quiet for the next month, but I'll post again when I have more input on what I'm doing that caused this in the first place (actually I/m pretty sure I know what I was doing wrong - too much pressure when repetitively practicing a sequence of slurs) what I really need to know is how to change things so I don't do it again!

OH MY! I overdid it..... trying to rehearse without the guitar (!)

I was really enthusiastic to get started practicing my guitar again after a summer where goals were somewhat fluid and messing around became the new norm.  Orchestra rehearsals have started (with some really fun pieces - yes!),  I got a new piece to learn from my teacher (OK I said I didn't want to do any Bach, but apparently it's what I need to be doing so...  Bach it is).  And I went back to concentrating on those pesky slurs....   Maybe there was a little too much enthusiasm - but when my fretting arm started to hurt after practice,  I was thinking  - "it's just like when you start to work out muscles that have been idle - they stiffen up and hurt for a few days until they get used to the new regime".   However a few days later, my arm still didn't feel any better - in fact there was now pain around the elbow in addition to the forearm muscles.  Time to do a little research - i.e. probing around in the elbow region and checking out the internet.  Physical exam turned up a few quite tender spots where the muscles attach around the elbow - rats! the tendons are now involved in addition to the muscle.  Tennis elbow anyone?   Ignoring it is not an option - I am prone to tendinitis and I'm definitely smart enough to desist before I cause a chronic injury.  On the other hand I need to prepare for an orchestra performance coming up in 10 days... it's a quandary.   So my best bet is to get serious about rest  and anti-inflammatories.

The first thing I did was to stop playing the guitar.  Well strictly speaking I am still practicing small amount, but moving my left hand into the correct positions without pressing down, or sometimes just playing the right hand (this involves singing, which can be painful for everyone else, but I'm used to it!)  I'm hoping this will work because most of what I have to do with the orchestra pieces is familiarize myself with the music enough to know the timing and how to play the next part...  for sure I'll have to wait and see if this hands-off approach works though.  Next call up my trusty orthopedic physician and request an urgent appointment for a possible cortisone shot.  I guess they know me too well from when I was heavily into skating, so I get 'fitted in' next week.  In the meantime I dig out the ice pack and apply it on a regular basis and put myself on some anti-inflammatories.

Next problem - what to do about the scheduled 3 hour rehearsal this week?  That's surely not going to qualify as "rest" and I know if I take the guitar, my resolution about not playing will last about 5 minutes.   So I go to the rehearsal sans guitar.  It turns out to be quite useful - I found I could hear a whole lot more of what was going on when I wasn't concentrating on my own playing.  I got all the instructions, and importantly, so long as I followed along with the music, I was getting the same  auditory cues from the other parts that I would have if I was playing, so I don't think I missed out too much.

I came away with one additional piece of information - the 'castor oil' treatment. Huh? ... what's that, you might say - reportedly local application of castor oil and heat has an anti-inflammatory effect that can work wonders.  Being a veterinarian I would have thought I should have heard of this -  sounded like quack medicine to me.    Nevertheless after enthusiastic recommendation from our orchestra conductor I google it - and find that indeed, it not only has a long history of being used to reduce inflammation, the active ingredient is a known anti-inflammatory.  So I repair to the pharmacy for a hot pad and a bottle of castor oil and with my arm swathed in an oily rag and a voluminous heat pad I look a little odd... but do get lots of sympathy for the sore arm! So the sixty four thousand dollar question is,  is it working?  After only a few hours it's probably too early to tell, but after a couple of applications it seems to be helping.  Of course this could merely be the placebo effect - but as they have now demonstrated that the placebo effect usually involves actual physiological changes, I'll take it!  So if the rest doesn't work, maybe the castor oil.  And if not the castor oil, the cortisone shot will almost certainly fix it, at least for this episode. The question remains though, how to avoid this in future?  Will have to pay attention to "smarter" practice...