Tennis Elbow/RSI?

Question: Can anyone help me out with the relationship between Tennis Elbow and RSI (if there is one)? I’ve had what I now believe to be “background” tennis elbow in both arms for several months now – probably due in the main to windsurfing. A couple of months ago, my right elbow flared up after playing badminton. I saw an orthopedic consultant who gave me a steroid shot into each elbow which, although painful, certainly did the trick. I also started to see a physio (sports injury specialist – probably a bad idea in retrospect) who claimed it wasn’t tennis elbow I’d got, but inflammation of the radial ligament (not clear to me whether or not this can be described as tennis elbow). She reckoned that the long-term cure would be to “beef-up” the shoulder muscles to relieve stress on the elbows and prescribed exercises accordingly.

However, last week I suffered somewhat of a relapse in my right elbow – again, probably induced by windsurfing – but this time in a slightly different location: Just below (outside) the lateral epichondyl. Add to this a certain numbness/tingling sensation down my right forearm when typing/mousing and life is starting to get pretty miserable. Question is what is the best type of “specialist” to see? My GP doesn’t seem concerned/doesn’t have time/doesn’t understand; I have little faith in my current physio. Should I see an orthopedic consultant again, or a rheumatologist or an osteopath? I’m currently having Alexander Technique sessions, the application of which seems to be helping my neck/shoulder aches, but haven’t got as far yet as good use of the arms. All advice gratefully accepted.

Answer 1: I’m only an engineer BUT…… What you need is a physio recommended by the RSI Inst. who you can first call and have a long chat with. I went to see one who was recommended by them, and instantly felt comfortable talking to someone who understood my problem, never mind the actual treatment. She gave me one session of very deep massage which made a huge difference. I didn’t feel as though she was just talking to me for gaining money, since I was seeing her privately. I also talked to two other physios, but after talking/questioning them at some length on the ‘phone, I did not think they actually knew what they were talking about! Ask them what type of treatment they give, and drop in a few words like ‘AMT‘, pressure point therapy etc….All the terms off the WWW. As you may know, I have had a problem is my wrist for ~18 months and sometimes my elbow is slightly sore because the problem in my wrist is travelling around and also affects the surrounding muscles by default anyway. So ring around and find a good physio!

Answer 2: The numbness/tingling sounds nerve related to me – perhaps you should read up on double crush syndrome, in which AMT-like nerve compression in the shoulder leads to similar symptoms to carpal tunnel syndrome. This is not the same as your forearm tingling but perhaps is similar in root cause. I suspect you have both tenosynovitis/tendinitis (i.e. true tennis elbow) and some AMT as well. If you get some good trigger point therapy on the neck/shoulders, or good AMT physiotherapy, this should have an effect on your hand/arm pain – if it does not, you most likely don’t have AMT at all. I would try to see a really good massage therapist (with a good track record in RSI, could be osteopath, chiropractor, or remedial massage therapist, or trigger point therapist) and/or an AMT physio. The Alexander will have good long term results but you also have to loosen up the muscles more actively. Also, try some form of relaxation/meditation to loosen things up from the inside, which will work well with Alexander.

And don’t go windsurfing (except with a very small sail, e.g. 1.5m) until this is all cleared up!! If you must go windsurfing, try to apply the Alexander ‘directions’ while you are doing this (neck free, back lengthen and widen, etc.) – I find this helps reduce the strain of using a rowing machine in the gym. Windsurfing is by far the most strenuous sport I have tried for arm use; I know it is hard to suspend this, but if you don’t then your body may suspend your windsurfing more permanently…

Answer 3: Definitely a good idea – there are many physios and others out there who claim to know about AMT etc but actually don’t. Anyone who does AMT therapy should not just do or show you stretches but should also mobilise the spine (neck and back) through fairly deep massage.

Answer 4: I’ve seen another GP who seemed somewhat more concerned about my condition: Essentially he agreed with your diagnosis – Good ole’ plain and simple (albeit painful and difficult to treat) Tennis Elbow, added to some nerve compression/damage, probably also in the elbow area. I saw a new physio today who also has treated a number of patients with RSI-type symptoms, so she is also fairly well versed in treatment techniques (she also mentioned seeing an alarming rise in this type of injury over the last three years). Neural stretches to try to relieve the nerve compression seem to be the order of the day (very much as you recommended to me a couple of months ago).

Oddly enough, windsurfing itself doesn’t really seem to aggravate the tennis elbow. EG: Last Sunday, long board racing in VERY light breezes, 7.5sq m sail, pumping hard all the way round 3 races. I had more difficulty elbow-wise lifting board and rig into/out of the water than all the pumping! Similarly, windsurfing in a force 6 in waves at Marazion recently also caused no elbow pain. I guess the shoulders take most of the strain. However, I do take your point that in general, I probably should be reducing the windsurfing, as it’s probably doing the nerve compression/damage no good at all (It’s difficult to reduce what I already consider a minimal amount!). I find that driving is also causing numbness/tingling now, & I’ve been advised to reduce that too.

Answer 5: Sounds like you are getting closer to an accurate diagnosis. Since your new physio seems to understand AMT, she should at least make sure that any AMT is addressed, though the nerve compression may be in the shoulders/neck not just in the elbow. Try to monitor whether there is a delayed reaction to windsurfing or other activities such as driving, typing etc. Sometimes it is only hours later, or even the next day, that you feel the pain. Also, the endorphin rush of any exercise, particularly an exhilarating windsurfs, will probably kill any pain for some time. Sometimes you have to rest; otherwise nature will force a permanent rest on you. Particularly since your symptoms are now appearing in formerly symptom-free activities – better to suspend windsurfing temporarily, if it is aggravating things, than have to stop permanently in the future.

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