OAKLAND/ALAMEDA
Dr. Jessica Greaux, D.C.
510-883-1126
Visit Dr. Greaux's website

TRI-VALLEY AREA
Dr. William Lue, D.C.
Dr. Thomas Lee, D.C.
925-829-8700
Visit their website

PATIENT TESTIMONIALS

“I was skeptical about Tennis Elbow Pros. After two of my tennis partners mentioned how the Tennis Elbow Pros helped them with their tennis elbow problem, I decided to give it a try. Just after several sessions the results were amazing. My pain is completely gone and I can play for a few hours without even thinking about my elbow. I would urge anybody with a "tennis elbow" problem to visit the Tennis Elbow Pros."

"Thank you for your help.”

Victor Velton
President of Versonix Corp
Tennis Player

“I was devastated when the nagging tendonitis in my right wrist grew so severe that I could no longer play tennis. I tried various approaches such as complete rest from tennis, cortisone shots, acupuncture and physical therapy. Nothing worked."

“One day I saw the Tennis Elbow Pros ad in “Inside Tennis” magazine, and decided I had nothing to lose. After a few weeks of therapy, I was back on the court – pain free! As an added bonus, I have about 75% more mobility in my “tennis shoulder”. I am now serving pain-free for the first time in years! I am also seeing improvement in my nagging neck and hip pain that I just thought I’d have to live with forever. I recommend the Tennis Elbow Pros to all my tennis friends and let them know that they don’t have to live with that tennis elbow or shoulder pain. The Tennis Elbow Pros treatments work great!

Thanks Dr. J, for getting me on the court again!”

Carol Darcy, San Jose, CA
A.V.A.C. Tennis Club player

THE 9 COMMON REASONS YOUR TENNIS ELBOW DOES NOT HEAL

1. FAILURE TO UNDERSTAND YOUR INJURY

At the root cause of all tennis elbow is tearing of tissue – usually tearing of the tendons of the extensor muscles (muscles used to bend your wrist back ) that attach to the upper arm. The root cause is not inflammation, and not tendonitis. Inflammation does NOT happen without a cause. It happens because tissue is injured, and in the case of tennis elbow, the injured tissue is usually torn.

Here’s the confusing part: An MRI will NOT reveal a tear in most cases of tennis elbow. “It’s not torn”, the doctor concludes. “All you have is tendinitis. But wait! An MRI can only reveal large, gaping tears. An MRI is not anywhere sensitive enough to detect microscopic tears (microtearing). Strangely, many doctors fail to realize the limits of MRI technology, and will tell there patient’s there’s no tear, when all the MRI has done is to rule out a large tear (macrotear).

A macroscopic tear is a large tear and will usually be visible on MRI. A tear like this may mean a tendon that is torn anywhere from 10% up to 100% torn. The larger the tear, the longer it can take to heal. We’ve seen tears up to 85% torn, heal naturally without the need for surgery.

The illustration above shows you exactly where and what is occuring in your elbow. The Extensor Tendon Degeneration (cut out above) is most often from tears of varying sizes within the tendons of the muscles that enable you to extend your wrist and fingers. Notice the above illustration shows the lateral/outside of the elbow. The same injury may also occur on the medial/inside of the elbow, in the common flexor tendons. The rules and principles for treating the lateral and medial side of the elbow are quite similar.

The next major point to understand about tennis elbow is that tears within the tendons typically result in a failed healing process called TendonOSIS. This is quite different than tendonitis. Tendonitis, an acutely inflamed state of the tendons, is usually short-lived, and typically self resolves. A tendon will be in a more acutely inflamed state immediately after some abuse (tennis) or other trauma. Tendonitis is not why you’d still have pain 3 months after resting a tennis elbow. There’s something actually quite the opposite occurring. That’s where tendonsis comes in.

Tendonosis is a dysfunctional healing of the microtearing that results in dysfunctional scar tissue, poor circulation and an overall degenerated tendon. Do you feel like your trying to play with at weak, degenerated tendon that never heals? That’s most likely tendonosis setting in.

2. FAILURE TO PROTECT THE TORN TISSUE

Failing to properly protect a torn tendon that’s developed tendonosis is a BIG problem. Tendons are dense, strong tissue designed to handle extreme tensile stress. But when you have a tear, just one wrong move, and you can re-open the tear site!! Tennis elbow is an extremely unforgiving injury. Every time we “mess up” and overstress that tear site, it’s just like picking a scab off your wound – everything get’s set right back to square one! Don’t believe it?? Try and see just how long one of these injuries can go for! They’ll go for years without healing if mistreated!

So obviously, continuing to play might be a problem if the injury is severe enough. "But I’ve already taken 3 months off of tennis!” you may exclaim, “and I’m still injured!” Well, there’s a lot to say here. We’ll only touch on a few key problems with that. For one, pure rest without any exercise for 3 months will of course, make your tendon weaker! We don’t want that! SOME activity is needed, the right kind of activity, that will make your injured tendon stronger without re-tearing the injury site. Including the right kind of activity to make the tendon stronger without re-injuring it is what we call “Active Rest”. We’ll come back to this concept later.

Many daily activities can insidiously prevent healing, even if they don’t reopen the tear. “Insidious” activities don’t hurt when you do them. You won’t know that the activity is actually preventing your arm from healing, so you continue engaging in daily activities that are keeping you off the courts.

Examples of insidious activities that prevent healing are:

• Using a keyboard (I know! It doesn’t hurt when you do these – but read below the section on “Constant Tension” and how it hurts tennis elbow).
• Using a mouse
• Gardening
• Cooking
• Playing a musical instrument
• Many activities are insidiously damaging when done “incorrectly” – we’ll help review your activities when you come in.

“Constant tension” activities insidiously cut off the blood flow to the injured tissue. In order to heal, the muscle or tendon needs blood flow. Constant tension on a damaged muscle or tendon decreases the blood flow to the injured tissue.

3. "TREATMENTS" THAT ACTUALLY WORSEN THE UNDERLYING PROBLEM

Poorly applied physical therapy exercises can hurt if you do too much, too soon. Many of our patients have tried physical therapy before coming to us. “The exercises made me worse!” they will often say. That’s because there is a fine line between therapeutic exercise and traumatic exercise – a very fine line!! If you don’t know how to properly graduate your exercise plan, with the right exercise for your injury, you can re-open your tear with the very exercises that were intended to promote healing! We’ll help guide you on a specific rehab plan that assures you don’t re-open your tear, while at the same time exercising your arm just enough to stimulate healing of the torn tissues. We’ll carefully lead you back into full-intensity tennis, without re-opening your tear.

Cortisone creams and cortisone injections can lead to tissue atrophy. Only 3 cortisone injections to the extensor tendons of the elbow, and there is a high probability of severe atrophy occurring! Severe atrophy means the tissue is shrunk, weak, degenerated and may never heal. Be careful with these! When this type of cortisone-related atrophy occurs, we might not be able to help!

Incorrect use of orthopedic supports can also be a culprit. Some tennis elbow braces can actually prevent the tissue from healing if worn incorrectly, or in the wrong spot. Wearing the wrong kind of brace all day long can cut off the essential circulation need to allow your arm to heal.

Positioning your tennis elbow strap in the wrong way will do absolutely nothing to help protect your damaged tendon. A precise placement, and carefully applied tension is necessary. We recommend neoprene tennis elbow straps with a felt pad. Exactly where the pad should go depends on your unique injury, and which muscle group is the most damaged. Furthermore, tennis elbow braces should only be worn when you need the extra protection – i.e., when returning to tennis play, or when you must perform a forceful activity with your hand or arm.

A tennis elbow strap should be worn only when attempting to perform more forceful activities (like playing tennis, or pulling weeds.) If a strap is worn 24 hours a day, it will cut off blood flow to the muscle-tendon junction, and could delay healing.

A tennis elbow strap should never be worn 24 hours a day (unless it’s kept quite loose). Instead, we recommend all day/night wearing of a neoprene elbow wrap that fits snugly without adding any significant compression to the tendons. We’ll help make sure the brace you wear is helping and not hurting you.

4. IGNORING THE "KINETIC CHAIN."

The "Kinetic Chain" is a technical term used to describe all of the muscles you use to perform a certain movement or motion.

• Kinetic refers to "movement" or "motion."
• Chain refers to all of the muscles used to perform that motion.

Many doctors don't check all of the muscles, tendons and joints in the chain. Checking the “Kinetic Chain” of an injury is the proverbial “Thinking outside the box”. MOST of the problems that impede healing in a tennis elbow occur “outside the box” of the tendon. Fibrous adhesions (scar tissue restrictions) in the muscles of the forearm, or tendons of the hand are often the primary cause of stress to the elbow. Even small restrictions in motion of the carpal (hand) bones, or elbow joints can lead to extra stress on the tendon and prevent healing of tennis elbow.

5. METABOLIC ISSUES SUCH AS DIABETES, THYROID CONDITIONS, AND EVEN STRESS

Undetected or poorly managed metabolic disorders can slow down your healing.

6. IGNORING THE NERVOUS SYSTEM

The first symptom of a pinched nerve is not pain. When a nerve experiences excessive pressure or reduced circulation, the first symptom can be simply tightness of the muscles that the nerve supplies. Excessive pressure on nerves that feed the elbow and forearm leads to increased tension of the muscles in the arm. Pressure on nerves frequently occurs due to occult (undetected and without symptoms or pain) problems in the cervical spine or muscles of the shoulder girdle.

Examples include asymptomatic (problems you don't feel) disc bulges, and bone spurs, muscular imbalances in the neck, chest and shoulder.

7. LACK OF SLEEP AND REST

Poor recovery: Working 60 - 80 hour weeks, and existing on 4-5 hours of sleep will rob the average person of the recovery time that they need to heal.

8. FAILING TO CHANGE BAD TENNIS HABITS

Enough said here. If you don’t’ know where your game needs work that’s what the tennis pro is for.

9. ATTEMPTING TO SELF TREAT

Elite tennis players will regularly employ the assistance of a coach or pro when they desire to improve their game. Even the professionals have a coach! Just like a tennis pro can help your game, a Tennis Elbow Pro can help improve your healing. Now you can engage the help of specialists who understand tennis injuries and can help assure that you are on the right path to healing!

Call a Tennis Elbow Pro now and allow us to be your coach… And get you back into the game!

THE TENNIS ELBOW PROS NETWORK OF TENNIS ELBOW SPECIALISTS
Find a doctor of in or around the following cities: San Francisco, San Carlos, San Rafael, San Jose, Campbell, Oakland, Alameda, San Ramon, Walnut Creek, Monterey, Salinas, Santa Cruz, Watsonville, Brentwood, Oakley, Calistoga, Sonoma, Napa, Sacramento

MONTEREY/SALINAS
Dr. Jay Cook, D.C.
831-375-5117
Visit Dr. Cook's website

SANTA CRUZ/WATSONVILLE
Seabright Spine & Sport
Dr. Karen Roitz, D.C.
831-425-3588
Visit Dr. Roitz' website