text:
Best Doctor for Tennis Elbow?
I'm 43 (male), live in Houston, TX, and have been playing tennis off and on for about 20 years. About 15 years ago I developed some very bad tennis elbow and probably some myocitis (sp?) and tendonitis in my forearm. It was so bad I could lift a glass and I basically quit the game for a few years. The bug hit me about 6 years ago and I got back in to it. Everything was fine until the early part of this past summer. After playing for about five minutes I noticed some tenderness in my forearm and elbow. I quit immediately for fear I would do any significant damage. Unfortunately, even though I wasn't playing the pain just got worse. I knew I shouldn't play until I had zero pain and after laying off for over 6 months it feels like I might be getting close. It is still there, but improved quite a bit.
My goal is to return to tennis pain-free and NEVER run the risk of having this problem again. The rest I'm sure did me good, but I should probably seek the advice of the best doctor possible who might specialize in treatment and recovery for tennis elbow. Does anyone happen to know anyone in Houston they could recommend? If not, is there a specific doctor that I should look for that would know how to properly treat something like this and offer steps to ensure it does not return?
Falls under sports orthopedics I suppose. You could go to any orthopedist, but some people insist on going to sports specialists. There must be many sports medicine clinics in Houston.
I can't recommend a doctor but I can (highly!) recommend this: http://info.thera-bandacademy.com/flexbarelbow. It really works... at least it did for me.
You might also want to take a look at your equipment as it could be attributing to the problem. What racket(s)/strings/tension are you using? How often do you restring?
And of course technique... which could be the main contributing factor (note that pros have all kinds of injuries but hardly ever suffer from tennis elbow). Of course addressing possible technique issues is complicated, and depending on personal circumstances may or may not be feasible.
Good luck!
a doctor is just going to load you up on some anti infalmitoriys and if it still hurts come back in a month, or suggest surgery which is a temporary fix. the best thing to do is rest it a lot, know your playing limits, make sure to stretch, and do triceps workouts.
A laudable goal, but completely unrealistic. Whatever you might do to improve the symptoms, nothing you can do can eliminate the risk of the problem recurring. There simply is nothing that "immunizes" you against it, particularly as you want to continue with tennis. Being over 40 in particular means greater risk of recurrence, so consider carefully how much you want to play tennis, and how often.
The reason I have it in my mind that it might be attainable is from doing P90X a couple years ago. P90X was no joke and it involved a great deal of weight training. Once I completed the 90 days (took everything I had) my arm and elbow felt as strong as it could be. Where it feels like I may have gotten myself in trouble was abandoning weight training and simply playing tennis often. My guess is that at my age I might need to be doing the strength training to allow me to play tennis pain-free. Hopefully, a doctor will be able to give me specifics.
The issue of Tendinitis (with inflammation) or tendinosis (defective healing)?
TW thread including these two publications.
I do not know this Dr in Houston – Dr John Cianca. He wrote a short description of how tennis elbow or other tendon injuries might become chronic after an acute injury and inadequate time off for healing. The time discussed was very brief. I believe that his description is very reasonable and applies to some or most acute tendon injuries.
Knudson description of wrist issues on the 1hbh. (1997)
Knudson book. (2006)
Pros using extended wrists on the 1hbh-
See if you can find any videos of pros impacting the ball with flexed wrists on the 1hbh. ? % ?
Search terms & get illustrations: wrist extension, wrist flexion
This is something you can manage yourself if you are willing to do the effort.
True, a doctor can play a role in this issue but think about it: what does a doctor have that you don't? He can do surgery-- very rarely used for this problem and nothing you want any part of at this point. He can write Rx meds-- the only one that that is not available OTC would be steroid injections, and again they are rarely used and I wouldn't jump to it, at this point yet. Lastly, they can have experience in the problem. Trouble is, if the individual doc does not have a particular interest in this area, their experience could be less than the posters on this thread.
Thanks everyone for the input, but I think this thread might help explain more of how confusing all this might be. There certainly doesn't seem to be any one right way to attack an injury like this. People simply have varying opinions, which makes sense. Ultimately, all the dicussion here has helped me and I think I might elect to go to a Sports Rehab Clinic somewhere. My hope is they have doctors that can diagnose exactly what my issues are, how they can be repaired, and maintained long-term.
I only wish I could find more information around those here in Houston. I've got to believe there are plenty of high-level competitive players here and I wonder who they might recommend for injuries like this. I'll continue to hunt around and if I ever find more information I'll post it back here.
Talk to some of the older players to see if any can recommend doctors who have been effective for them and/or specialize in physical therapy approaches.
The Dr I mentioned above, John Cianca, wrote an article that led me to believe that he has a sound understanding of tendon injuries and treatment. I had golfer's elbow and believe that what he wrote stopped me from playing more tennis and likely helped me avoid a chronic GE injury (tendinosis). I can't know for sure but that is what I believe. After reading the review articles above I believe that many tendon injuries have mostly become tendinosis perhaps mixed with tendinitis. Effective treatment is difficult. I would seek the opinion of a Dr who would discuss both tendinitis and tendinosis with me. Get more than one opinion.
You have the right idea - find a good Sports Rehab doctor and follow their advice.
Working with a therapist can also help guide therapy.
Still, understanding the basics in return to play should help.
As you have already done, rest is the first step until almost all the pain is gone.
A common first step is to do very gentle "range of motion" exercises.
These are not to truly "strengthen" the muscles, but rather to get the muscles and tendons smoothly gliding past one another again.
[Some internal "scar" tissue may have "glued" adjacent tendons/muscles together. Loosening up some of this internal scar tissue may cause some minor soreness, but should not cause real "pain".]
One of the most common range of motion exercises is to use the red Theraband Flexbar, doing the Tyler twist and reverse twist.
[The red Flexbar seems "too easy" to many, but again the objective is just to get the muscles and tendons moving past one another again.]
If there is no pain with the red Flexbar, it is then time to progress to the green Flexbar.
Slowly increasing the number of reps can let you begin to increase some strength without overdoing it.
Any return or increase in pain means you need to drop back a step and start over after the pain is better.
Next, strengthening the forearm even more with other adjuncts, including dumbell wrist curls, reverse curls and pronation/supination exercises can build more strength.
Return to tennis should be gradual - start with short hitting sessions without serving.
Good luck!
I am an instructor and tournament player. i had the worst case of tennis elbow. I couldn't lift my arm to brush my teeth, wash my hair, hold a coffee cup etc but waas finally able to heal myself with this great rehab glove..it's also reimbursed by insurance http://www.flextend.com/
Here's a video with do's and dont's:
Top Five Mistakes to Avoid When Using Flextend http://www.youtube.com/watch?v=06dE_-oa0wQ
I don't have experience with the Flextend. It seems it was made largely to treat carpal tunnel syndrome of the wrist.
Just based on how it works, I would think the twisting motion of the Theraband Flexband http://www.youtube.com/watch?v=zB3TVb8a5mk would be a better exercise for the muscles/tendons involved in tennis elbow, but it certainly does seem that comeback had great results using the Flextend.
I hope comeback sees this and can explain further the specific exercises he used - how much flexion and extention and how much twisting exercises. Also I would love to know if he first used the Theraband Flexbar without results.
Your TE is severe and was quick to develop. This suggests either that you may have a congenital flaw in your elbow or that you are hitting the ball with some unusually damaging technique. In other words after it heals it will come back again. Have a sports doc make and evaluate a diagnostic image (ultrasound or other) of your elbow and have tennis expert observe you on your technique. Just my opinion from having severe TE in the past.
2012 Review on Tennis Elbow Treatments by Todd Ellenbecker
2012 Review on tennis elbow treatments -
Current Concepts in Examination and Treatment of Elbow Tendon Injury, Todd Ellenbecker, R. Nirschl, and
Per Renstrom
Update 7/17/2014 - this link works
This board has some discussions on sports injuries, most often in baseball. Sports medicine specialists in various locations are occasionally recommended by Dr Fleisig, a prominent Dr and researcher involved in pitching, baseball injuries and research.
See reply 1/30 by Dr Fleisig.
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If you find a good lab that takes pride in what they produce, and how they maintain their machinery, you'll get excellent results once you've established a rapport with them.

subset: commoncrawl


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Special Correspondent
The objective is to achieve faster economic growth
Scope for fostering technological partnerships About 200 delegates participated in the discussions
THIRUVANANTHAPURAM: An international conference of scholars, GLOBELICS India 2006, which concluded here on Saturday, called for the setting up of an efficient mechanism for the developing countries to share their technologies to achieve faster economic growth to enable them to catch up with the developed nations.
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Annual conference
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Centre for Development Studies Director K. Narayanan and GLOBELICS Board Chairman B.A. Lundvall were among those who participted the press conference.


text:
May 08, 2007 08:16 AM|millet|LINK
What is easiest way to get difference between two dates in years, months, days, hours, minutes and seconds, taking into account month length and leap years?
TimeSpan has Days and smaller properties but does not have Years and Months.
May 08, 2007 08:24 PM|Dyno1979b|LINK
I got interested by this and I ran some tests.
Let me ask you a question. What is normal:
30 January - 28 Feb = 29 days right.
How About 30 January - 1 Mar = 1 month 2 days or 30 days?
Because if it's 1 month 2 days, then this is the code that computes it:
DateTime date1 = dateTimePicker1.Value; DateTime date2 = dateTimePicker2.Value; int oldMonth = date2.Month; while (oldMonth == date2.Month) { date1 = date1.AddDays(-1); date2 = date2.AddDays(-1); } int years = 0, months = 0, days = 0, hours = 0, minutes = 0, seconds = 0, milliseconds = 0; // getting number of years while (date2.CompareTo(date1) >= 0) { years++; date2 = date2.AddYears(-1); } date2 = date2.AddYears(1); years--; // getting number of months and days oldMonth = date2.Month; while (date2.CompareTo(date1) >= 0) { days++; date2 = date2.AddDays(-1); if ((date2.CompareTo(date1) >= 0) && (oldMonth != date2.Month)) { months++; days = 0; oldMonth = date2.Month; } } date2 = date2.AddDays(1); days--; TimeSpan difference = date2.Subtract(date1); txtDateDifference.Text = "Difference: " + years.ToString() + " years" + ", " + months.ToString() + " months" + ", " + days.ToString() + " days" + ", " + difference.Hours.ToString() + " hours" + ", " + difference.Minutes.ToString() + " minutes" + ", " + difference.Seconds.ToString() + " seconds" + ", " + difference.Milliseconds.ToString() + " milliseconds";
Jul 14, 2008 12:54 AM|uwillmore|LINK
Wow! That's a lot of code, which is of course what I wanted to avoid if possible. But you had some questions (in Italics below) at the top of your reply. Let me answer them first in bold print below.
Let me ask you a question. What is normal:
30 January - 28 Feb = 29 days right.
I would call that 1 month + 2 day unless it is a leap year. In a leap year, it would be 30 days (january has 31 days).
How About 30 January - 1 Mar = 1 month 2 days or 30 days?
I see that as 1 month plus 3 days, always. Since the entire month of febuary is included in the time frame, we have 1 month (Feb 1-29 or Feb 1 - 28) plus Jan 30, Jan 31 and Mar 1 or 3 days.
I noticed that my number of days is one larger than yours. Either I am introducing an off by one error, or you are counting only 30 days for January, which has 31 days. It is not important to figure out who is wrong, I just wanted to point out the difference and what is so complicated about this seemingly simply conversion.
I will copy your code to my system and run it thru some tests, but I assume you did not consider leap years in your calculation. Is that correct? I am not sure if that can even be done, or if it matters in the long run, since the leap day is added every 4 years to make up for partial day we don't count in the 3 years before the leap year. (A years is actually 365.24 or 365.25 days long. I don't recall the actual number right now.)
Thank you for working out the code for me. I was really hoping for something less complicated, but if nobody else comes up with a simpler solution, I will use your code.
So for now my question is still unanswered: Does anyone know of a reliable C# method that can do the conversion for me?
Jul 14, 2008 01:06 AM|uwillmore|LINK
I just realized that I replied to the wrong post. I clicked the wrong like somewhere and ended up replying to this post, rather than replying to my own threat which has a similar topic and subject. I apologize and hope I did not cause too much confusion.
Jul 14, 2008 01:14 AM|uwillmore|LINK
I asked a very similar question a few minutes ago and just got the anwser I needed. Since I posted to this threat accidentaly earlier, I figured I'll make up for my mistake by sharing the answer. My question was only concerned with years and months, but TimeSpan contains properties for days, minutes and smaller as you know. ANyway, here is the answer I got:
protected void Button1_Click(object sender, EventArgs e)
DateTime Birth = new DateTime(1954, 7, 30);
DateTime Today = DateTime.Now;
TimeSpan Span = Today - Birth;
DateTime Age = DateTime.MinValue + Span;
// note: MinValue is 1/1/1 so we have to subtract...
int Years = Age.Year - 1;
int Months = Age.Month - 1;
int Days = Age.Day - 1;
Response.Write(Years.ToString() + " Years, " + Months.ToString() + " Months, " + Days.ToString() + " Days<br />");
I have not tried it yet, but I would be surprised if it did not work as advertised. SGWellens gave me this solution and I hope it will work for you too.
0 Points
Oct 01, 2008 03:53 PM|toddtm|LINK
Oct 04, 2009 11:17 PM|Mechanic|LINK
I tired the suggested solution and the created this solution based on the first suggeston.
Here is a test that proves its accuracy.
Basing this kind of date diffrence on DateTime.MinValue is very inaccurate because it does not account for leap years or number of days in a month. April 19th will not end up 3 months away July 19th using DateTime.MinValue you will end up with incorrect days.
Michael Kappel
0 Points
Oct 07, 2009 12:12 AM|Ross Presser|LINK
Great work, Michael. The only thing more tha I could ask is an equivalent to the TimeSpan.TryParse() method, so I can use it to represent long spans of time without having to work from a date. (Actually, so I can pass a program something like "2y3m5d8h ago" and come up with the time that matches that.)
Oct 07, 2009 01:23 PM|Mechanic|LINK
That is a great idea!
Oct 07, 2009 03:08 PM|Mechanic|LINK
I added a factory method with a few overloads to create DateDifferentials based on input parameters. It would not be to hard to use a regex to parse out the values from a string. Unless I am missing somthing the CreateDifferential method does not need to do anything difficault. THis is basicly all I added.
DateTime tempLaterDate = startingDate;
DateTime tempEarlierDate = startingDate;
if (differentialType == DateDifferentialType.Ascending)
tempLaterDate = tempLaterDate.AddYears(millennia * 1000);
tempLaterDate = tempLaterDate.AddYears(centuries * 100);
tempLaterDate = tempLaterDate.AddYears(decades * 10);
tempLaterDate = tempLaterDate.AddYears(years);
tempLaterDate = tempLaterDate.AddMonths(months);
tempLaterDate = tempLaterDate.AddDays(weeks * 7);
tempLaterDate = tempLaterDate.AddHours(hours);
tempLaterDate = tempLaterDate.AddMinutes(minutes);
tempLaterDate = tempLaterDate.AddSeconds(seconds);
tempLaterDate = tempLaterDate.AddMilliseconds(milliseconds);
return new DateDifferential(tempLaterDate, tempEarlierDate, calculateMillennia, calculateCenturies, calculateDecades, calculateYears, calculateMonths, calculateWeeks,calculateDays, detail);
if (differentialType == DateDifferentialType.Descending)
tempEarlierDate = tempEarlierDate.AddYears(-millennia * 1000);
tempEarlierDate = tempEarlierDate.AddYears(-centuries * 100);
tempEarlierDate = tempEarlierDate.AddYears(-decades * 10);
tempEarlierDate = tempEarlierDate.AddYears(-years);
tempEarlierDate = tempEarlierDate.AddMonths(-months);
tempEarlierDate = tempEarlierDate.AddDays(-weeks * 7);
tempEarlierDate = tempEarlierDate.AddHours(-hours);
tempEarlierDate = tempEarlierDate.AddMinutes(-minutes);
tempEarlierDate = tempEarlierDate.AddSeconds(-seconds);
tempEarlierDate = tempEarlierDate.AddMilliseconds(-milliseconds);
return new DateDifferential(tempEarlierDate, tempLaterDate, calculateMillennia, calculateCenturies, calculateDecades, calculateYears, calculateMonths, calculateWeeks, calculateDays, detail);
return new DateDifferential(tempEarlierDate, tempLaterDate, calculateMillennia, calculateCenturies, calculateDecades, calculateYears, calculateMonths, calculateWeeks, calculateDays, detail);


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