Arm injury question

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Randy
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Arm injury question

Post by Randy »

I’ve been sidelined with arm injury and was wondering what any of you physicians and/or kiters with similar complaint have learned. Years ago, before the windsurf harness, we experienced a lot of arm/shoulder injury from the repetitive motions involved in the sport. Many a good sailor was sidelined under doctor’s orders. After nearly two weeks straight of terrain sailing Superior and Mille Lacs, I eventually found myself feeling like the Tin Man. Each morning I could barely straighten my arms. The pain centered just above the elbow (lowest part of bicep) and extended up to the shoulder and down to my forearm. It was quite extreme in both arms and the combination of rest and hot yoga has worked out the injury in the right arm, but the left arm continues to be limited. Is this a mild form of bicep tendonitis?

I see Duluth going off today and tomorrow. I’ve also defined addiction as that behavior we engage in even though we know it’s causing harm to ourselves or someone else. I’ve also got years of experience repeatedly showing me that attempts to push through an injury often compound it. If I do head up, I’m limiting myself to windsurfing since the fixed harness line doesn’t involve the constant movement of the kite bar. Additionally, riding one handed seems to be requisite for wave riding, and seems to be a major culprit in this injury, particularly when riding toe side. The stretch feels so good when doing it, but hurts so bad the following hours.

I know Judd’s a huge believer in the power lock, and now I see why. Are most of you locking in your power with a similar device or using a fixed harness line? I can now see my kiting days may be limited without such an option, yet it seems manufacturers are moving away from locked power for safety reasons.

With regard to Steve’s “Newbie Question”, Dave, Dean and others have totally captured my sentiments. There’s been a tremendous support team continuously helping us through the learning process. In my case, Judd and Steve have repeatedly sacrificed good ride time to educate me to the sport. No one’s tried to intimidate me, and the stoke of the sport has been great. I can’t even begin to compare kiting to windsurfing. They’re both awesome vehicles to enjoy air, wind and water. So please, don’t ever ask me which I enjoy most…it’s just not a question that makes any sense to me.

Sooo, Terry, Chris, Kurt and any other physicians or wind/kite surfers with similar experience, am I to continue rest or can I make the trip north?
Ride...just be it!
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drknap
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Post by drknap »

Randy
Sorry to hear about your arms. I'm not an orthopod but it does sound like you have good old fashion tendinitis caused by overuse leading to inflammation and pain of the tissues that connect your bicept to your radius (arm). Bicept tendinits generally involves the upper two heads of the bicept muscle where it attaches to the scapula but it could also occur on the lower part as with you. Typical tendinitis involving the elbow is called lateral and medial epicondylitis (aka tennis and golfer's elbow which is on the outside and inside of the elbow) but you do describe your pain as involving the lower bicept tendon. Really no new magic treatment that I am aware of and unfortunately treatment involves activity restriction
1) resting the injured tendon to allow healing, 2) decreasing inflammation with ice and use of an antinflammatory such as ibuprofen/aleve etc, 3)PT and strength training generally isometric movements once your pain has resolved. Perhaps some sort of elbow support might take some of the load off your arms during activity. A good diet, sleep and multivitamin as well. As a doc I would tell you to rest as you are only going to prolong your symptoms. But as a wind junkie I would likely find myself adding insult to injury. I too have developed a recent elbow tendinitis (lateral epicondylitis) from kiting. Further I have a very chronic patellar knee tendonitis that I've had for 10 years because I could never rest long enough to allow proper healing. I limp for a day after almost every session but I just can't give up the stoke and ride.
I hope you heal rapidly and that I see you out there soon. Maybe others have further thoughts
Kurt
Coach
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Post by Coach »

"Kiter's elbow", been there... It comes back now if I don't pay heed to it now and again.

Getting to the gym for some bicep curls (and other fun) helps a lot. Once you feel better, do some curls a few times a week. Whatever you think your normal weight for curls is, *reduce it* or risk the elbow pain coming back. Start slow and work up.

I resorted to doing pretty light curls (barely feels like work) when I haven't been to the gym in a while and even that little bit helps a lot.

-Coach
Tighe
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Post by Tighe »

sorry to hear about that Randy. I've been very fortunate to not have any similar ailments....yet. Good advice from Coach and Kurt though.

As far as riding with the power locked in, via what ever system you have. I used to ride that way with the C kites, though I have found with the bows I prefer to have the fluidity to move with the changes in the wind. I don't know but I would think that movement would be better all round, even if one is creating tension and the other not. People say that the TD has one of the higher bar pressures of the bows, but I find that I ride them like a wave sail, just inside the power...let it out an inch or two and the power is off. I would check to see what your arm position is when riding. I prefer to have my arms 3/4 extended, this allows me to pull in on jumps (when powered up) and still not have the bar in too close.

Hope you have a speedy recovery. The only exercise I do that might help other than curls is to lean over something and pull the weight up to you. I also use one of those cheap bungee cord things attached to the door. I can get pretty close to the movement of the bar with that.

You treat your body far better than I, maybe this is just telling you you need to sit this dance out for a bit. Be open to what this break brings you.

peace
Tighe
Randy
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Thanks!

Post by Randy »

A wealth of info. Thanks so much for all your input. It seems the hardest part of any injury is having the patience to receive the lesson. Still trying to decide about Duluth tomorrow, though.
Ride...just be it!
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chanrider
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Post by chanrider »

Below is a quote from a Tom L post Aug 2005... search "tennis elbow."

(Those arm bands look pretty cute!)

Tom L:

"Steve has it right. Keep your arms extended.

Search Kiteforum.com, some info on tennis elbow. Get an arm band and never go out without it. Good info here: http://www.nismat.org/ptcor/tennis_elbow

Arm bands:

http://www.painreliever.com/Elbow+Braces.html

http://www.holabirdsports.com/cgi-bin/s ... me=aircast

I have it bad on both elbows. Doc just gave me a cortisone injection in one. The pain is caused by inflamation and if you can stand the pain you are not really doing any harm. It will eventually go away but sometimes that can take a year or even more.

Find time when you will not be using it alot for several months, get the injection, stay off it, and pray, if your lucky it won't come back. You might still want to wear the arm band even after you get rid of it. Mine just came back from kiting after being absent for 15 years."
steveb
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Post by steveb »

Randy, I got it at first too. I think for me what caused the issues was bending the arms and gripping tight. I setup my kites so the normal " nice power" position for the bar is when my arms are nicely extended. For me thats the middle knot on the back lines.
Having figured that out I felt my elbows tweek sometimes when jumping, I noticed I would be steering the kite with my arms bent and a death grip on the bar. ( don't tell anyone but I think it may have been fear related) So I try really hard when jumping to relax my arms and if I have to make corrections through the bar to do them gently. Touch wood by focussing on straight arms and a light grip I've pretty much got rid of elbow pain ( every thing else is still a wreck though) , Having said that I may feel a tweek during a long day but it's usually cured by lightening up the grip.
As you know we are all different, you may not be gripping at all, just what I found worked for me.
Judd or Dianne
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Post by Judd or Dianne »

Randy I got the same thing, left elbow, talked to arthritis doctor about it, thinking my RA was having a flare, he informed me it was like a tennis elbow, either from kiting or riding alot of bike. He told me anti-inflam. drugs and ice. Rest for a week really helped.

Hope it gets better for you. Maybe when we're not such green horns at kiting, we'll learn to relax our arms some, instead of being in a death grip.
Dianne
JERRY
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Post by JERRY »

I too have slight pain in left elbow area. Just assumed misc. pain was just of part of getting old.

I use a fixed hard line on my bars for total release of any bar pressure. I tried riding w/o the hard line and immediatedly put it back on, because I missed the hooked in ride. Stopper ball would also help, but imediate kill of kite is lost for the SLE/Bows. Just make sure fixed hard line is long enough for release from hook when bar is pulled in.

j.
Randy
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Thanks

Post by Randy »

Again, thanks for all the feedback. Those of you who know me know I'm a big believer in Nature's Law of Least Effort. It seems the aim of an activity is to reach a point of style where it's "easy". It would be great if there were an instructional pressure meter to put on kite bars, windsurf booms, golf clubs, tennis rackets, guitar picks, trumpet mouthpieces, etc. No doubt, I'm sure I'm still far from this point of complete effortlessness.
Yet, I'm sooo far away from the death grip thanks to some great instruction in Texas with the bow kite. If anything, I'm much more prone to let the kite go at the slightest sense of something not going right. Donnie, a California instructor, drilled this into us, only after I had broken some lines and taken the uncontrollable ride in the clutches of the bar so many times before it really, really sunk in back in April. So I'm pretty much instinctively trained to let the bar go if anything feels unusual. That said, I suspect I'm still not fully relaxed into the full outstretched arms. Yet, my problem came after several days of extended wave kiting, working the kite excessively, followed by running a 9M slightly underpowered at the Bear, continuously working the kite through the sky.
So I'm leaning more toward repetitive arm action than any tight grip issue
(short of the time I was using Judd's bar, accidentally locked in the power lock when a gust hit, traveling 10' above the water while kite looping). The beauty of the bows for us has been the capacity to fully relax. Yet, I'm sure on my jump landings I'm gripping pretty hard to get the kite coming forward.
Anyway, there's no black and white on this, the arms are feeling good enough for Superior today, and I again thank you all for your feedback.
Ride...just be it!
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Terry Dunklee
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Post by Terry Dunklee »

Have fun in Duluth today --- hope you don't wake up too stiff and sore tomorrow. It's not clear if you had true lateral epicondylitis ( tennis elbow ) or more biceps tendonitis. Tennis elbow tends to localize at and just below the bone prominence on the outside of your elbow but when severe can give you pain down the foream or radiate upwards towards the shoulder. That's probably what you have experienced. This is referred to as a repetitive or overuse injury and it sounds like you have been kiting/sailing enough lately to create it. Strong grasping can also be a factor but in your case the frequent and prolonged sessions are more likely.

The therapy instuctions linked above (http://www.nismat ) are excellent. I would add applying heat for 10minutes before stretches and icing for 5-10 minutes after stretching and exercise. The tendons are composed of collagen fibers that suffer micro tearing if subjected to repetitive stess or too much pressure. The fibers become more elastic with heating and stretch rather than tear. Once stretched ice application attempts to keep them in the elongated position rather than contracting, shortening thus lessening the force exerted on the tendon with future activity. The wrist extension/flexion exercises with weight are excellent but follow Coach's advice and go cautiously, increasing repetitions before increasing weight.

Terry
Denis
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Re: Thanks

Post by Denis »

Randy said:
...Donnie, a California instructor, drilled this into us, only after I had broken some lines and taken the uncontrollable ride in the clutches of the bar so many times before it really, really sunk in back in April...
Is that the same Donnie from Kitopia? The smoking man flying a North Vegas? Met him in Padre in March. Really nice guy. Should lay down the tobacco though.

Denis
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djmadmike
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Holy bum elbows batman!

Post by djmadmike »

Wow, there are a lot of bum elbows out there! Yikes!

Lots of great advice posted above. I work as a trainer and am not an MD, so always talk to your doc first before doing anything.

There is a difference between tendonOSIS and tendonITIS. It is very hard to tell the difference, but tendonOSIS can be fixed most of the time in my opinion. TendonITIS is a little more tricky. A vast majority of cases are actually tendonOSIS, but everyone calls it tendonITIS.

So why the diatribe and who gives a hairy rat's butt? There is some research showing that if you have tendonOSIS, there is a problem with the collagen in that area. By doing eccentric only (most of the time only LOWERING a weight) you may be able to stimulate new collagen formation in that area. TendonOSIS does not have inflammation, so a cortisone shot will not buy you much long term. If there was not acute trauma, it is most likely due to overuse. In general I am not a fan of NSAIDs since there is some research showing that long term they may interfere with the healing process. Again, talk to your doc and that is a personal decision.

What movement hurts to do? Maybe I missed this part as you talked about pain in that area, but what CAN'T you do without pain? Does it get better with movement? In general, tendonOSIS gets better with movement, tendonITIS does not.

I've had tendonOSIS in both elbows in the past and I've been able to treat it by doing eccentric only exercises.

In general, don't do anything that is painful for now until you know for sure what it is going on. Have you seen a doc or physical therapist?

Another option is Z Health. (http://www.zhealth.net). Sounds too good to be true, but by watching you walk, trying some simple joint mobility exercises, then watching you walk again, you can determine what is a good drill for YOUR body at that time. The drills work on the nervous system, so the effect is immediate. I've been able to reduce shoulder pain from a 10 (on a 1-10) scale to a 2 in minutes on one client, increase range of motion by 50% in another client with shoulder issues in minutes also. Does everyone respond to Z Health? No, but currently I can get a pretty good response in about 70% of people with musculoskeletal issues. Email me at djmad_mike AT yahoo DOT com for more info or post a question here. There are lots of great options out there, but so far I have seen anything with as profound effect as Z Health.

If anyone has any other questions, post them here and/or email and I will do what I can. As a fellow windsurfer and kiter wannabe, I can related to your pain of WATCHING your buddies have too much fun. I've been there and done that and it really sucks.

Anything I can do to help, let me know.

Take care
Mike N

Mike T. Nelson MS, CSCS
PhD Student, Kinesiology, U of MN
"Using Science to Get You Results Fast"
Randy
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What a great resource!!

Post by Randy »

Wow!! The wealth of information on this is staggering. Again, thanks to all of you. Denis, yes, that is the same Donnie...heavy smoker, but perhaps one of the best watersports instructors I've ever witnessed.
Terry and Mike....very much appreciate your replies. It would seem mine is tendonOSIS. It gets better with movement, and all but disappears when the endorphins take over upon encountering strong wind. It's almost disappeared from my right arm (still a little shoulder pain), but continues to persist with inner rotation of the left arm, sharp pain located just below elbow, on the inside. I practice Bikram yoga three times/week, and it has a huge effect on relieving the symptoms. It's practiced in 105 degree heat for 90 minutes and seems to allow a very deep working of the involved muscles, again, indicating tendonosis??
I had a great session on Superior, windsurfing, and actually felt better afterward. It was survival sailing, so I really was playing the waves, in and out of the harness, nearly as much as usual.
For now, looks like I'll start practicing the eccentric exercises you recommend, Mike. Definitely going to investigate ZHealth, and will follow the wisdom the rest of you have put out there. Mike, I'll be emailing you for an appointment. Collaboration's such a wonderful thing!!
Ride...just be it!
www.just-be-it.com
djmadmike
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aches and pains

Post by djmadmike »

Yep, Bikram yoga is great! I've seen you there a few times Randy in WBL at Bikram. Good stuff.

Drop me a line for the Z Health. My yahoo account is not working, so you can try michael DOT nelson AT guidant.com also.

My guess is that it is tendonOSIS, but not sure about the knee and shoulder pain. I would need to check it out and do a few tests. Might be an issue with your foot also.

For anyone else that is interested in the eccentric only protocol, the standard is 1 sec concentric (lifting a weight) or even using your other arm to help the weight into position and then a 5 sec lowering (eccentric) of the weight. Start with 1 set of 15 reps and you may even work up to 3 sets of 15 reps with each rep having a 5 sec eccentric.

For example, I had pain in my left arm (the first time) when I would turn my palm down and lower my forearm from 90 degrees to straight down towards the floor. So I started with a light weight (10 lbs), used my right arm to get my left arm in place with my palm down, and slowly lowered the weight over 5 seconds, then repeated this for 15 reps.

If your arm does NOT feel any better within a few days, reconsider. If it feels WORSE, then by all means don't do it. This is one of the very rare circumstances I would have a client actually move into pain, so proceed with caution. Initially I would try Z Health, and if they do not respond to that and I think that it is tendonOSIS, then eccentric exercises would be my next step. Again, talk to your doc, use your head, and be wary of internet help :)

Glad the Superior session was good! I need to get out myself! I was on call this past weekend---boo hiss.
Mike N

Mike T. Nelson MS, CSCS
PhD Student, Kinesiology, U of MN
"Using Science to Get You Results Fast"
Tighe
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Post by Tighe »

When I was riding on Superior last time I noticed that I was riding one handed with the bar vertical and my hand twisted with the thumb down. This position is not really used for many other things.

I recently saw this on kiteforum and found it interesting.

http://www.kiteforum.com/phpbb/viewtopic.php?t=2332498

BTW: I as yet have not had any elbow issues riding my bow.
Tighe
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