Question
QUESTION: Hello;

I really want to know when I can get back to sport activate?
I injured the right arm triceps more than 2 months ago by playing badmintons (repetition overuse injury). The pain is in the back part of the upper arm near the point of my elbow. Plus the bad tennis elbow, so I stopped playing badminton to rest my elbow.
    Now, I have done 2 weeks of 揺lbow & triceps rehab exercise after 2 months of rest?
Yesterday when I did the rehab exercise, there is no pain from French stretch; almost no pain/very minor pain from Triceps towel stretch and Towel resistance exercise, almost no pain from French press; no pain from Triceps kick back with holding about 8 lb.  No pain from Modified push-ups.

However, I am still not able to do the push up because there is pain from the back part of the upper arm near the point of my elbow.  There still have pained from the back part of the upper arm near the point of my elbow when I raise my arm to swing a racket or throw stuff.  Plus Can you advice when I can get back to sport activate?  


ANSWER: Dear Wai,

You have a common condition.   Keep in mind that often the anatomic source of pain is from the tendons, and usually at the tendon attachment sites at the bone.   Repetitive strain injuries also affect the soft tissues surrounding the tendons, mostly of the fascia, the connective tissue that weaves around everything.  The tendons often develop micro-tears over time that fill in with degenerative tissue ("garbage") called granulomatous tissue.  This is quite often seen in MRI images of tendinopathy.  The surrounding fascia can develop irritating fibrotic lesions.   The only way to change the tendon's anatomy is to do stimulate it with manual frictioning and "debride" it with mechanical tools.    See www.grastontechnique.com    Muscle and fascial lesions can also be worked out manually, with massage and "active myofascial release" as well as with stretching, etc.   Eccentric exercises, or "negative" reps, load the tendons in such a way that there is better reorganization of collagen, so after they are worked on manually, you want to do eccentric exercises.  For example, someone can help you up with the weight, and you slowly lower it down on your own.    Other modalities that are helpful to add to the treatment protocol include ultrasound and low level laser.     When you can press on the bones and they don't hurt and you can do a push up without pain, then you are good to go!    In my office, I would prep' the area with a little bit of ultrasound, then do active myofascial release to the triceps and forearm muscles, graston technique to the tendons, low level laser to the tendons, and then light eccentric exercises.   If you had to go back into competition right away, even with pain, I would also add Kinesio Tape.   

'Hope this helps.

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Thanks for answer my questions.

I won't back to badminton competition until I can do the push up without pain. Here I have a few questions and hope you may providing answers again

1) it's very excruciating when Rupture triceps? what is the symptom of rupture the triceps?
What I remember is there was just a minor sharp pain for a few second,  then the pain was gone and I was able to continues to play the game.

2) what is mean "When you can press on the bones and they don't hurt"? does the bone around the elbow?

3) I have a ultrasound massager at home. when I massaged the elbow/injure area with ultrasound massage, I felt warm from some spots and some spots just felt nothing. It's this mean I just massage the spots with warm feeling.


Answer
Wai,

You need to get appropriate treatment!  Find a chiropractor via www.grastontechnique.com    You probably do not have a triceps rupture.   You most likely have tendon irritation.   Thus, you must get appropriate treatment for the tendons.   If the chiropractic doctor finds that there is more going on, or are other complications, then he/she will order an MRI or other tests.   The ultrasound massager is not like the ones we have in our offices.  You can use yours anywhere that there is tenderness.  It probably will not fix the problem.  

'Regards,

Dr. G