I'm fifty-one years old and have been drumming (right-handed) for forty years. Last year I started to get tendonitis in my left elbow. When I play, I have immense pain in my elbow that extends down to my left forearm. Even when I'm not drumming, my elbow feels as if it's on fire and my forearm aches. I'm losing strength and muscle tone in my left arm, and I'm just starting to feel the initial pangs of pain in my right elbow as well. I had a cortisone shot in my left shoulder and elbow a year ago; it helped for about two months. I've tried acupuncture, massage, prescription medication, heat liniment, and ice, but nothing works except stopping drumming altogether. But that cannot be an option for me. How do I get rid of this pain without having to stop playing?

Brent Deakin

The elbow is a commonly affected joint in drummers. By your description, this resembles a case of either medial or lateral epicondylitis, better known as golfer's and tennis elbow, respectively.

Here are some movements to try to help you diagnose the type of condition. Start with your arms outstretched as much as you can bear, with your palms pointing up. With your good arm, press on your affected arm's elbow. Is the pain on the inside (medial) or on the outside (lateral) of the elbow? To determine whether you have lateral epicondylitis, a presumptive diagnosis requires pain aggravated by wrist extension. (With outstretched arms, turn the palms up and stretch your hands down toward the ground.) For medial epicondylitis, which is much less common than lateral epicondylitis, pain is aggravated by resisted wrist flexion. (With outstretched arms, turn the palms up and stretch your hands toward you at the wrist.)

Both medial and lateral epicondylitis will have the following symptoms:

1. Local tenderness directly over the respective epicondyle (bony outgrowth at elbow)

2. Pain aggravated by radial deviation (turning your wrists)

3. Pain aggravated by strong gripping (or having a decreased grip strength)

4. Normal range of motion in the elbow

Here are some reasonable treatment options.

Stretching. Try stretching your wrists and forearms at 15- to 30-second intervals for 10 to 15 minutes, then rest for 10 minutes and repeat. Slowly increase your stretching time to 75 to 90 minutes before playing, until your pain is resolved.

Activity modification. Reduce your drumming time.

Biomechanical modification. Adjust your drumset positioning and seat height to put your body in a more natural, ergonomic state when drumming.

Eccentric- and heavy-load exercises. This may be the best option for your injury, since you want to keep playing. Eccentric exercise is the application of a load (muscular exertion) to a lengthening muscle. To do that, pre-stretch your injured arm by holding a weight in your hand, dangling the arm down as much as possible, and moving your arms in a slow, controlled circular manner for 6 to 10 seconds at a time. This appears to stimulate tissue remodeling and the normalization of tendon structure. Such exercise is often uncomfortable, but when done properly it shouldn't cause severe pain or result in any worsening of symptoms. You shouldn't experience increased pain or joint swelling the next day; if you do, hold off on these exercises until you can bear it.

Alternating applications of ice and heat is a mainstay in many other injuries, but for your condition research has shown that neither ice nor heat will help after the acute phase of injury, which usually lasts two weeks. I would also avoid further steroid injections. They will reduce pain initially but will ultimately lead to worse long-term outcomes. Anti-inflammatory medications, including Motrin and Tylenol, can help somewhat, but you should limit the use of them to a maximum of two weeks. Surgical consultation is reasonable if there is no improvement after six months of physical therapy using a well-designed program in combination with medical treatments.

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