Thursday, July 23, 2015

Tennis Elbow...Minus the Tennis!

By Dr. Greg Lusk, DC

"Tennis Elbow" is the common term for lateral epicondylitis, which refers to an overuse muscle strain injury of the tendons that attach to the outside of the elbow.  This is in contrast to "golfer's elbow" where pain is experienced on the inside of the elbow.  Despite its name, most cases of tennis elbow are not related to tennis but to other causes of stress and strain to the elbow.  Repetitive gripping or leveraging activities are common culprits as muscles involved in these activities attach to the bony bump on the outer elbow.  Occupations or activities with repetitive hand use, such as carpentry, weight training, and even constant computer mouse use can contribute to development of this condition.

The symptoms of tennis elbow may include pain at the bony bump on the outside of the elbow and possibly down the back of the forearm to the wrist.  Pain is often experienced with gripping activities and even things as simple as holding a cup of water can become quite painful, requiring the assistance of the other hand to support the load.
 
Early on (i.e. within the first few weeks), self care efforts such as icing, avoiding aggravating activities, and the use of pain medications may be sufficient to ease the pain.  However, if the pain persists, which is quite common, it would be appropriate to seek treatment to help get things under control.  In fact, the longer this condition lasts the less likely the pain is due to inflammation in the soft tissues but rather to degenerative changes in the tendon.  This is true for all tendon injuries and at least in part explains why long term ice and anti-inflammatory medication use may not be effective beyond their "pain killing" benefits.

Management of a degenerated tendon is different than that of an inflamed tendon as the tendon structure has become disorganized and scar tissue is present, in the absence of inflammatory markers.  Healing and regeneration of the tendon must be facilitated and conservative treatment to assist this may involve the following techniques and strategies. 

·        Manual or tool-assisted soft tissue therapies are effective at breaking up scar tissue, improving blood and lymph movement in the tissues, decreasing tissue tension, and improving relative movement of one tissue across another.  Also, the micro trauma caused by the soft tissue treatment itself helps to restart the healing process with the end goal being a healthier, more properly organized tendon structure.

·        Eccentric exercises.  This refers to the part of an exercise movement where the muscle is lengthening while maintaining control of the weight.  Research shows this increases protein production in the tendon which is important for healing.

·        Other treatments, such as acupuncture or electrotherapies, may help at promoting healing and managing the associated pain.

·        Adequate rest is important to let the structural damage to the tendon heal.

·        Looking at the aggravating activities and modifying things to decrease the load imposed on the tendon.  In the case of tennis, there may be swing or footwork improvements that can be made which will decrease strain at the elbow.

 On a final note, if the above ideas or other treatments directed at the elbow are not yielding positive results after a fair trial period, it would be worth having your shoulder and neck assessed as anatomy located here can cause pain at the elbow and may be the ultimate source of stubborn elbow pain.

This article is for general information purposes only and is not to be taken as professional medical advice.