What Is Tennis Elbow and How to Fix It
The elbow participates in many daily activities we take for granted. From lifting a gallon of milk out of the fridge, to cooking, to swinging a tennis racket, it plays a fairly big role in our daily tasks. So it’s no wonder that when pain strikes this joint, life can become a lot more difficult. One of the most common problems of the elbow is lateral epicondylitis, or tennis elbow, and one of its hallmark symptoms is pain to the bony aspect of the outside portion of the elbow when gripping objects, lifting objects, or straightening your elbow. What can start out as a mild discomfort can turn into a major pain and disability if left untreated.
What is Tennis Elbow?
Tennis elbow or lateral epicondylitis is truly an “overuse” problem of the muscles that help extend your wrist upward. These muscles attach to the bony portion of the outside of your elbow, which is typically where people with this issue complain of pain. Lateral epicondylitis is a repetitive strain injury, which means it is caused by micro trauma from repetitive activities involving the arm and wrist movements.
Activities that could cause Lateral epicondylitis:
- office work (clicking a mouse or typing)
- hammering or drilling
- playing tennis or other racket sports
What muscles are involved?
The muscles involved include the proximal tendons of the extensor carpi radialis (ECR) and extensor digitorum (ED). Studies have shown that the ECR in particular comes under extreme stress during activities that requiring the use of the wrist.
Who is susceptible to Tennis Elbow?
Approximately 40% of people will experience Tennis elbow during their lifetime. It happens more often in women, those with office jobs, doing work that demands repetitive use of the elbow and hand.
Other risk factors Include:
- history of neck pain
- concurrent rotator cuff problem
- smoking
Is Tennis Elbow a tendonitis?
The answer is NO.
A tendonitis means there is an acute inflammatory process going on within the tendon or where the tendon attaches to the muscle. The pain experienced with Tennis elbow is not due to inflammation. Instead, it’s due to a Tendinopathy, which means a longstanding problem with the tendons internal structure (think of rebar within the concrete of slab on concrete). With tendinopathies, the “rebar” is very disorganized, weak, and irritable. This is why you may have noticed that using an ice pack or rubbing an ice cube over your painful elbow brings only mild, short term relief of your elbow pain. The good news however, is that there is solution to ease the pain from tennis elbow.
Tendonitis vs. Tendinopathy, why does it matter?
It matters because it helps the clinician treat the problem. As I mentioned earlier, tendonitis is an inflammatory process that typically responds well to medications like Advil, ice packs, and rest.
Tendionopathy issues, like Tennis elbow, are different. Tendinopathies respond well to controlled strain on the tendon from exercise. Tennis Elbow has been shown to benefit from a specific type of therapeutic exercise: eccentric exercise training. We will discuss this shortly.
How can we treat Tennis Elbow?
There are many treatment interventions out there for Tennis elbow.
These include:
- Dry Needling
- Therapeutic Exercise
- Manual Therapy
- Ultrasound
- Laser
- Elbow braces
- Taping
At Move Empower Concierge Physical Therapy, we pride ourselves in providing treatments that are evidenced based and effective. Research supports the use of manual therapy, dry needling, and therapeutic exercise. Our manual therapy trained therapists use hands on techniques to effectively treat Tennis Elbow. These techniques include joint mobilization and manipulation, deep tissue massage, and IASTM. Another treatment we use at Move Empower for Tennis elbow is dry needling. Dry needling is an effective way to reduce pain and improve activation of muscles that have been dysfunctional and painful for long periods of time. Think of dry needling as providing a “Control, Alt, Delete,” to the muscle, essentially re-setting it to make it activate and function more properly.
Another important and useful treatment we use with our patients’ suffering from Tennis Elbow is therapeutic exercise, in particular, Eccentric training.
Eccentric training has been shown to be very effective for treating tennis elbow.
One exercise we are big fans of and use when treating Tennis Elbow is FlexBar® for eccentric wrist extension. This rubber bar can be wound up to create resistance for an eccentric wrist extension that promotes healing of the tendon.
This researched backed exercise protocol has been shown to be highly effective in reducing pain and increasing strength of the muscle tendon complex affected by tennis elbow.
If you don’t have a FlexBar, no problem. Simply use a small dumbbell with a weight that you can do ~15 repetitions with.
See the video below for more details on these exercises.
Is the pain from your tennis elbow not going away, or worse, increasing? It’s time to visit with a physical therapist! Schedule a FREE discovery session with us to get started.