Tennis elbow is a pesky injury that seems to never go away, but is it all doom and gloom?
Damian Boddy, our Head Trainer in Sydney, has done a deep dive on what the injury is all about, and how we can take control of the recovery and rehabilitation.
What is Tennis Elbow?
Tennis elbow, or lateral epicondylitis (tendonitis), is an overuse condition where the elbow becomes sore and tender. Pain occurs due to irritation of the tendons that join the forearm muscles on the outside of the elbow, with middle-aged people suffering the most.
It’s not just playing tennis that causes tennis elbow. Trade work or overuse of the forearm through desk work can also cause tennis elbow, with between 1-3% of the population affected!
That’s nearly half a million people in Australia alone!
How do you know if you have it?
Tennis Elbow can present symptoms such as tenderness or stiffness on the outside of the elbow, sometimes with a persistent ache. The muscles of the forearm can also feel sore and worsens when you grab or hold things.
Before you rush on to the steps how to fix your pain, these symptoms can be mimicked by other conditions such as arthritis, elbow instability or even referred pain originating from the neck. These conditions require specific variations from the treatment plan below, so it is important you have any injury checked by a doctor, physiotherapist or osteopath and receive the correct diagnosis before choosing a rehab plan.
Once you’ve done that and you have a confirmed case of tennis elbow, here are a few steps to help you reduce the pain and repair the damaged tissue.
Step 1 – Reduce the pain
Ice it up
Firstly, icing or cryotherapy can activate a great response from the body when it is strained or injured.
When soft tissue is damaged, it can become inflamed, swollen or hot. These are all types of chemical and neurological changes that happen, whereby blood vessels dilate and increase the amount of oxygen, nutrients and white blood cells that enter the tissue.
This process can stimulate nerve cells of the surrounding area, generating a pain response.
Inflammation is a necessary evil, acting as your bodies mechanism for fixing and restoring the tissue, although it is usually hyperactive at the initial onset of injury and can cause excessive pain and stiffness. Blood vessels will constrict the flow of blood and inhibit the immune systems response when ice is applied directly to the injured area.
Ice therapy is a useful, cost effective and non-chemical way of temporarily reducing pain and potentially speeding up the recovery process.
Strap the elbow to reduce joint stress
Strapping of the elbow works by compressing the muscles of the upper forearm and absorbing the forces which are transmitted through the soft tissue outside of the elbow.
If strapped well by a physician, or by using a specific tennis elbow clasp, the change of angle at which the tendon works at the elbow will change the force applied to the tendon attachment, allowing the injured area to recover over time.
Nonsteroidal anti-inflammatory’s (NSAIDs)
Nonsteroidal anti-inflammatory’s are either taken orally or applied to the skin with products like creams or gels.
You can get these products from your doctor or over the counter to help manage pain. Like anything, it’s important the correct dosages are adhered to.
Step 2 – Facilitation of tissue repair
Soft tissue massage
Soft tissue massage can aid in muscle relaxation after the inflammation has reduced and injured tissues are beginning to repair, largely because it helps with increased blood circulation and lymph flow.
These systems are integral to the delivery and excretion of nutrients and waste. Increasing their function will not only speed up the healing time, but also prevent the formation of scar tissue.
Moreover, massage has been shown to reduce joint inflammation and improve range of motion and flexibility.
Myofascial release is a form of soft tissue therapy that you perform on yourself. Foam rollers and soft balls are commonly used to release muscle fascia, plus there other similar substitutes to treat those tight muscles and hit trigger points. I often find myself leaning heavily into a protruding wall in my house, trying to release tension in my lower trap muscles.
Step 3 – Restoration of the normal joint range of motion and function
Gentle joint mobilisations
Joint Mobilisation techniques focus on attaining a normal range of pain-free joint motion. Joint play or accessory movement can be performed by another individual to assess range of movement at the joint.
Joint distraction is a type of mobility technique that we can incorporate into stretching exercises to create more ‘space’ inside our joints.
This would mean applying an elastic force to the ulna on the forearm for tennis elbow. Pulling the forearm away from the upper arm can provide space and reduce stresses within the joint.
Lastly, make sure you’re aware of the muscles in the forearm which are engaged through gripping or extending the fingers, so tension could remain on the forearms which would make it worse!
Step 4 – Restoration of normal muscle length, strength and movement patterns
- Hold a Foam roller, a small ball or a rolled-up towel in your hand.
- Squeeze in your hand and hold for 10 seconds, then release.
- Repeat to fatigue on both arms if necessary.
- Supination is an external rotation exercise with the hand rotating the weight outward, turning the palm up.
- Rotate the hand back the other direction until your palm is facing downward.
- Repeat as required.
- With the palm facing down, extend your wrist by curling it upwards towards the sky.
- You should feel the extensor muscles of the forearm engage.
- If this is too easy, try adding a light weight.
- Similar to extension, however, with the palm facing up.
- Flex your wrist by curling it towards the sky.
- Slowly return to the starting position.
- Repeat until fatigue.
Muscle Energy Techniques
Muscle Energy Techniques (MET) is a gentle manual therapy intervention, targeting the soft tissues. MET is the utilisation of gentle muscle contractions of the individual, relaxing and lengthening muscles to normalise joint motion.
The affected muscle is gently stretched to its longest pain-free range in five sub-maximal muscle contractions of five seconds each. This is very similar to PNR stretching!
Overall, this encourages the muscle to naturally relax and results in an improved range of motion.
Finally, eccentric strengthening involves working the affected wrist extensor tendon and muscle while they are lengthening. Let’s using a wrist extension as our example. Youu would hold a weight with the palm facing down, aiming to lift the weight by extending the wrist quickly, before slowly lowering the weight for around five to ten seconds.
The return serve
Tennis elbow is a debilitating injury, but there are ways to improve the injury and get ourselves fit again!
If you suspect you have tennis elbow, it’ essential to seek advice from a health professional as a starting point. Once you’ve done that, use the above as a guide, and as always, listen to your body!