Have you or someone you know been diagnosed with Tennis Elbow but don’t really know what that means or what to do about it? Why is it called Tennis Elbow when you don’t even play tennis?!! This blog will tell you what Tennis Elbow or Lateral Epicondylitis is, what causes it, how to know if you have tennis elbow, tennis elbow treatment and more! Let’s find out.
What is Tennis Elbow and What does Tennis Elbow pain feel like?
Tennis elbow, also referred to as, lateral epicondylitis, is often described as a chronic (long-term) pain on the outside (thumb side) of your elbow joint. This pain is due to irritation or damage to the tendons that connect the forearm muscles to the lateral epicondyle (outside of the elbow) of the arm. Here’s a little breakdown for better understanding:
The elbow joint is made up of three bones, the humerus, radius, and ulna. These bones are connected to each other via ligaments because ligaments are the connective tissues that connect bone to bone. Tendons connect muscles to bones. Tennis Elbow is a condition where the ligament that is connected to the arm on the pointy part of the elbow is irritated.
You can find this point on your self by identifying the bony points on either end of where your forearm meets your upper arm to make your elbow joint. If you are looking at your arm palm up, the lateral epicondyle is the bony point on the thumb side of the elbow. If you have tennis elbow and apply a bit of pressure over this point to find it, you probably feel pain or soreness! That’s how you know you’ve found the spot! (See the photo above by performhealthwellness.com)
This bony point is where multiple muscles attach to the bone via tendons. These forearm muscles perform many movements involving your wrist and fingers. The main muscles involved with this elbow pain are known as the extensor muscles because they perform extension of the wrist. Wrist extension is the movement when the back of your hand gets closer to your arm (as seen in the photo by crossfit.com) and wrist flexion is the opposite.
Although wrist extension typically gets all the blame for tennis elbow, other elbow movements such as pronation (palm down) and supination (palm up, like you’re holding a bowl of soup) are just as involved. Now that you know the structures and movements involved with Tennis Elbow, what causes this pain?
How Does Tennis Elbow Happen?
Tennis elbow is an overuse injury meaning that it is caused by repetitive motion of the wrist/forearm muscles. Repetitive use of these muscles results in micro-tears and damage to the tendons which tend to be painful. The overuse of a muscle often results in a tight muscle also causing a pull at the attachment site, in this case, the lateral epicondyle. Tight muscles restrict a full range of motion from being performed, causing problems. This means the issue is not only overused muscles but overly tight muscles.
Now, who abuses their wrists so much that this happens? Surprise! This repetitive motion is seen in the game of tennis if you couldn’t guess from the non-scientific name of the injury but you don’t have to be a tennis player to have tennis elbow! The funny, not so funny thing is that Tennis Elbow is most commonly seen in non-tennis players. Anyone whose job or daily actives requires repetitive use of the forearm muscles is at risk for tennis elbow such as:
- People who sit at a desk, type a lot, and have the wrong desk set-up! ( who I mostly see)
It can be the desk set-up, the way you type, and the limited range of motion you have behind the desk that may have put you in this predicament. The good news is that we can do something about it!
How Do You Know If You Have Tennis Elbow?
The first factor in diagnosis is pain. You have this elbow pain so you go to your primary care doctor, physical therapist or your chiropractor to get it checked out. To get rid of the pain is one thing and I will tell you about the non-medicine treatment BUT let’s face it, the pain will come back if you don’t clean up your life style and the ‘mess’ that is created because you have been with elbow pain and favoring not just that elbow but over compensating with the same side shoulder and wrist and neck to just name a few.
When I examine the patient, I want to know what the range of motion is like, and what movements actually increase or decrease the pain. Tennis Elbow and Carpal Tunnel are not directly related BUT one can cause enough issues in the movement of the arm to contribute to the creating of the other. Some of the potential tests listed below are performed but I think they should be reserved for more ‘obscure’ cases.
- X-ray: An X-ray may be necessary to rule out any bony injury and just because it is normal does not mean you do not have Tennis Elbow.
- Magnetic Resonance Imaging (MRI): Hopefully you’ve read our other blogs so that you are aware most areas of pain are not necessarily the cause of your problem! While Tennis Elbow is pretty localized to a specific area, some neck issues can lead to pain down the arm. For the record, I have never ordered MRI of the elbow to rule in Tennis Elbow !
- Electromyography (EMG): This test is not used for diagnosis but in severe Tennis Elbow cases, there may be damage to the near by nerve and then the manifestations of that nerve issue on the muscle(s) that the nerve is responsible for.
Once the appropriate diagnosis is made, a treatment plan can be put into action!
What is Tennis Elbow Treatment?
If you are thinking why Tennis Elbow does not heal, you must not be doing the right treatment!! It’s one thing to get rid of the pain but unless you find out how it came about to begin with, this problem will return. Have you ever seen a tree trunk that is cut off but the next year, a fresh shoot comes off of it? Well, that’s because the ‘feeder’s were still there to support a new beginning. If the goal was to get rid of pain and just bring the movement to the area back, the whole problem was NOT addressed! After all, not everyone playing tennis gets Tennis Elbow and also not every Tennis Elbow case is in those playing tennis.
This condition can be painful and most often results in the use of medication and at times, injections! Let’s see what the conservative treatment is like!
Natural Treatment for Tennis Elbow
In acute cases, Cold Laser, and Active Release Technique (ART) are my go to places. At the same time, reviewing the life style that may contribute to this problem is crucial. This includes both work and personal. Things like Ergonomics at work (or home), hobbies and even sleeping!!. I am amazed at how some strange sleeping positions are found comfortable by many. Here is what to look for when you are sleeping.
Once we have minimized pain, giving us the full focus of the brain, we can begin with Dynamic Neuromuscular Stabilization (DNS). You can learn more about DNS by reading our blog at that link. DNS, in this case, applies to the connection between the wrist, triceps and scapula firing or misfiring.
The main poses associated with the treatment of lateral epicondylitis include the early stages of 3 month prone and late-stage 3 month prone (shown in the video below). In these moves, we focus on syncing the movements of the forearm muscles and scapular muscles together.
If you read our blogs, you know we don’t do static or isolated stretching. Through the DNS poses we stretch what needs to be stretched through movement. Why? Because the problem is not in isolation it’s in movement!
Another important component of injury recovery and health, in general, is nutrition! When an injury is present you should always up your vitamin C intake and increase protein consumption. If you really want to get better you’ll use all the tools you have!
Prevention of Tennis Elbow
If you know your job or other actives you do overuse the muscles or restrict the range of motion of your elbow joint then don’t wait for the pain to come. Increasing mobility of the wrist, elbow and shoulder joints are necessary and can be achieved using the same poses discussed above. Adjust your workspace to ensure you have space to move your elbows freely and are not too confined. This Ergonomic Awareness is an excellent tool for anyone sitting behind a desk looking to minimize damage and promote good posture.