I will preface by saying all of what you read below is to seek out a medical professional if you are feeling pain or discomfort either lifting or during your daily life!!! I wrote a post on scapular dysfunction last week here but this week I am going to discuss lateral epicondylitis aka tennis elbow.
What is it?
Tennis elbow is a degenerative condition in which there are small tears of the muscle fibers of the extensor tendons in the arm. Usually people associate this condition with inflammation of the elbow. Tennis elbow is NOT an inflammatory condition! There has been a multitude of studies which have confirmed this finding and researchers now prefer the term epicondylagia to describe this injury. The most common muscle associated with tennis elbow is the extensor carpi radialis brevis (ECRB). This specific muscle is the strongest of the three main wrist extensors and assists with all extension of the wrist. It typically affects people who do repetitive stressing of the elbow either through working out or life in general. Pain is usually with activities where the elbow is fully extended with the palm facing down. The usual age range this can affect is people after the age of 30. If left untreated, it can progress to a very painful condition in which surgery can be indicated.
How to diagnose
Tennis elbow can be diagnosed in a few ways. The first is to find the epicondyle of the elbow and press down. To find this, find the bony part of the outside elbow and press in using your index and middle fingers. If this is painful it could indicate tennis elbow. Sometimes people feel pain more in the extensor mass of the arm located about 6 cm from the epicondyle. If this is the area that is sore, this is what is called radial tunnel which is more of a nerve discomfort. Hereare the areas marked for the two conditions. Tennis elbow is the smaller circle. Another common test is the middle finger extension test. To perform, place hand on flat surface and extend the middle finger. Now try to push the middle finger back down while resisting this downward force. If this is painful, this could also indicate tennis elbow. A third test is to extend the wrist and try to push the back of the hand down flat while resisting this downward force. Again if this is painful you may have tennis elbow. If you are unsure, see a medical professional for a full evaluation.
How do we treat this?
With tennis elbow the biggest piece of advice I can give is to REST. This can be hard for people to follow through however since we use our arms for many activities throughout the day. If your elbow is painful for longer than 6 weeks I usually recommend a patient to wear a wrist splint similar to this one. What the wrist splint does is it keeps the wrist in neutral to slight extension which rests the elbow extensors. This will also remind you to avoid heavy lifting. If you have to lift, lift with your palm facing up (supination) with your elbow bent close to your body. This again takes the load of the extensors as they are in a shortened state in comparison to the extensors in a lengthened state with your palm down. Always keep your elbows in which will help rest the extensors. I also recommend people heat the tissue with a hot moist heating pad which will bring blood to the tendons. I usually have people follow up and massage the outside of the elbow to help relieve pain. To review:
- Avoid all activities where you have your arm fully extended and lifting at the same time
- If you have to lift, lift with your elbows bent by your side as close to your body and lift with your palms facing up.
- Wear a wrist brace that keeps the wrist in neutral or slight extension to rest the wrist extensors.
- Use moist heat on the elbow and follow with massage using any cream.
Usually following this program for 4-8 weeks can bring pain down. If not, seek a medical professional.
Once the pain level is down, I begin stretches. There are 5 stretches you perform in order to fully stretch the extensors. They are in order from easiest to hardest. Again, AVOID PAIN with these stretches. Only do the stretch that doesn’t produce pain. Here they are in order
It may take a while before you can progress to the next stretch so don’t worry if it takes a few days or weeks. Keep the elbow bent and by your side on numbers one and two (I had my elbow out a little for demonstration purposes). I also like to do a unilateral chest stretch as sometimes people are very tight in their chest and the elbow can sometimes be a referral zone for pain.
Finally when you start feeling little to no pain at all, it’s time to start strengthening. At this point, most people should continue doing what I have mentioned above in conjunction with strengthening. One exercise that has shown some reliability is eccentric exercise. To perform place arm over table edge and hold a weight in one hand with the wrist in extension here. Then bring weight slowly into flexion like here. The most important part is to use your other hand the bring the hand holding the weight back into extension here. Don’t lift the weight back up in extension as that would make it a concentric exercise. Repeat up to 10 times 1-2x per day. Start with a one pound weight and work your way up slowly. You can also resume light lifting starting at weights that are very low (5-10 pounds depending on the exercise). You can always increase it later however you don’t want to do too much weight as you can have a recurrence. If pain comes back, drop weights or go back to rest and stretching.
Other treatments for tennis elbow can include cortisone shots. This is generally a short term treatment option but can resolve pain completely in some people. I would recommend following the above treatment if you get a cortisone shot to help stretch and strengthen the muscles.
So that’s pretty much it for tennis elbow. I can answer questions down below or clarify comments. Hope this helps!