The main important anatomy that needs to be considered when discussing tennis elbow or lateral elbow pain is the common extensor tendon that attaches in the lateral elbow. All the muscles along the top of the forearm that control the “extension” (lifting up) of the fingers run along and attach into the common extensor tendon. This is the area of inflammation and aggravation with tennis elbow and the cause of peoples symptoms. Some people experience what is known as “golfers” elbow which is commonly experienced on the inside of the elbow on the underside. Although this is a different site of pain, it is often helped with the same techniques discussed in the blog below.
What is Lateral Epicondylitis / Tennis Elbow:
As suggested in the name, “itis” suggests an inflammatory response at the lateral epicondyle of the humerus (upper arm as it joins at the elbow).
The muscles that control movement of the wrist and fingers all run along the top of the forearm and converge into the “common extensor tendon” and attach into the lateral side of the elbow. As a result of overuse and repetitive strain, this tendon becomes a site of irritation, inflammation and leads to pain at the site of the lateral elbow.
What are the symptoms of tennis elbow:
The most common symptoms of tennis elbow are pain and discomfort over the lateral elbow when using the muscles of the wrist and forearm. Pain can be experienced as a sharp stabbing pain or a dull ache or a combination of both.
Most commonly pain is worse when actively using the extensor muscles of the arm and rotation the forearm and these movements include – holding a kettle and twisting to pour, lifting bags with your palm facing down, bending the wrist backwards, doing overhead gym activities with weights and squeezing and opening door handles.
These are all activities that load and put stress through the common extensor tendon and when this is inflamed and irritated during tennis elbow causes pain and discomfort. As this is an inflammatory injury, you may notice some swelling or some tenderness to touch at the site of the lateral elbow also.
What are the causes of tennis elbow:
Tennis elbow is caused by overload and repetitive strain of the extensor tendon of the forearm. Repetitive strain particularly of movements or activities that repeatedly use those muscles such as lifting, carrying, twisting, typing or clicking a mouse are the most common activities that can lead to this, as well as sports such as tennis, golf and throwing sports.
- Office jobs with repeated typing and mouse clicking for 7-8 hours a day can lead to overload of the muscles and irritation of the extensor tendon of the forearm.
- Throwing sports that have repeated throwing action with wrist extension and flexion at high speeds can also lead to aggravation and irritation of the extensor tendon in lateral epicondylitis.
- Suddenly starting an activity or sport that requires wrist and forearm use and having a sudden increase in the load that goes through this tendon is another cause of inflammation. You may be comfortable with the amount of strain that goes through this tendon in your job or usual activities but you may take up a sport that requires its use and this additional load may be the last factor that results in inflammation and causing lateral epicondylitis.
- Acute strain or aggravation – usually lateral epicondylitis is a build up and progressive injury that leads to inflammation. You can have an acute aggravation or strain of the extensor tendon that also results in very similar symptoms and can be managed the same way. This can be caused by trying to lift, carry or throw something that may have been too heavy or too quickly for the tissue to handle and caused an acute strain and aggravation in the moment.
Management of Lateral Epicondylitis:
The management of lateral epicondylitis / tennis elbow like many rehabilitation processes involves reducing load, reducing inflammation, improving pain free movement and then re strengthening and exposing the tendon to stress and strain progressively. It is an injury that you can be guided by pain, if something doesn’t hurt then you are ok to do this activity knowing that you are not making it worse. And similarly if pain is sharp or more than 4/10 while doing an activity then this activity should be avoided as it can be prolonging the recovery of this tendon.
Reducing inflammation
o Utilising cold therapy and compression will help to reduce the aggravation and inflammation in the tendon. Both will help to alleviate any swelling and improve the “happiness” of the tendon which is a requirement before you can start strengthening it.
o Self massage through the forearm muscles to help reduce tension of these commonly overtight muscles that can pull and irritate the site of the aggravated tendon.
Improve movement and strength
o Initially having an exercise program that will progressively load the forearm tendon is really important as tendons like load and will heal faster and stronger with small amounts of stress.
o This movement initially is in a eccentric direction (lengthening throughout movement) and using your non ionjured hand to help set yourself up for the exercise.
o When this movement is pain free and managing the load well you can start to concentrically contract the muscle with some resistance
You can use small weights like 1-2kg dumbbells or even cans of food that you may have at home. As long as it is not too heavy or causing your pain it will do the rebuild process that were looking for.
As mentioned earlier, these are recommendations that are generalised for those that have non specific lower back pain and may be slightly different for different people. Additionally, even if you have bulging discs, facet joint inflammation or SIJ instability and these are the structural causes of your pain of imbalance you can greatly benefit from self release techniques and from a strength and stability program. Follow up with your healthcare professional for more individualised advice on how to best manage and recover from your lower back pain.
Commentaires