What Is Tennis Elbow?
Let’s start with the basics: Tennis elbow (lateral epicondylitis) is a very well-known example of a tendon injury that we treat here in Smithtown, New York. Tendon injuries can be divided into several categories based on their onset and the tissues involved. We as clinicians need to be able to distinguish if the injury is an acute epicondylitis or a chronic epicondylosis because the nature of the injury greatly impacts the rehab process.
- An acute tendonitis (epicondylitis) of the elbow results from trauma or something like an improperly hit backhand in tennis that causes micro tearing of tissues at the lateral elbow.
- A chronic tendonosis (epicondylosis) refers to the degeneration of a tendon when it doesn’t heal properly after an acute injury OR after repetitive microtrauma resulting from overuse.
Tennis elbow doesn’t only result from a tennis injury. It can be the result of over-gripping during a work-out, computer work, painting, plumbing, carpentry or any other repetitive hand/wrist movements. More often than not, tennis elbow is a recurring issue for many people because of muscular imbalances and weaknesses. These issues are not obvious until the pain begins – and unfortunately this means the damage is already done. Pain is usually the last thing to reveal itself, while the damage from microtrauma has been building for a while.
Addressing the root cause of the injury is the ONLY way to permanently resolve the problem. Investigation not only of the elbow but above and below the joint is necessary as well. If a patient has an issue with, let’s say, shoulder mobility or wrist, hand, or finger weaknesses, these issues can absolutely contribute to elbow dysfunction and damage. A good clinician will evaluate even further – there could be weaknesses in a lower extremity that are affecting the performance of the upper extremity during activity. There are so many variables that come into play and they all need to be explored.
What Does Tennis Elbow Feel Like?
Tennis elbow presents as a dull ache or burning pain along the lateral or outside of the elbow. This means if you are looking at your palm, it is on the thumb side of the distal arm. This discomfort worsens with repetitive everyday motions such as lifting, typing or just shaking hands. You may also experience weak grip strength and pain when gripping objects. This could be as simple a task as twisting a bottle cap or lifting up the laundry detergent bottle.
Common Symptoms of Tennis Elbow
- Pain that radiates from the elbow to the forearm or wrist
- Stiffness and soreness, especially in the morning
- Tenderness when pressing on the outside of the elbow
- Increased discomfort when using the hand or elbow
Anatomy of Tennis Elbow
The main players in tennis elbow are the extensor carpi radialis brevis and the extensor digitorum communis, but to keep it simple we’ll just refer to these muscles as the common extensor tendon where it inserts onto the lateral epicondyle. Again, these muscles themselves can be weak and dysfunctional OR they can be overworking for other weak and dysfunctional muscles. This is why thorough evaluation is necessary and just blindly treating the symptoms will not permanently fix the problem.
Causes & Risk Factors of Tennis Elbow
As mentioned above, repetitive arm motions contribute greatly to this injury. Tennis, pickleball, golf and ping pong are the main sports that bring patients into the office with lateral epicondylitis. There is such a thing as golfer’s elbow which affects the medial elbow, but plenty of golfers use improper form and wind up with tennis elbow as well. Although this is one of the most common causes of tennis elbow, others include:
- Overuse of forearm muscles that leads to microtears in the tendon. This is the common theme that runs through our office – fix the stuff that isn’t working so that other muscles don’t jump in to help and wind up getting hurt. Everybody should be pulling their weight!
- Poor wrist and shoulder (or elsewhere) mechanics putting extra strain on the elbow. If we can’t get what we need from one area, we’ll force it from another.
- Age-related degeneration that leads to tendons that are more prone to injury. Hate to say it out loud but older materials lose strength and resilience.
Most people can self-diagnose tennis elbow by pressing on the area on the outside of the elbow. If it produces familiar pain, chances are there’s something going on. Resisted wrist extension will also reproduce discomfort. If both the right and left side are tested and only one side hurts, it’s pretty telling that something is happening that shouldn’t be.
How To Relieve Pain From Tennis Elbow
- Rest and activity modification: We don’t like telling patients to stop doing the things they love but sometimes it’s necessary to get a handle on the situation.
- Ice therapy to reduce inflammation and swelling: This is unfortunately debatable because inflammation is the good stuff with all the healing components we need. But it can still be used to help alleviate pain momentarily.
- Compression sleeves or bracing for support: Again, only for a short while. We don’t want the body to start to depend on external bandages for injuries.
- OTC pain relievers: Again, not for the long haul. Depending on meds is never the answer.
Break The Cycle of Reinjury: How to Stop Tennis Elbow from Coming Back
Let’s walk through a case study of a patient that presented in the office with right lateral elbow pain that started after playing pickleball 4 days per week. Icing and self-massage at home had zero effect on his symptoms, so he decided to come get it checked out. Just to keep things simple, I’m going to highlight the main parts of the treatment.
Step 1. Muscle Testing
Muscle testing revealed weaknesses in the tricep, rear deltoid, infraspinatus and rhomboid. Take note – none of these muscles are in the forearm. They are in the upper arm, shoulder, and mid-back. The supinator and wrist extensors were trying to help all of these muscles during pickleball games, eventually leading to tennis elbow.
Step 2. Soft Tissue Work
The course of treatment involves soft tissue treatment of the forearm musculature via ART, Graston, or cupping. I especially like to include movement while performing these therapies. The reasoning behind this is as follows: All of the soft tissue treatments utilized are meant to recreate the healing process (inflammation) and to break apart scar tissues adhesions. If done so with movement, the theory is that proper collagen deposition and maturation will occur in order to restore proper function of the soft tissues.
Step 3. Chiropractic Adjustment
Chiropractic adjustments to the neck, mid-back, shoulder, elbow and wrist are all performed (if necessary) to maintain proper joint mobility and range of motion. However, if muscular imbalances are not addressed, joint issues will keep happening. Adjustments alone do not fix joint dysfunctions.
Step 4. Corrective Exercises
In this instance the tricep, rear deltoid, infraspinatus, and rhomboid were given strengthening exercises. Remember, this is specific to THIS PATIENT. Every patient will be different and how they wound up with tennis elbow will be different.
There is NO ONE WAY that will fix every tennis elbow diagnosis – or any other diagnosis for that matter. The evaluation and investigation is paramount in order to find the root of the problem. Blindly giving strengthening exercises to muscles that aren’t weak and are being overused makes matters worse. Read.That. Again.
Why True Sport Care Should Be Your First Stop for Tennis Elbow Treatment
The typical course of action is as follows: A patient will go see an orthopedist with their complaint. The ortho will then recommend physical therapy. The patient will get therapy for a while and feel better. They resume their activity and the problem comes back. For some reason, we are a last ditch effort that a patient makes before considering a much more aggressive approach. Why they don’t start with us first I’ll never understand.
Our detailed evaluation and specifically tailored rehab programs are so incredibly effective. Being seen and treated initially at True Sport Care in Smithtown, NY, will save so much time and money for so many patients. And if we can’t help, we’ll know sooner rather than later – the approach we take works quickly. If we aren’t making a difference we’ll refer out to the necessary professionals to aid our patients on their healing journeys. So please consider getting evaluated and treated here at True Sport Care as your primary stop before going the typical route – we won’t disappoint.
