Arm and Shoulder, Elbow

Tennis Elbow Treatment

There has recently been an inundation of clients complaining of tennis elbow. Now, the diagnosis of tennis elbow can often be misconstrued with any general elbow injury so it’s important to check the symptoms, doctor opinion and imaging to confirm the diagnosis of tennis elbow before appropriate treatment can be prescribed. 

Tennis elbow has become more and more commonplace due to society’s addiction to spending time on the computer where we rely on repeat use of the fingers and hand in order to type and click the mouse (excuse me while I take a quick break and rest my poor muscles).

Tennis elbow occurs as a result of injury to the common extensor tendon that attaches to the lateral epicondyle at the elbow.  It is described as chronic degeneration of the tendon. It was previously thought to be an inflammatory injury as was termed lateral epicondylitis but that has now been debunked. The common extensor tendon spans from all the fingers and is primarily responsible for extending the fingers up off the surface of the table or keyboard.  

Tennis Elbow
“Chronic degeneration” sounds pretty intense. It implies that with each subsequent use, the tendon becomes a little weaker. Slowly (and silently) damage piles up until degeneration has reached critical mass until symptoms present and then treatment is sought, well after the root of the problem has occurred. If only we could start preparing for this issue before we need to.

The reason tennis elbow occurs in some people and not others is believed to be a result of certain people being predisposed to elbow injuries. Genetically, we know that some people are built with more slow twitch (endurance) muscle fibres, while others have a dominance of fast twitch (power) muscle fibres. I believe that certain people have finger extensor muscles that do not have sufficient endurance to be able to tolerate prolonged periods of typing and fine motor movements which results in muscle fatigue and injury.  A recent client with tennis elbow tried to solve his recurring pain by switching his mouse to his other hand. Within 3 weeks he was experiencing similar symptoms on the other arm. This implies his threshold is diminished compared to the average being.

Treatment

The good news is that tennis elbow can be prevented and treatment with fairly simple therapy. The treatment protocol aims at improving the muscular endurance and flexibility of the extensor muscles so that pressure is decreased on the common extensor tendon at the lateral epicondyle.

As we know, it is tough to give general rehabilitation advise without knowing the specific health makeup of the patient. There are many factors that contribute to chronic degeneration of the tendon and tennis elbow, so the advice below may or may not apply to you. In any case, they are low impact exercises that I have found can get some positive results. However, for full treatment consult your local Exercise Physiologist or health care professional.


Flexibility

As the muscle is continually used it gets shorter and pulls on both its origin (the elbow) and the insertion (the fingers). If we only use the muscle without ever stretching it, the impact on the lateral epicondyle will be magnified.

  • Finger Extensors Stretch – Stand with your arm straight facing a wall. Place the back of your hand on the wall trying to keep it in contact throughout. Hold for 30 seconds.

    Tennis Elbow

 

  • Finger Flexors Stretch – Stand with your arm straight facing a wall. Place your palm on the wall with your fingers pointing down at the floor (the higher the palm is on the wall the more the stretch will occur). Ensure your palm is always in contact with the wall.  Hold for 30 seconds.

    Tennis Elbow

 


Strength

As mentioned earlier, we will need to increase the muscular endurance of the muscles involved with the elbow joint. Muscular endurance is a form of strengthening albeit ignored in many circles. I use the analogy of making these muscles into marathon runners rather than sprinters. They need to be able to weather the battering provided with several continual hours of work. Strengthening these muscles can be a little finicky but below are some of the options I use:

  • Finger Extensors – Place your hands flat on a table. While keeping as much of your palm in contact with the table, extend all your fingers off the table and hold for 15 seconds. Add a blanket over your fingers to add a slight resistance.

Tennis Elbow Finger Extension

  • Finger Flexors – Place your hand flat on a table. Flex your fingers trying to scrunch the table in to one point in the middle of your palm. Hold for 15 seconds.

Tennis Elbow *Alternatively, get a stress ball and squeeze it for 15 seconds

  • Wrist Extensors – Extend your wrist and hold for 15 seconds.

Tennis Elbow

  • Wrist flexors – Flex your wrist and hold for 15 seconds.

Tennis Elbow

  • Radial Deviation – Make a fist with your thumb pointing to the ceiling. Move your wrist up towards the ceiling then down to the floor ensuring you are going through the full range. Complete 10 deviations pausing for 2 seconds at the end of each range.

Tennis Elbow    Tennis Elbow


Other Contributing Factors


Habits

As with many conditions, poor technique and bad habits become a large co-contributor to the injury and is the case with tennis elbow. Here are some of the bad habits that are associated with tennis elbow that you should try to reduce.

  • Hovering of the fingers over the keyboard/mouse when its not being used is the largest strain to the extensor endurance.
  • Sitting with poor posture
  • Sitting too close to the computer.
  • Having your elbows hovering in mid air over the edge of the table.
  • Resting your elbows on a table that’s too high.


Comorbidities

In some cases, tennis elbow can occur as a result of various other conditions limiting the body’s efficiency. I won’t go into full detail as I don’t want to promote guess work but if usual care does not relieve the symptoms then there are a few other areas that can be considered for treatment. Seeking professional advice specific to your situation is crucial.

  • Nerve impingement
  • Poor posture
  • Cervical spine
  • Shoulder injury
  • Trapezius tightness
  • Tricep/Bicep imbalance


Summary

The take home message is to start considering preventative treatment at the earliest possible stage. Treatment aims to limit the chronic degeneration involved in activities involving prolonged hand usage (computer/mouse usage etc). Treatment combines flexibility exercises as well as increasing the muscular endurance of the muscles in the region. Ensure that your injury is correctly diagnosed and seek specific medical attention if the suggested exercises have no effect as there could be comorbidities.

Happy Recovery.

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