Should The Cure For Tennis Elbow Only Be Focused At The Arm?
The proper cure for tennis elbow, also known as lateral epicondylitis, is often approached incorrectly by both physicians and physical therapists. This can be very frustrating to the anxious athlete or layperson, who often has to wait weeks to months for their painful symptoms to finally abate, only to find themselves facing another unexpected painful flare up. The big question is why do these flare-ups occur in the first place, and how can the injured person prevent these frequent recurrences. Is there something deeper to look at other than just the isolated symptoms at the elbow? If the elbow keeps inflaming, is the treatment modality really working? I will take a deep dive into the actual cause of tennis elbow and show you some helpful tips and tricks to lessen and eliminate that elbow pain once and for all.
What Exactly Is Tennis Elbow Or Lateral Epicondylitis?
The tendons and ligaments on the lateral aspect of the elbow joint become inflamed by rubbing on the side of the condylar joints of the ulna, therefore creating progressive and often debilitating pain when squeezing the hand grip of a tennis racket or object. A similar situation happens to golfers who squeeze excessively on the hand grip of a golf club. The difference is the pain in golfers elbow is usually located on the medial aspect of the elbow joint. The current self-management treatment for epicondylitis is direct icing on the inflamed elbow, a prophylactic elbow band and rest and restriction from all activities which presumably caused the inflammation. A more aggressive therapeutic approach involves ultrasound, therapeutic stretching of wrist flexors and extensors and strengthening the opposing weaker muscles with therapeutic exercise. All this is medically prescribed believing that the pain in the elbow joint is primarily the result of pattern overload, and treating the symptom at its exact location is far more beneficial than addressing the true cause of the ailment. In most cases, upper body dysfunctions are the root of the problem. This dysfunction is well known to upset the stability of the shoulder, elbow, and wrist. In this post, I will give you proven tips, tricks, and tactics on how to better manage a painful tennis elbow. The cure for tennis elbow requires some methodical thinking and objective assessing by the patient. Once you figure out your particular problem, versus what is recommended on WebMD, you can greatly reduce or eliminate your elbow pain and prevent future occurrences.
Tennis Elbow Pain Symptoms And The Standard Medical Approach Used To Cure Tennis Elbow.
Symptoms of tennis elbow can range from a dull ache to the lateral side of your elbow, to sharp stinging pain noted when flexing or extending your forearm. You may even have localized pain to the condyles of the wrist joint, which can magnify tennis elbow symptoms through a neural pathway known as referred pain. Many of my clients have reported difficult turning the steering wheel of their cars, unscrewing jars and even using their computer mouse. These nagging symptoms psychologically leave the injured person feeling debilitated, forcing them to seek out a quick cure for tennis elbow with a visit to the local emergency room. Unfortunately, the emergency room visit seldom leads to patient satisfaction or pain resolution. The emergency room staff will recommend the perfunctory resting, icing, and immobilization of the painful elbow joint, and a referral back to the primary care physician for follow up care. If you are lucky your primary care physician will immediately refer you to physical therapy.
Do Tennis Elbow Supports Work To Cure Tennis Elbow Pain?
Another common cure for tennis elbow or lateral epicondylitis is a tennis elbow support. This elbow support serves as a band-aid and does provide immediate relief. However, this is not a cure and once you discontinue using the tennis elbow support, pain re-emerges. The disadvantages of tennis elbow supports are that they are big and bulky and can also affect the quality of your tennis stroke. If you are not an athlete then this, of course, is a non-concern. A better less bulky option is Mulligan Mobilization Taping which has shown favorable results as a pain reduction cure for tennis elbow when properly applied. However, this is another band-aid and still does not address the underlying problem. The proper application of Mulligan Mobilization Taping must be applied by a licensed physical therapist, which means frequent visits to the therapist for reapplication of the tape.
The Best Cure For Tennis Elbow Is To Start Looking Somewhere Other Than Where It Hurts!
It’s time to get to the root cause of tennis elbow in order to find the best long lasting cure for tennis elbow! It is important to look above and below the inflicted joint. Keep in mind the elbow is a hinge joint and simply moves up and down. It is important to determine what is causing the malalignment of the connective tissue and bone.
- Look at the opposite side of the pain: The wrist flexor muscle group is not obvious. Most therapists look at the forearm extensors which are overloaded. However, why are they being overloaded? Perhaps weak forearm flexors which are too inactive and asking forearm extensors to do a job they weren’t meant to do? Solution: Preload the forearm flexors with lengthening exercises and precise conditioning.
- Look at the shoulder joint: Are your shoulders excessively pronated inducing a faulty posture? Solution: Get a postural analysis and see how much shoulder pronation you actually have. Poor posture beginning with an abnormal head carriage will cause a domino effect to all joints from head to toe. Shoulder pronation causes internal rotation of the arm which is a big factor in elbow joint pain. If you have prolonged pronation you will have a prolonged stretch to the extensor of the forearm which means weakness to the ligaments and supportive soft tissue.
- Look at trunk rotation: If your trunk is not rotating at least 25 degrees, then your shoulder, elbows, and wrists will bear the shear force that your trunk naturally absorbs and generates. If your trunk is not rotating properly then core mobility issues need to be addressed. Swinging a tennis racket or a golf club correctly begins by generating force energy from the feet upward to your head in a corkscrew manner. Proper rotation of the trunk alleviates the shear force on upper extremity joints and connective tissue. If your hips, spine, and core lack mobility, then all forces generated in a normal twist/rotational pattern are collected into the facets of the spine and articulating joints of the shoulders, elbows, and wrists.
- Look at the wrist joints: Often a binding compensation at the wrist will misdirect the energy flow directly to the elbow joints. Is your wrist joint equipped to handle eccentric overload? In other words, does it seem weak when asked to perform flexion and eccentric extension work? The way to determine this is to observe how your wrist behaves when extending your tennis racket in front of you. Can you hold the tennis racket in the extended position for one minute or more without fatigue or pain? Also, how do your wrists respond to holding five, eight or ten-pound hand weights? What is your hand weight threshold before your wrist gives way to extension? Also, how do your wrists react when performing everyday tasks such as lifting grocery bags or boxes? If you observe a weakness with any one of the three tests, then strengthening the forearm flexors and/or extensors is probably indicated. It is not unusual to see people who acquire an acute bout of elbow pain from moving furniture. They will always report that their wrists were bent backward before experiencing the sharp pain leading to the tennis elbow. Although tennis elbow is thought to be caused by the repetitive overload of the tennis racket, it is also seen in people who use tools or have to lift heavy objects for a living.
My Recommended Cure For Tennis Elbow.
- Assuming that you are suffering from chronic pain, the first course of action is to control the inflammation and pain with Non-steroidal anti-inflammatories such as Aleve. These NSAIDs are usually fast acting and work at quieting down ligament and soft tissue pain very well. Five-minute ice pack applications should also be implemented to accelerate the healing process. It is absolutely necessary to reduce the inflammation to prevent the formation of calcification in the joint and bone spur formation. If you get a bone spur this can exacerbate your elbow condition often requiring surgical intervention as the only cure for tennis elbow.
- Purchase a wrist extension splint for the most effective pain management. Research has shown that wrist splints are superior to forearm bands in the management of tennis elbow or lateral epicondylitis. But other researchers have shown that elbow splints are only marginally better in improving direct tennis elbow comfort. So as a supplement, I would also advise using a good quality elbow splint to provide added comfort to the elbow. Both are quite affordable and are well worth the investment. But remember both of these will only provide a temporary passive cure for tennis elbow, and it is vital that you investigate the underlying causes that created your painful elbow, to begin with. It has been shown that both elbow and wrist splits can cause muscle atrophy and a decrease in the neural drive which both contribute to forearm weakness. Therefore, making immediate corrections to other body dysfunctions that could be contributing to the elbow pain is very important, so you do not become dependant on these splints.
- Look at shoulder positioning which contributes to elbow dysfunction. Have a friend, family member or professional analyze your faulty postural biomechanics. Specifically, have them evaluate your upright posture. Are you slumped over with an arched back and is your head is positioned over your shoulders, or is it craned forward? As mentioned, craning of the neck also known as a forward head carriage causes a host of joint issues to include rounding of the shoulder and internal rotation of the forearms and wrists. This faulty posture always leads to faulty arthrokinematics, which leads to unnatural, painful restricted movement patterns of the shoulders socket, elbows joints, and sides of the wrists. In advanced cases, upper body dysfunction often leads to a reciprocal lower body dysfunction, which means hip and lower back pain noted when bending, twisting, throwing, pulling or lunging. If you are a golfer or tennis athlete these movement deficiencies can sideline you. Professional PGA golfer Tiger Woods is a good example of an athlete who struggled with an upper-body dysfunction which eventually morphed into a lower body dysfunction. He spent five years having multiple surgeries for chronic lower back pain. His medical history revealed multiple upper body dysfunctions at the neck, shoulder, elbow, and wrist. These dysfunctions led to multiple disc ruptures, a spondylolisthesis, and torn anterior cruciate ligaments in his knees. His game suffered for 6 years, and not until numerous surgeries later was he able to return to playing competitive golf. To date, his performance has not been at the same level as it was prior to his dysfunctions. The great news about Tiger Woods is that both his health and game are improving. He won his 80th PGA Tour in Atlanta this past September, in a thrilling victory, beating Billy Horschel by two strokes. Forty-two-year-old Tiger Woods finished out the 2018 Fed-Ex Cup Tour in 2nd place overall behind Justin Rose.
- Get to work with an expert in corrective exercise or medical exercise and fix your postural deficiencies. A corrective or medical exercise specialist will fix your postural deficiencies and later prescribe you the proper sports conditioning program that is compatible with the bio-motor requirements of your particular sport. Medical and Corrective exercise specialists are experts at curing back pain and dysfunction. They are also highly skilled at post-operative rehab. Simply going to a gym and performing random strength training movements, not in line with correcting your orthopedic issue, will only magnify your dysfunctions and pain. A good corrective exercise specialist is medically trained to handle both upper and lower body dysfunction and is specially trained to help people function normally again. If you spend adequate time fixing your biomechanical deficiencies, you can look forward to living a healthier pain-free lifestyle. Not only will you retard aging to your body, but you will improve your motor skills, and hence your sport.
- Develop your intrinsic core to its peak potential. This doesn’t mean excessive sit-ups, crunches or planks. These improper abdominal training exercises are sagittal plane movements and often lead to abnormal forward head posture, rounding of the shoulder, depressed ribs, elbow pain, wrist pain, and a host of many other arthrokinematic problems outside the scope of this post. Again, it is important to look to the opposite side of the dysfunction and fix this weakness. A well balanced intrinsic core conditioning program will protect and negate a poorly functioning spine. When a well-designed core conditioning program is performed, good results are always felt and seen.
- Your range of motion is also very important. Both tennis and golf require a good degree of body mechanics and therefore spine rotation. if you’re carrying a protruded belly also known as a Milwaukee tumor, this alone will dramatically affect all ranges of motion of the spine. Squatting, lunging, twisting, bending and pushing with abnormal compensation now becomes the norm. If you can’t perform these simple primal patterns then you can expect an array of orthopedic joint problems to include a painful tennis elbow and wrist. This cure for tennis elbow requires an in-depth analysis of your primal pattern movements and a specific exercise program to fix the deficiencies. There are several sport-specific exercise modalities that can be implemented into your corrective exercise that will greatly enhance your rotational range of motion and free up your immobile joints. My favorite is the Stick Mobility system which I have used for both sports conditioning and spine rehabilitation. Many of my clients swear by them and love how they feel after training with them!
The Cure For Tennis Elbow Is Achievable If You Develop A Sound Self Management Strategy.
Physicians are limited to the amount of time and investigation they can put into solving your particular health problems. Often they have templated prescriptions for each category of health ailment, but as we all know one shoe doesn’t fit all! That’s why there are so many subspecialists in the medical profession. If you are like most Americans and have to be referred from a primary care physician to a specialist and then to a physical therapy clinic, it can take weeks to months of waiting for your appointments. And unfortunately, your elbow and wrist pain does require immediate attention as well as your anxious desire to feel normal and functional again. So you are probably wondering what should I do? Well, I believe following the holistic approach to health care management is the most efficient route. These holistic solutions are outlined in the preceding sections of this post. As a former health care provider with almost 20 years under my belt working in clinical and surgical medicine, I can resoundingly say less is always better. In the case of the treatment cure for tennis elbow, a corrective approach requires a bit of contentious work on your behalf, but the fruits of your labor will come back to you threefold. Your other option is arthroscopic or open surgery to the elbow which carries the risk of infection and damage to nerves and blood vessels. And not to mention many patients experience a loss of strength after the procedure. The choice is purely yours and is contingent on your activity level and degree of pain. I have spent the last eighteen years of my life working with special populations as a Medical Exercise Specialist, Corrective Exercise Specialist, and CHEK Practitioner. I have helped hundreds of clients who suffered from both golf and tennis elbow pain recover and return to their activities of daily living. What I have learned over the years through trial and error is immediate intervention is crucial to overall amelioration of musculoskeletal pain and rehabilitation success. Haste does make waste in this situation. Often clients would first seek out help from their physician before I was able to step in. I had the opportunity to observe the same treatment modalities over and over again. The usual treatments included ultrasound, shockwave therapy, and consecutive steroid injections. Unfortunately, their symptoms would return and additional steroid injections were required. Once their physicians maxed out on the third and final round of steroid injections, the pain and swelling immediately returned, leaving my clients back to where they originally started, frustrated and in agonizing pain. With no other options available I was given the nod by the attending physician to begin post-rehab therapy. Within a week, clients experienced a fifty percent improvement in symptoms, and within a one-month time frame, the majority of their elbow pain was gone with only some residual elbow stiffness remaining. These enlightening moments always leave me reflecting upon what Carl Jung a famed Swedish Psychologist discovered about human intellect.” We should not pretend to understand the world only by the intellect; we apprehend it as much by feeling. Therefore, the judgment of the intellect is at best, only half the truth, and must if it is, to be honest, also come to an understanding of its inadequacy”.
About the Author.
Rivak Hoffman, President of Every Bit Fit Arizona is devout health, wellness and exercise professional practicing his art in beautiful Scottsdale Arizona. He is a licensed Scottsdale Arizona CHEK Exercise Coach & Practitioner, a CHEK Holistic Lifestyle Coach, a Scottsdale Arizona Corrective Exercise Specialist, a Scottsdale Arizona Precision Nutrition Coach and a Nationally Academy of Sports Medicine / Scottsdale Arizona Certified Personal Trainer. His passion and niche’ in the health and fitness industry is troubleshooting cervical, thoracic and lumbar spine dysfunctions, complete orthopedic rehabilitation and medical exercise training for the special populations. He has successfully healed hundreds of distressed and now happy clients who have been plagued with spine and other orthopedic issues over the past eighteen years. Should you require a comprehensive, productive exercise therapy program to address your medical issues, then contact Rivak for a complimentary consultation at EveryBitFitAZ.