Elbow Pain, Tennis Elbow, Golfers Elbow; Treatment and Prevention.

Since I’ve been back in Brisbane I’ve been surprised at how many cases of Tennis Elbow or Golfer’s Elbow (medically known as lateral and medial epicondylitis, respectively) have presented at the clinic.  In cooler climates it tends to show a seasonal variation, that is, when summer was approaching many people were returning to the golf course and tennis courts for the first time since the previous season and this sudden increase in activity created an overload on the de-conditioned muscles of the forearm and elbow.

This sudden return to reasonably high-impact activities is one of the main historical features of this condition’s presentation. Thankfully the Brisbane winters aren’t that harsh which affords us the opportunity to play these sports, and many others, all year round. However, those of you among us who have jumped in the deep-end after a long lay-off may find yourselves with a pain in the elbow- not just when playing these sports, but it can be felt anytime you grip, hold, twist or turn with the elbow or wrist.

Recently I have noticed a change in this historical trend, wherein a number of patients have presented with this condition with no history of playing sport! In these cases what it turned out to be was some other repetitive task that they often performed in their work environment such as: using a MOUSE! How crazy that such a simple and, one would naturally think, very easy task, would end up causing these people months of pain in the elbow. This underscores why it is so important to be ergonomically sound in your work environment.

The underlying cause of this “mouse” injury was to the small muscles of the forearm (the one’s that run from the elbow into the non-palm surface of your hand) whereby they were being repetitively contracted; clicking away many thousands of times throughout the day causing tissue damage and eventual scarring of the muscles near their origin at the elbow!

The frustrating thing about these conditions is that by simply ceasing your involvement with the thing that caused the problem in the first place- WILL NOT translate to immediate pain relief.  In fact, this is a very difficult condition to get under control, even with the appropriate treatment, and months of rehab are not uncommon.

Treatment and Prevention Strategies

If you are considering playing a sport that involves swinging a racquet or bat there are a few strategies that you can employ to decrease your risk of developing this problem.

A gradual increase in your activity level and a focus on proper technique can help prevent these injuries from occurring. Proper warm-up and stretching the forearm muscles also help with prevention and can be a good place to start treatment if you do begin to have pain. Rest, ice and an anti-inflammatory medication help reduce symptoms in the early stages of the injury but have limited effectiveness as the injury progresses.

It was previously thought that pain associated with chronic tendon pain such as tennis elbow, was due to inflammation. However, recent research has shown the tendon to have little, if any inflammation. Instead, repetitive stress on the tendon causes an over-development of scar tissue that effectively weakens the tendon. This is important when you consider the best treatment approach.

The most effective treatment will help stimulate the tendon to remodel itself and get stronger. A type of strengthening exercise called eccentric exercise has been shown to be effective at stimulating tendons to remodel and become stronger, leading to a reduction in pain.

Eccentric exercise involves slowly lowering a weight against resistance so the muscle is engaged while it is lengthening. Our therapists can show you how to perform these exercises.

My own personal approach that has produced some great results in addition to the above would include:

Deep Friction: a hands-on form of soft tissue release that is very effective for breaking up scar tissue that has resulted from chronic irritation of the tendon and can help stimulate remodeling.

Dry-Needling: of trigger points in the forearm and elbow.

Releasing restrictions: in the neck and shoulder to allow for full biomechanical ability of the entire neck, shoulder and arm complex.

In addition to the management strategies above I have found the application of Kinesio-Tape to be useful when playing sports.  This stuff became famous in 2008 when they gave a plane load of it out for free to the athletes at the Beijing Olympic Games.  Since then I’ve seen it applied to a multitude of muscle strains and tendon injuries. They say it works by acting as a second layer of muscle over the injured area. Whatever the exact underlying method by which it works, I’ve had good results with it and patient’s report that they do feel more supported when they use it while playing sports.

Enjoy the journey!

Anthony Collins