Tennis Elbow is a common illness that can affect any of us at some point in our lives. Medically, it is called lateral humeral epicondylitis which, for those unfamiliar with such jargon, is no blind help. Even the most recognized term, Tennis Elbow means very little.
You do not need to play tennis to experience this problem, although many players in this popular sport have been handicapped by it. Before there were power tools, some jobs, for example screwing could cause this problem. When using a screwdriver or tennis racquet, the very act of gripping and forcefully twisting for hours on end amounts to what is commonly referred to as repetitive fatigue injury (RSI).
Having established why this can happen, the $ 64 million question is what can be done to alleviate it and ultimately cure it? In order to provide effective non-surgical treatment, it is important to understand which physical structures have been injured and to know precisely where they are.
For most people, the medical term for lateral humeral epicondylitis is double Dutch, but it defines the location. The elbow is the visible joint between the lower and upper parts of the arm. The long bone between the shoulder and the elbow is called the humerus and on this bone there are various bumps and bumps that have names. At the lower end of the humerus, there are two prominent bumps which are called Condyle; therefore an epicondyle is a round point on the condyle (epi- means on). To further define the origin, the word lateral is used, which simply means on the side of the bone away from the middle of it.
So now we know the site of the injury, but the epicondyle has been added to it, which means inflammation, so words like tendonitis and neuritis mean these parts of your body are inflamed. Therefore, lateral humeral epicondylitis is nothing more than inflammation of the bony prominence on the side at the lower end of the long arm bone.
This is not quite the whole story because if it is just a little bit of the inflamed arm bone, what about the pain and sometimes quite debilitating that we feel in it? ‘forearm itself, especially the muscles involved in gripping and twisting.
Having had the opportunity to treat several top professional tennis players, it is impossible not to notice how incredibly developed the muscles of the forearm are compared to the opposite unused arm. It reminds me of the cartoon character Popeye whose forearm muscles would become massive after swallowing a can of spinach. In some cases, the muscles can easily be twice as large.
Basically, it is the clue to the cause of the inflammation. It has to do with the fact that there are five muscles that have a common tendon that anchors them to the lateral epicondyle. I often like to think of the idea of five type ropes that secure a structure, in this case the forearm, all attached to the ground with a single pin. Normally, this tendon that all muscles have at each end, is usually quite happy. However, as you can imagine if you continuously use the forearm day in and day out, like tennis players do, it leads to thickening and tightening of these five muscles.
Eventually, what can happen is that the strain on the tendon’s actual attachment point to the epicondyle bone becomes more irritable and vulnerable, especially if the forces involved are sudden and violent. This leads to tension and attachment point injury which in turn leads to loss of support from the associated muscles involved in supporting these gripping and twisting actions.
One obvious way to help this injury is to simply rest it. In mild cases, the patient is often willing to wait until there is some form of spontaneous recovery, but many people do not accept this, especially if the symptoms last for two years or more! For the best professional tennis players, pain and loss of function is totally unacceptable.
The one and only time I personally got to know Tennis Elbow was as a college student, when a guy from the year above challenged me to an arm wrestling match. Although my arm is longer than his, he beat me quite convincingly, not so much to do with strength but because of his shorter lever. It was in the last bout of three that I felt something snap in my forearm and immediately knew from the loss of grip that I had started Tennis elbow. My winner happily told me not to worry and that he would get it fixed for me within a week. So said, so done.
This is the treatment I have used on all Tennis elbow since I qualified. What is needed is a very deep penetrating soft tissue massage over the muscles of the forearm, which in the vast majority of cases are very tight and often quite lumpy and lumpy. In truth, I would be lying to you all if I didn’t say it can be excruciatingly painful. Many adult men have succumbed to tears and asked if this therapeutic approach was necessary.
In my experience, this condition can be slow to respond. In order to speed up and facilitate the body’s natural healing abilities, it is important to work on strained tissue specifically to break down adhesions and nodules that can build up as a result of injury. In doing so, the act of massage drains the tissues by removing the products of cell degradation, improving blood flow which provides all the nutrients necessary for healing.
After the treatment, the muscles may be sore, so I encourage the patient to apply ice packs for 10-15 minutes at a time which reduces inflammation and stimulates blood circulation again. Of course, the actions that caused the condition in the first place should be changed or stopped altogether until the normal status quo has returned.
Using a strap around the forearm placed just below the elbow can be helpful in supporting actions we take so much for granted, which can help reduce strain on affected muscles.
So far I have focused on the non-surgical intervention. In short, there is the use of hydro-cortisone injections to reverse the local inflammation. It must be delivered precisely to the sore spot. It is not easy to do and may require several injections before resolution. I know many people have little appetite for these injections. At the end of the day, there is an operation that can be performed. I am not an orthopedic surgeon so I will not venture down this path.
Finally, prevention is much easier than cure. Just be careful when engaging this part of your body in an energetic and stressful way, especially when gripping and twisting hard. Muscles are not machines and are not able to perform indefinitely and tirelessly, even though they are well conditioned as with athletes, who are equally susceptible to injury.