The most common type of elbow pain that we treat in our clinic is either lateral epicondylitis or tennis elbow and medial epicondylitis or golfers elbow. You can search online for a detailed description of the anatomy of these conditions. To summarize, both of these conditions are activity induced. In other words, it is typically overuse that causes micro-trauma and a subsequent inflammatory reaction at the tendinous attachment of the wrist muscles to your elbow. Lateral epicondylitis or tennis elbow is pain on the outside of your elbow. It occurs at the attachment of the wrist extensor muscles that are on the back side of your forearm. Think about the action of your wrist as you perform a forehand swing of a tennis racket. Medial epicondylitis or golfers elbow is pain on the inside of your elbow. It occurs at the attachment of the wrist flexor muscles that are on the front side of your forearm. Think about the action of your wrist as you initiate the downswing with a golf club as well as the rotational action of your forearm as you follow through with your swing. Now, multiply that by 100 times or greater while you play a tennis match or attempt to outdrive your buddies on the golf course. This overuse syndrome starts as micro-trauma to the tendinous insertion accompanied by inflammation and pain. If left untreated, the condition persists due to chronic scar tissue and muscle knots that can inhibit the proper function of the tissues.
Principles of Treatment:
- Activity Modification: refer to P.R.I.C.E link
- Specialized Manual Therapy Techniques: Both lateral epicondylitis and medial epicondylitis present with pain to palpation at the insertion of the tendon at the medial or lateral epicondyle of the humerus. There is pain and significant soft tissue knots in the muscles of the forearm. These knots are the result of micro-trauma during activity which results in scar tissue. Scar tissue is considered dysfunctional if it binds onto adjacent healthy tissue and prevents normal movement of that healthy tissue. Techniques such as ART and Graston Technique are used to release these adhesions. Please check out those links as well.
- Altered Biomechanical Forces: It is crucial to identify any abnormal forces that may be occurring while playing tennis, golf or simply performing household activities. Working with a swing coach to identify problems is an important first step. Simply changing your grip can have a substantial impact on the pain that you experience while playing tennis or golf. Avoiding pain is crucial as pushing into the pain only perpetuates the syndrome and will prevent proper healing. We may utilize taping techniques or advise you to use an elbow splint in order to stabilize the tendon during activity or during functional retraining exercises.
- Stretching: Stretching exercises are used to increase the length and elasticity of your tissues. We utilize passive and dynamic stretches as well as the neurological principles of reciprocal inhibition to hasten your recovery. We utilize self-mobilization techniques on styrofoam rolls or use “The (massage) Stick” as part of a home exercise program to break adhesions. Consistency with a program of self mobilization and stretching is crucial to reformat and rebuild scar tissue.
- Strenthening: We use graded and controlled resistance exercise to reconditon the tendon. We also use the principles of eccentric exercise training to recondition and stimulate healing. Eccentrics are contractions in which the muscle elongates against resistance ie slowly lowering your hand while holding a dumbbell. Scientific evidence supports the use of eccentrics. Please refer to The Missing Link link.
- Home Exercise Program: The rest is up to you! Compliance with your home exercise program is paramount to a speedy recovery.