You have Tennis elbow…but you don’t play tennis!

You don’t have to play tennis like me to get tennis elbow!

Lateral epicondylitis is the ‘fancy’ medical term for what’s commonly known as Tennis elbow.  It was originally coined ‘tennis elbow’ because doctors were seeing the same type of elbow pain occurring with people who played alot of tennis.

But these days, just about ANYONE can get tennis elbow.  It’s more than just about playing tennis.  It’s about subjecting the forearm and elbow structures to REPETITIVE stresses over time.

So into my Richmond Hill clinic will walk in men and women, young and old, who have a shared symptom pattern:

  • sharp pain along the outside portion of the elbow (the bony part is called the lateral epicondyle…the inside portion is called the medial epicondyle)
  • pain with lifting objects, even light ones
  • pain turning door knobs or shaking hands
  • pain with grabbing things like grocery bags, plates from the cupboard, your dog’s leash, etc.
  • most don’t play tennis or any other racquet sport
  • many have sedentary lives and work in front of a computer all day
  • elbow stiffness in the morning

No single treatment has been shown to be totally effective and each individual’s situation is different.  However a combination of possible treatments are known to resolve tennis elbow over time.  Everyone will respond differently to different treatments.

So what can you do for yourself?

  • Apply ice to the elbow for 15 mins, 4-6 times a day.  This will help reduce pain and inflammation.
  • Rest you arm as much as possible which is an extremely important component in the healing of this injury.
  • Wear a specialized elbow braceto protect the tendon while it is healing and strengthening, particularly when returning to playing / equivalent. The brace is placed approximately 2″ down from the area of pain and relieves strain on the tendon when doing activities with your hand and arm.
  • Stretch out both sides of your forearm regularly.

What can a doctor or therapist do to help?

  • Determine if other issues are at work including a (radial) nerve entrapment at the elbow, nerve irritation/sensitivity in the neck, muscular imbalances or tension in the neck and shoulder region
  • Use manual therapies such as Active Release, Graston Technique or cross-friction massage over affected muscles and tendons
  • Apply electric stim, ultrasound or laser therapyto help reduce pain and inflammation as well as stimulate healing
  • Try acupuncture which has been shown to be extremely effective for tennis elbow.
  • Instruct you on appropriate exercises to assist with recovery and rehab
  • Provide advice on neural stretching exercises if nerve tissue involvement is suspected.
  • Examine ergonomic factors at home or work which need to be addressed in order to avoid recurrence.
  • Discuss other possible treatment options like steroid injections or extracorporeal shockwave therapy (ESWT).

A recent patient of mine is a 38 year old, male pipe fitter who was having pain in his elbow and shoulder because his work requires daily repetitive use of tools that involve gripping and turning.  After examining him, it was clear that he had dysfunctional muscles and soft tissue structures in the neck, shoulder and forearm that were resulting in the pain.

I ended up having to address his problems with a variety of tools.  Graston Technique is a soft tissue therapy that helps to break down scar tissue and adhesions in his neck, shoulder and forearms.  I also started initially with Bioflex laser therapy applied over both the shoulder and elbow/forearm.  Although he got some relief from a few sessions, I felt that the response wasn’t as much as I intended.  So I switched him over to electroacupuncture using a combination of classical Chinese acupuncture points as well as inserting needles into various trigger points in the affected areas.  Also, I used a “surround the dragon” technique where I encircled the lateral epicondyle with about 6 short needles to stimulate a greater immune system response where the tendon attaches to the bone.

This treatment combination worked very well and a few more sessions later, he was no longer feeling any pain with his work.  Unfortunately, there is little that can be done to change the nature of his work so he regularly returns every few weeks to have some acupuncture done to relieve the stress and strain on his shoulder and forearm muscles/tendons before any significant elbow or shoulder pain develops.

As I mentioned earlier, although each patient may present with a similar set of symptoms, not everyone will respond the same to therapy so it’s important to design a treatment plan that is custom made for the individual.

Dr. Keith

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