Tennis Elbow - Iron Health Physical Therapy & Cryotherapy
Joseph Rendina

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Tennis Elbow

Do you feel a sharp painful flare up on the outer side of your elbow? At first, you thought that its regular pain and would go away on its own, but it has worsened over time. Whether playing evening tennis or badminton game with your friends and family, doing yard work or driving, you are constantly in pain.

If those are your symptoms, you could be suffering from Tennis Elbow, also known as Lateral Epicondylitis.

Never fear! Tennis elbow responds very well to exercises. Like with any injury or exercise, it is essential to consult your physician and physical therapist. Rehab in the clinic is always personalized to the patient’s symptoms, limitations and goals.

What is a tennis Elbow?

Tennis elbow is an excruciatingly painful condition that affects the outside of the elbow when the tendons that extend the wrist become aggravated. This often occurs after an excessive load is placed on the tendons or simply when you go too hard too soon.

Usually, I’m questioning why so much load is going through those muscles-too much too soon? A lot of repetition with gripping or twisting? Or new activities? 

 Did you know that you can develop a tennis elbow even if you’re not a tennis player? Here are some professions in which tennis elbow is common

  • Dentists
  • Carpenters 
  • Painters
  • Gardeners 
  • Computer typing
  • Driving for long hours
  • Chefs
  • Electrician
  • Plumbers
  • mechanics
  • Overhead athletes

Regardless of the name, you will also commonly see this chronic condition in other sports which include field throwing, such as;

  • Squash
  • Badminton 
  • Baseball
  • Swimming
  • Cricket

It has been seen that novice athlete players and those who want to build up some bulk and do loads of gym exercises suffer from tennis elbow. Improper instrument handling and improper technique: It is easy to slack with when we’re tired but don’t overuse your muscles. Poor form leads to additional injuries.

The problem usually occurs with the supination and extension at the wrist coupled with shoulder movement discrepancy. 

Stages of tennis elbow

Typically, there are four stages in the development of this injury concerning the intensity of the symptoms.

  • Faint pain a couple of hours after provoking activity

  • Pain at the end of or immediately after activity

  • Pain during the provoking movement, which intensifies after ceasing that activity

  • Constant pain, which prohibits any action.

Ways to prevent

As the famous proverb says, “Prevention is better than cure” If you are new to any new activity, you either started a new hobby or got a new job that involves a lot of desk work. Then improve the functionality of muscle by doing small stretches in the morning.

  • Build tolerance by gradually exposing and progressing load on the affected area.

  • Increase your forearm strength. This will keep both your elbow and wrist healthy.

  • Break up the repetitive task when possible, so you are not fatiguing your forearm all in one sitting

  • Warm-up and stretch before working out and going to work. 

  • Incorporate mobility routine first thing in the morning.

  • Always consult a Physical therapist for ideal rehab exercises.

  • Avoid painful movements; try to incorporate pain-free movements.

  • Use night splints if you feel pain

  • Use ice to reduce inflammation

What could be the possible causes of Tennis elbow?

The cause is a continual contraction of the forearm muscles that you use to straighten and raise your arms. The persistent motion and stress to the tissue cause tiny tears in the tendons of the forearm muscles that attach to the bony prominence at the outside of your elbow.

Tennis elbow is an overuse injury. The pain usually increases when the person tries to hold and grip, with the usage of wrist and hand during the household, occupational, and recreational activities. Tennis elbow can also occur after knocking your elbow on any hard surface.

Movements involving mundane tasks like picking objects, turning doorknobs, driving, yard work, lifting, playing games or doing other forearm dominant movements. The pain shoots up from the lateral side of your arm. Sometimes it gets worse at night.

Think about the reason you might have tennis elbow. A novice is new to the sport. They are swinging more than usual and are not used to high repetitions. Whenever you do something new, a new exercise, a new sport or a new job, you are susceptible to musculoskeletal injuries. 

How can I treat my tennis elbow?

Exercise therapy helps to reduce pain and improve the functional deficits associated with tennis elbows, such as weakness in the supinator and wrist extensors. Strengthening the muscles of the shoulder, wrist, and forearm provides superior benefits than solely focusing on the local area.

Rest and ice may help initially, but exercises to gradually strengthen your muscles are required for long term relief.

Exercises

Note that tendons take more time to heal compared to muscular injuries and thus need specific progressive loading. Rehab aims to trigger the tendon to stimulate healing and recovery, where the key is rehabbing at the right intensity- too hard will worsen the injury, too little will be ineffective. 

A physical therapist can effectively teach you exercises to gradually stretch and strengthen muscles. Here are a few simple exercises you can use to start towards initial strengthening and progressive loading the joint.

  • Use the hardball to self-massage and release the tight forearm muscles. Anywhere between 1-2 minutes 2-3x per day.

  • Radial Nerve stretch

  • Wrist extensor eccentric strengthening

  • Eccentric supination and pronation

  • Side-lying external rotation

  • Prone T

  • External rotation wall walks

  • Elastic finger opener with wrist circles 

  • Forearm trigger with wrist extension against the band

  • Wrist supination and pronation against bands

You can also look into investing in a counterforce brace; it can help reduce short-term pain management load. Don’t rely on it. And this should never substitute instead exercise. It is recommended to use it while performing the activity that provokes the pain. 

Stretching, massage and bracing, or even cortisone injection can help, but they only provide short term relief. If you want lasting relief, you have to strengthen your elbow joint.

Joseph Rendina PT, DPT, OCS

Joseph Rendina PT, DPT, OCS

Doctor of Physical Therapy, Board-Certified Orthopedic Specialist
Joseph received his Doctorate in Physical Therapy from New York Medical College and is also recognized as a Board-Certified Orthopedic Specialist. As a former competitive athlete and weightlifter, Joseph understands the specific needs and demands of the human body. Joseph’s goal is to maintain an active approach to rehab while facilitating recovery.
Joseph Rendina PT, DPT, OCS

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