Nancy Whelan, PT
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Do you have tennis elbow and don't play tennis?
Elbow pain keeping you from participating in your everyday routine or even leisure activities? Research has shown that over 3% of the general population suffers from some type of elbow pain. The most common elbow pathology is tennis elbow or lateral epicondylitis, which is an inflammation of the extensor tendons of the wrist and fingers. Tennis elbow is considered to be an over use syndrome that causes pain on the lateral (outside) part of the elbow.
More often than not, patients suffering from this syndrome are not tennis players, but are over using their arm with some kind of continuous activity. Due to the fact that this is an over use syndrome, rest is needed to allow the tendons and joint to calm down. Unfortunately, resting the joint means the muscles are not being used which can cause weakness in the surrounding muscles.
Research has shown that it is important to balance the amount of rest and exercise of the tendons and joints to avoid weakening of the muscles or acute "flare-ups" of pain. Isometric exercises are the safest way to strengthen the muscles surrounding the effected joint because with this type of muscle contraction the joint is not moving. An example of an isometric exercise would be pushing, with light pressure, into a ball in different positions. Again, this exercise will allow the muscle to contract, without moving the joint, which should be pain free.
Research has also shown that working the muscles and tendons "eccentrically" will increase the strength of the muscles and reduce pain. Eccentric exercises strengthen the muscle as it is lengthening, rather than a concentric contraction that strengthens the muscle as it is shortening.
Eccentric exercises are more difficult and require great control because the exercise is performed slowly, to achieve the greatest effect. Eccentric exercises include twisting a rubber bar or even a wet towel, but focusing on a slow controlled release of the twisting position.
Stretching is also needed to manage tennis elbow pain. The extensor tendons on the top of the forearm are what become tight and sometimes tender. If these tendons are stretched gently it will reduce the pulling on the joint and reduce pain.
Other ways to manage tennis elbow are with ice or heat, which ever works better for you. A device called a counterforce brace (sold at drug stores) can also be worn during activities that include repetitive twisting or grasping. The brace is worn a few inches below the elbow joint directly on the extensors tendons of the wrist and hand. This will reduce the load on the tendon itself and spread the load throughout the arm. Ultrasound guided injections into the tendons is a more invasive treatment, but is said to reduce pain significantly when partnered with eccentric exercise, mentioned previously.
Again, tennis elbow is considered to be an over use syndrome, so rest is needed to be able to begin a strengthening program. Often doctors will have a patient go to physical therapy to be shown how to manage this syndrome with a proper balance of rest, exercise and stretching activities. If you are a person with elbow pain, do not push through your pain! Speak to your doctor to receive some helpful techniques to reduce you your pain and get back to your normal routine.
Contributed by Krista Magnoli, PTA. BS who works at The West Palm Beach Physical Therapy Center, http://www.wpbphysicaltherapycenter.com/