What causes my tennis elbow pain?
Tennis elbow problems can be a frustrating issue to try and deal with. It can impede so much of your day to day activities due to the dull ache, or sharp pain that can be associated with any activities of gripping, lifting or even just working at the computer and we haven’t even mentioned the problems with tennis that the injury is named after.
The key to resolving a tennis elbow pain is to make sure you understand the mechanism of loading that is creating the problem, so you don’t just remove the pain but address the underlying factors that can cause a return of your elbow pain at a later date. If you are reading this and are currently experiencing elbow pain, there is a solution for you that will get you back to your activities and sports.
Our team have worked hard to put together a tendinopathy solution for clients suffering from issues like tennis elbow pain, review our treatment pathway for tendinopathies at www.bodylogichealth.co.uk/resolving-tendinopathies
Firstly, you need to confirm it is tennis elbow. The video attached will help with finding and identifying the right area, but if you place your arm by your side with your palm facing forwards it will be the bony point on the outside of your elbow that will be the centre of your pain – both the dull ache and the sharp pain on palpation or activity.
If this elbow pain is set off by activities like lifting a saucepan, carrying shopping bags, digging in the garden, even potentially just clenching your fist then the indication is that your problem is a tennis elbow. In fact to look at it from a medical perspective you have a common extensor tendinopathy, irritation of the elbow tendons through overloading, which we will investigate further.
Right so you have identified you have tennis elbow pain. What is the cause of the elbow tendinopathy? The main reason for tennis elbow pain is related to increased loading of the tendon, which runs from the lateral epicondyle, that bone point on the edge of your elbow where the pain is and runs down to attach our muscles that run down to your wrist to the bone.
If you sit at a desk and place your palms on the table, you are in pronation. In this position you are putting a small stretch on the tendon which can be the start of the problem. You are also tightening the flexors on the other side – in fact you should be able to rotate your hands over with no movement away form the body by the elbows and place the back of your hand flat on the table too, in full supination. If you find you are unable to get all the way over then these flexors are tight too. The loading of the tendon places stress on the bony attachment of the tendon but can also lead to a breakdown of the tendon matrix, which becomes your elbow tendinopathy. This is your local reason for your tennis elbow pain.
There are however other factors that can influence the pain, areas that you will need assessed by an expert, however if you are aware of these as it helps your management. The first area is the shoulder girdle, essentially your shoulder joint and shoulder blade. How your rotator cuff functions, how you move your shoulder the effects of habitual postures can all affect the integrity of your shoulder complex. Weaknesses in this region can place further stress into your elbow joint, which can load the tissues through extra work and lead to your tennis elbow pain.
The other key area is the neck region, which can affect both the nerves running down through your elbow to the hand, but also restrictions in movement and function here can again lead to your body compensating to manage your movement. The influence of these areas needs ot be assessed and addressed to help you achieve the best results.
Now onto the important part, dealing with your tennis elbow pain. The first thing I suggest is ice, especially in the acute or new phase of the issue. This is to help with the bone bruising being created by the loading of the tendon pulling on the lateral elbow region. Bone has plenty of nerve endings and if we can help desensitise these then the pain will improve as a result. You may find an ice massage more effected, just run a block of ice across the area from the bone down towards the hand, remembering that working for about five minutes is ideal before you give it a rest. If you are just placing the ice on the area, then use a damp cloth so the ice is not directly in contact with the skin during the treatment.
There are many different treatment options to address tennis elbow tendinopathies or elbow pain and the options are discussed in more detail on our dedicated tendinopathy page www.bodylogichealth.co.uk/resolving-tendinopathies , including a discussion on the wonderful effects of shockwave treatment to help settle your tennis elbow pain.
The next options are best explained in the video; however, the aims are to work on improving the range through the tighter flexors taking pressure of your tennis elbow tendinopathy. Here we look to complete this in four-point kneeling and working to find the point of the stretch with the fingers facing back towards your knees, hold for 20-30 seconds loading through the palms of the hands and repeat about 4-5 times for the best effect.
The best option next is to help release the muscles with rolling, which you can do with a tennis ball or massage ball, using a surface that has some grip work through the muscle belly and find the tender points to release. You don’t need to press to within an inch of your life, but enough pressure to work through the restrictions. I would work for no more than about one minute at a time on this each day to build the mobility in the forearm.
Finally, you ideally want to start strengthening the weak supinators, this will help balance the muscles around your elbow out so they work together more effectively. You will need some theraband for this or a form of resistance to work on the movement. Just make sure you keep your wrist from working it should be exclusively moving from pronation to supination, about two sets of sixty seconds would be ideal, twice a day. It is important before you start this step that you are able to grip without pain.
Along with this strengthening for your elbow pain you need to start to work the tendon region to help build the matrix complex again and resolve your tennis elbow tendinopathy long term. This is one of the key steps, but you must start it at the right time, essentially if it is just increasing your pain, you are not ready. Use a small weight, I think about 2kgs is a good place to start, use the edge of a table and let your hand rest. Use the opposite hand to bring your hand to neutral – you must be in extension of the wrist at this stage, again the video shows this well. The reason for holding still is that is builds the tissue capacity and tolerance without aggravating the tendinopathy at the same time, work for three sets of sixty seconds.
So, the good news is that there is a solution for your tennis elbow pain, that you can begin to settle the symptoms down and improve the mobility in the region. It is also hopefully clear that there are a number of factors that can cause tennis elbow tendinopathy and so getting to the source of the problem is key to the long-term solution, which will require a professional to assess and help you achieve the best results.
Finally elbow tendinopathies are complex and the management of these issues can take time but with the right team helping you and guiding your treatment you can achieve great results and get back to your activities and sports quickly and effectively. Don’t leave it to long hoping it settles, generally we find that the problem can return and is more complex to resolve as the underlying issues have not been addressed and continue to build in the background.
To find out more about the total solution Body Logic Health have put in place to address these types of tendinopathies review our dedicated tendinopathy page at www.bodylogichealth.co.uk/resolving-tendinopathies
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