Blog

Elbow Pain: Pt. 1 – “Tennis Elbow”

Although one of the most stable joints of the body, the elbow is frequently a site of reported pain.  Pain here can be caused from a variety of factors such as strain, sprain, tendinopathy, synovitis, bursitis, dislocation, rupture and more!  Adding to the complexity is the fact that pain may be multi-factorial – not a single cause.  This article is by no means intended for use in self-diagnosing.  It is intended to help those already diagnosed with two of the most common types of elbow pain (lateral (outside) and medial (inside) elbow epicondylalgia) to understand the pathophysiology involved and provide guidance on home therapy you can do to help care for the affected area and relieve the pain.

Lateral Epicondylalgia – aka “Tennis Elbow”

Pain from the this area is felt on the outside of the elbow (see figure 1).  The outside aspect of the elbow is where many of the wrist extensor muscles originate so pain often increases when the wrist is actively extended back, the hand grips an object and when the area is touched or pressed on.

lateral epicondylalgia
Fig. 1 Location of pain, lateral epicondylalgia

“Tennis Elbow” is typically an overuse injury to the musculotendinous tissue, therefore, rest and ice are highly recommended in the initial stage (first 24-48 hours).  It often affects athletes, active individuals, those with repetitive tasks occupations; especially those aged 40-55.

Elbow pain is especially frustrating because we use are arms and hands so frequently –  bathing, dressing, eating, grooming, driving, typing, talking on the phone, texting , etc. Even for the athlete who has diligently stayed away from the gym to provide rest to the affected area, it quickly becomes evident that this area is used and stressed under circumstances other than weightlifting.  For those who have trouble resting the affected extremity, fascia tape can provide a visual reminder to the individual to take things easy  in addition to reducing inflammation and potentially providing pain relief.

As time progresses, the individual should continue to “rest” the arm, use ice or heat as desired and gradually perform selected exercises and stretches^1.  Here is my general progression suggestion:

Stage I – Goal of 10 times each; fewer reps, or continue complete rest if pain is too intense.

  1. Clench fist, hold 1-3 seconds; release grip.
  2. Wrist extension. (Concentric contraction of affected muscles.)
  3. Wrist flexion. (Stretch; eccentric contraction when resisted.)
  4. Wrist rotation. (Flip hand over and back.)
  5. End with 30 sec stretch in extension; then 30 sec stretch in flexion. (Use other hand to stretch affected hand. Be sure to affected hand is relaxed as it is stretched and muscles are not contracting.)

Stage II – Goal of 10 times each; stay with previous stage if pain is too intense.

  1. Repeat above exercises but modify using specialized therapy band (or other hand if no therapy band available) providing appropriate resistance for #2-4.
  2.  Hold arms out in front of you and press hands into wall. Hold for 30 seconds.

Stage III – Repeat any of the above as you prefer, adding more reps and/or resistance.  Supplement with some or all of the following:

  1. Ball squeezes.  Begin with soft, progress in firmness.
  2. Scatter small objects on a table (such as buttons). Places objects in a cup or a bowl.
  3. Use a small- or medium-sized towel and twist it.
  4. Rest forearm on table.  Rotate palm face up and face down.

Of course, the biggest rule, just like in yoga, is to always listen to your body.  While these therapeutic movements may not always be comfortable, they should not be continued if pain increases severely, pain begins radiating to other areas, type of pain changes, numbness or tingling is experienced.

Be patient. Lateral epicondylalgia can take weeks to relieve.  Rest is key.  Be aware of things you do that increase pain.  Be aware of things that reduce pain.  Eat well.  Sleep well.  Visualize healing.  Don’t be scared of movement!  Movement increases blood flow and healing chemicals to the affected area.  It will also help to keep the muscles functional and strong as symptoms improve.

Again, these are intended to help those already diagnosed with lateral epicondylalgia.

If pain continues or worsens, contact your physician.  There are other therapies that can be performed by a physical or occupational therapist.

Part II will address inside elbow pain, aka “Golfer’s Elbow.”  Stay tuned!

Elizabeth Ybarra, SPDT

References:

  1. Pienimäki, T. T., Tarvainen, T. K., Siira, P. T., Vanharanta, H. (1996). Progressive Strengthening and Stretching Exercises and Ultrasound for Chronic Lateral Epicondylitis. Physiotherapy, Volume 82 (Issue 9), pp. 522-530