You have severe pain on the thumb side of your elbow that throbs and aches. It hurts worse when you make a fist or extend your elbow. Congratulations, you have been lucky enough to develop tennis elbow. You say, "But I don't play tennis!" Neither do I. However, I've battled with tennis elbow numerous times in the past. For me, it started after doing a chiropractic adjustment on a patient's knee. It was a big knee, and I had strained my shoulder and bicep. After about a month of dealing with that strain, my elbow started hurting. Most people think that tennis elbow is indeed an elbow problem. They want to throw on elbow braces and use those straps that go around the forearm. While the pain is definitely at the outer elbow location, to say that lateral epicondylitis is an elbow problem is not really accurate. In my case, the general inflammation related to the bicep strain didn't help, but the real problem that led to tennis elbow was primarily a compensation happening my wrist. "Wrist?" you say. Yep. Wrist. We'll get to that in a moment. Although I don't want to bore you, for me to get to the point, we need to review the anatomy.
The pain from tennis elbow comes from chronic inflammation at the lateral epicondyle, the bony outer part of your upper arm bone called the humerus. The lateral epicondyle is the origin point for a few muscles. The supinator, extensor carpi ulnaris, extensor digiti minimi, extensor digitorum, anconeus, and the extensor carpi radialis brevis muscle (ECRB) all attach there. Additionally, the extensor carpi radials longus and the brachialis attach at the supracondylar ridge right above the lateral epicondyle. These muscles primarily extend the wrist, hand and fingers. Finally, the lateral collateral ligament complex attaches here as well. On a good note, the ligament is pretty solid, and usually isn't involved unless there is significant injury. However, all of the other muscles mentioned typically get overused in many people’s daily activity and beat up this area, frequently on the dominant arm. The key thing to understand is that since the majority of those muscles (with the exception of the anconeus) are responsible for actions of the wrist, hand and fingers, and not really involved in elbow motion. This knowledge will change your personal treatment of this condition and any type of rehabilitative approach.
So why did my bicep and shoulder injury cause this tennis elbow? I have to work on patients every day. I am an old school style chiropractor, and I use my hands extensively. Speed and direction are very important in doing a chiropractic adjustment correctly, and because I had to guard my shoulder and bicep, my wrist motion ended up picking up the slack for their weakness. After about a month of that happening six days a week on up to seventy patients per day coupled with five days per week of weight training, it was just too much, and the overuse inflammation set in. Why is this called "tennis elbow"? In tennis, the backhand shot requires wrist extension as well as elbow extension. Additionally, because of the speed of this stroke, the origin of all the above-mentioned muscles takes frequent micro-trauma. That's pretty much it.
Now that all of that is explained, we can outline some strategies to minimize this condition and allow you to get back to near normal function. Assuming that you are probably a busy person, I'm going to try to give the remedies that work the fastest with the least amount of "doctor office" times.
- Wrist Support: Forget elbow wraps or those tendon stabilizers. They really don't work well. To limit stress on the tendons, limit the motion at the wrist. Whether you are in the gym, at your job or on the tennis court, get an easy to apply wrist wrap that holds you in a neutral position during activity. Don't wrap too tight, as you still need circulation to your fingers!
- Ice: Apply ice for 20 minutes every night before bed. You can also use an ice-cup to apply direct ice in a circular motion for 5 minutes as a time saving alternative.
- Topical Anti-Inflammatory: Apply a topical anti-inflammatory like KinetiCream after your ice treatment before bed. Additionally, put this on immediately following your morning shower.
- Flex-bar rehab: After about a week of the wraps, ice and cream, Theraband makes these cool bars that have their own well-researched protocol for tennis elbow. They work very well. You can check out the exercise protocol here. Most chiropractic offices can get these flex-bars for you, or I'm sure you can find them online. Start with the lightest weight one, regardless of how strong you think you are.
- Chiropractic Care: If you can find a good chiropractor that works with extremities, adjustments of the elbow and wrist will help. Additionally, if the chiropractor does any soft tissue mobilization like Graston® or Active Release Technique®, they is also very efficient at improving mobility of the extensors, reducing stress at the muscle attachment site. Also, most sports chiropractors can use some type of kinesiotape (I prefer RockTape) in such a way to minimize the amount of muscle action needed to extend the involved muscles.
- Last resorts: PRP or other regenerative injections/Cortisone injections/Surgery. If you're diligent with the above five strategies, these last resorts will not be in your future. Obviously, I would prefer not to recommend anything invasive. I am not a surgeon or a pain management doc, and you can't do it on your own, so I'm not even going to bother discussing this in this article. The key is to not let it get that bad.
The strategies will not likely be 100% relieving right off the bat, and you will still be a bit more prone to flare ups even if you do get complete relief. Even knowing exactly what to do, I get a little lazy with the rehab and I will have a flare up about once per year. I figure that with my chiropractic job and lifting habits, I'm pretty pleased with a once per year flare up.
If you have been struggling with lateral epicondylitis, you don't have to sit back and give up the activities you enjoy. Get some wrist wraps, get some KinetiCream, learn to love ice, do the exercises with the flex bar and you will get there. Be patient and don't give up on it. It may take up to a month, although most folks will see up to 80% relief in about two weeks. Good luck with it, and if we at Phoenix Bioperformance can ever be of any assistance, don't hesitate to contact us. As always, our goal is to help the world move better!
Until next time, keep moving!
- Craig Banks, DC, CCSP®
Founder, Phoenix Bioperformance