Tennis Elbow treatment North Vancouver: continue reading to learn more about the anatomy, causes and treatment options available at our North Vancouver chiropractor clinic Mountain Health & Performance.
What is Tennis Elbow?
Tennis elbow is also known as lateral epicondylitis or extensor tendinopathy. It is a common disorder that causes pain on the outside of the elbow. This pain usually occurs during lifting, gripping, playing tennis and other repetitive tasks that involve finger, wrist and elbow motion.
Anatomy:
The elbow joint is made up of three bones: the upper arm (humerus) and the two bones in your forearm (radius and ulna). The bony bumps at the bottom of the humerus are called epicondyles and the outside (lateral side) is called the lateral epicondyle.
Muscles, ligaments and tendons cross from the upper arm and forearm to insert onto the bones of the elbow. The muscles on the back of your forearm are called extensors because they extend the wrist and fingers.The extensor muscles turn into tendons, which attach to the lateral epicondyle of the humerus.
The muscle and tendon typically involved in tennis elbow is called the extensor carpi radialis brevis. This muscle produces the motion of wrist extension, which is required for gripping, lifting and performing a backhand in tennis. Other muscles that may be involved in tennis elbow may include: extensor carpi radialis longus, anconeus and extensor digitorum.
Overuse of the extensor tendons due to excessive movement of the elbow and wrist may lead to overloading of the tendon and injury. When the muscles and tendons are weakened from overuse, microscopic tears form in the tendon. This leads to inflammation and weakening of the tendon. After a period of time pain, weakness and dysfunction in the elbow will also occur.
The causes of tennis elbow are similar to those of other common tendon injuries such as achillies or patellar tendonitis. Tennis elbow and other tendon injuries usually start with a period of inflammation early on. Over time this inflammation may lead to changes in the structure of the tendon itself. This can include: tendon thickening, partial tears and swelling.
Tennis elbow can be mild to severe. The pain may only cause slight irritation but in some cases it can become debilitating. It can also become chronic lasting anywhere from several months to years.
Tennis Elbow Symptoms:
-
Gradual onset of pain.
-
Worse during periods of physical activity.
-
-
Pain and tenderness on the outside point of the elbow.
-
Decreased grip strength.
-
Pain with gripping.
-
Pain aggravated by: tennis, gripping, lifting, and other daily activities and sports that require wrist extension.
-
Pain may be described as:
-
Sharp or dull
-
Intermittent (comes and goes)
-
Localized at the outer elbow.
-
Pain that radiates into the forearm as well.
-
Risk Factors/Common Causes:
-
Repetitive manual tasks – i.e.: keyboarding
-
Lifting heavy loads.
-
Tennis and many other sports that require repeated wrist and elbow motion.
-
History of increased resistance activity or increased duration of activity.
-
Acute trauma to the elbow (falling on elbow).
Additional Causes of Elbow Pain:
At our North Vancouver chiropractor clinic Mountain Health & Performance our doctors will conduct a physical examination in order to rule out other potential causes of your elbow pain. In addition to tennis elbow the following diagnoses can cause symptoms that are similar to those of tennis elbow. These conditions need to be ruled out during the physical examination to ensure correct diagnosis and treatment.
1. Elbow Arthritis:
In addition to elbow pain patients may also experience elbow stiffness, impingement, locking and or clicking.
2. Radial Tunnel Syndrome:
Tennis elbow symptoms may also include, aching into the forearm, and or sharp shooting pain into the forearm that is worse at night from an overlapping radial nerve condition.
3. Posterior interosseous nerve entrapment:
In addition to elbow pain patients may experience, weakness in the fingers and thumb, and pain into the forearm and wrist.
4. Cervical Radiculopathy:
When the nerves in the neck are irritated or injured it can lead to symptoms into the shoulder, elbow, forearm, wrist and or hand. Symptoms typically are worsened by neck movements, and may involve: numbness, tingling, burning, weakness and pain into the upper extremities and neck. At our North Vancouver chiropractor clinic Mountain Health & Performance our doctors are experts in the treatment of cervical radiculopathy and other forms of neck pain. Check out our conditions page to learn more by clicking on the blue title above.
Do I need a Tennis Elbow Brace?
Tennis Elbow braces are believed to decrease forces at the elbow by absorbing some of the tensile forces that are generated by the wrist extensors at that location. This strap is worn near the insertion of the wrist extensors just below the elbow. Elbow splints and straps are often prescribed for the treatment of tennis elbow. These are intended to restrict forearm movement and relieve loads on the origin of the extensor muscles (near the elbow).
There are various types of braces and straps that may provide various benefits for the patient. Some studies have found that patients who wore a spiral splint that restricted wrist extension as well as supination and pronation (rotational movement at the wrist) had significantly reduced pain and improved function in grip strength after 4 weeks of use. Splints and straps may be helpful to reduce initial pain and disability but should not be used as a stand-alone treatment. Once the extensor tendon has undergone degenerative change, strengthening exercises and treatments are required to rebuild the tendon strength and improve overall function.
Tennis elbow treatment North Vancouver at Mountain Health & Performance may include a tennis elbow brace or strap prescription.
Tennis Elbow Treatment North Vancouver: How the Mountain Health and Performance chiropractor team can help!
Tennis elbow is a complex disorder. It is therefore unsurprising that numerous treatment options are described in the research to be both effective and ineffective. For this reason, a single treatment or one-size fits all approach to tennis elbow is not going to be effective for most people.
At our North Vancouver chiropractor clinic Mountain Health & Performance our doctors tailor their treatments to the individual patient, pathology and presentation. For this reason it’s critical to have a proper assessment and diagnosis before starting a self-treatment or rehabilitation plan.
1. Active Release Technique (ART) and Functional Range Release (FR):
These myofascial release techniques address any abnormal soft-tissue tension associated with tennis elbow. Tension in the muscles of the forearm, arm and shoulder may lead to improper biomechanics and increased stress at the elbow. This increased stress can contribute the overloading of elbow tendons.
Myofascial release helps to decrease the abnormal tension in the muscles and fascia and improve overall. Small studies have found ART to have additional treatment effects compared with ultrasound, muscle stretching and strengthening exercises for tennis elbow in the short term.
2. Manipulation/Mobilization:
There is evidence that manual therapy techniques have immediate effects on pain and grip strength in patients with tennis elbow. Mobilization and or manipulation may be targeted at affected joints including the neck, shoulder, elbow and wrist, depending on the function of these joints after an exam. Manipulation of the elbow has been shown to provide pain relief within the first few treatments, up until an 8-week follow up of patients with tennis elbow.
3. Class IV Laser Therapy:
At Mountain Health and Performance our chiropractors offer class IV laser therapy. Laser helps to stimulate deep tissue healing on a cellular level. When targeting the extensor tendons and muscles, laser therapy can help to increase energy for cellular healing. It also improves blood flow, which increases the amount of oxygen and nutrients delivered to the damaged tissue. All of this helps to improve healing and tissue regeneration. Laser therapy has been found to be effective in reducing pain and improving grip strength, especially when used with exercise therapy in patients with tennis elbow.
4. Kinesio Tape:
Kinesio tape is a non-invasive therapy used for pain relief, lymphatic flow, joint support and improved joint and muscular awareness. Kinesio taping can help decrease pain, improve grip strength and in some cases may be used in the place of a brace or strap. Some studies have found that patients receiving manual therapy/exercise and kinsio taping had better results vs manual therapy/exercise alone without taping.
Tennis elbow treatment North Vancouver at Mountain Health & Performance may include laser therapy, myofascial release, taping, bracing, mobilization and or manipulation.
Tennis Elbow Treatment North Vancouver: exercises
Traditionally rest was regarded as an effective treatment for tendon injuries. We now know that safely strengthening and moving the affected tendon should occur as soon as possible. Eccentric loading (which is a specific way to load the muscles and tendons) has been shown to improve collagen alignment, and stimulate collagen cross-linking, which improve strength in weakened tendon. Eccentric exercises have a positive effect on pain, function and patient satisfaction, return to work vs. traditional exercise, stretching, splinting and ultrasound.
Eccentric wrist curls and the use of the flexbar (a popular treatment for tennis elbow) are both great ways to stimulate tendon healing. The flexbar is a rubber bar that is sometimes prescribed, which helps patients perform eccentric exercises without weights or bands. Though these treatments are great options for some patients, other patients may not be ready to perform eccentric exercises right away. Some patients have a reactive tendinopathy, which may require hands-on treatment to reduce pain and less intense exercises to strengthen the tendons without the risk of overloading them. These may include gentle isometric exercises and exercises to target other joints that are dysfunctional (i.e.: shoulder exercises, neck exercises etc.).
Tennis elbow treatment North Vancouver at Mountain Health & Performance will always include a specific rehab plan because our chiropractors recognize that the body needs to be strengthened in order to heal.
Tennis Elbow Treatment North Vancouver: stretches
Though stretching the forearm muscles may provide short-term pain relief and can potentially decrease some of the strain on the tendon, stretching alone will not heal your tennis elbow. Tennis elbow, as discussed above, is a degenerative tendon condition and exercises are critical to rebuild the tendon and normalize function. It’s very important to get a proper assessment and diagnosis to direct proper treatment. There is no one size fits all approach to treating tennis elbow, so what works for one person may not work for you, or worse may aggravate your symptoms.
Additional Tennis Elbow Treatment Tips:
Avoid pain-provoking activities for a period of time (as discussed with your healthcare provider). These may be re-introduced slowly once the tendon has had time to rest and treatment has progressed. Activities to avoid may include:
-
Tennis and other sports.
-
Lifting with the forearm pronated (turned inwards)- try lifting with the forearm and wrist in a neutral position.
-
Work tasks, which are highly repetitive for the elbow, forearm and wrist.
-
Heavy lifting.