The Therapist is In...Getting a Grip on Tennis Elbow

The Therapist is In...
Getting a Grip on Tennis Elbow
by Shannon Murphy, MPT

Most people don't realize how much they rely on things until they are gone or broken. That is certainly true with movements of wrist and forearm -functions often taken for granted until they hurt!
Background
The term "tennis elbow" was first coined in the 1870's for its association with pain in early tennis players. Nowadays, the condition is known as "lateral epicondylitis". However, both terms are really misnomers. Only about 5% of are related to tennis at all, and scientific studies have challenged the assumption that inflammation is even involved in the process (which is what "-itis" means when tacked to the end of a word). Epicondyalgia is considered a more precise term, as it simply means "pain at the elbow".
Causes
Semantics aside -- what causes "tennis elbow" and how can it be treated? In most cases, the pain is thought to be caused by degeneration of the muscles and tendons that attach to the bony part of your outer elbow (called the lateral epicondyle). In a factory worker, ice-cream scooper, or racquet-wielding athlete, that breakdown can be related to repetitive gripping that overloads the small muscles of the forearm. However, there are also a number of syndromes that can feel like "tennis elbow" but have slightly different mechanisms - such as dysfunctions of the radial head (a bone in your forearm), nerve entrapments (usually a branch of the radial nerve), cervical radiculopathy (pain generated in the neck that is felt in the arm), and trigger points (hyperactive nodes in muscle that refer pain to a distant area). In many patients, symptoms result from a combination of factors.
Symptoms
Regardless of cause, the symptoms share a common profile:
* Pain over the outside of the elbow and into the forearm
* Pain with lifting and squeezing that can produce weakness
* Pain that develops gradually, typically in those between 30-60 years of age
In those who perform repetitive-grip activities, pain is more likely to develop in the dominant arm; among the general population, the distribution is more mixed.
Strategies
Treatments vary, but generally focus on reducing strain by:
* Resting the arm until pain diminishes
* Performing gradual flexibility and strengthening exercises to restore muscle balance to the wrist, elbow, shoulder, neck and trunk
* Warming muscles before activity and icing afterward
* Using clinical modalities (like ultrasound, microstim, etc) to improve healing
* Utilizing pain medication (NSAIDs are typically effective, even though current science questions the inflammatory component)
* Addressing task-specific ergonomics (tools, keyboards, habits, etc)
Counter-force bracing (the straps you can buy from local pharmacies) can be effective in decreasing force transmission across the elbow, but can make symptoms worse if applied improperly or used in a case where symptoms are related more to nerve dysfunction than tendon pathology.
Steroidal injections are occasionally recommended for persistent cases, but should be considered with caution - cortisone can weaken tissue and predispose to further injury. In a very small percentage of cases, surgery may be an option - but rarely a first resort.
Fortunately the vast majority of cases resolve with management through physical therapy or complimentary disciplines. The key is to get a grip on symptoms early-the difference between "nagging" and "unbearable" is usually just a matter of time!

This series of columns are by Shannon Murphy, MPT, Owner/Director of BodySense PT in Boonsoro. 9 Saint Paul St, 3rd Floor, Boonsboro, MD 21713. 301-432-8585 phone, 301-432-1987 fax, smurphy@bodysensept.com.