Tennis & Golfers Elbow

Many clients come to me with elbow pain. It’s a very common condition, and I myself have had both tennis (twice) and golfer’s elbow at different times!

There’s lots of information on the web about these conditions but in this article I want to share my own experience and explain some ways that I can help my clients. I will also highlight why some treatments I have had for tennis elbow in the past before I was a therapist were partly a waste of money!

General

‘Tennis elbow’ or to give it its technical name ‘lateral epicondylitis,’ is very common. It basically just means pain on the outside bony edge of the elbow! Before becoming a therapist I had it twice (and yes it often reoccurs) on both occasions due to overdoing DIY using concrete breakers, and hammers and doing hard physical work, which I was not used to. The pain normally builds up over many months and I should have taken action to see someone earlier before it become so debilitating that even turning on a tap was too painful! 
There is a lot of information about this condition but most seems to focus on the elbow. Agreed that’s where the pain is, (due to micro tears in the tendon attachment) and using ultra sound or other devices on the tendon attachment does help but it is does not solve the root of the problem. The problem is normally the tight extensors muscles in the forearm that pull on the tendon attachment.

‘Golfers elbow’ or the technical name ‘medial epicondylitis’ is not as common as ‘tennis’ but I still see a fair number of cases. It’s a similar condition to tennis elbow but just affects the opposite side. I had a mild form of ‘golfer’s elbow’ as a therapist and I realised that it was my gripping and trigger point work during massaging which was causing it! Shamefully I did not notice it coming on until after an intense week working followed by hours massaging almost non-stop at a dance weekender – and then I felt the pain on the Monday! So it can appear to come on quickly, but as I often say to my clients – “your car may be rusty but you don’t realise it until you see it emerge on the paintwork!”

Treatment

The treatment objectives for elbow pain are to achieve a reduction in pain and to restore the individual’s function. The traditional way of managing with rest, ice and anti-inflammatory medications – do not tend to work on these conditions. It is in any case very difficult to rest as even normal small everyday activities keep hurting the elbow.

Therapists who concentrate work on the elbow or use ultrasonic treatments are focusing on the pain area but not the cause of it!

My approach is to work on either the extensors (tennis) or flexors (golfer’s) muscles in the forearm that have normally been over-worked and are tight and fibrous which has led to the micro tears at the epicondyles. I also check the pronaters and supinators of the forearm and often find the pronator teres is tight with tennis elbow. These muscles need to be stripped and separated (not the most pleasant of massages nor easy work for the therapist) to loosen up the tight fibres. Then the muscles need to be stretched mainly using a ‘soft tissue release’ method using false muscle origins which do not put further strain on the epicondyles.

I also use Scenar Therapy which is effective in relieving or reducing pain at the elbow, but is of less help on the muscle bellies where good hands-on work is far more effective. I also use Kinesiology Tape which is very effective and helps to support the tendons, accelerates the healing and seems to reduce the pain. My clients also like the feeling of the supporting tape and it helps provide a gentle reminder that their condition is under treatment and they should avoid overusing the affected arm.

Self Help Advice

Advice I provide to my clients for self-help includes:-

• Putting heat on the joint. I like elbow braces less for their bracing action but to keep the body heat at the elbow which increases capillary size so more blood gets to the area thereby accelerating the healing. Alternate hot and cold packs on the elbow help some clients.
• A propriety brace around the top part of the forearm that grips either the extensors or flexors does help and takes the strain of the epicondyle. Kinesiology Tape can do a similar function.
• Transcutaneous electrical nerve stimulation (TENS) can be used. Results are inconsistent but a number of my clients have found it reduces the pain for relatively low cost.
• Ultrasound is often used by therapists but many of my clients have said they have not noticed much benefit from these treatments for this particular condition.
• Home stretching exercises. These work well undertaken correctly and in a controlled way.
• Controlled rehabilitation exercises (eccentric exercises) can strengthen the forearm and help avoid a repeat problem.
• Acupuncture can help and may be worth trying to speed the healing process.

Summary

Elbow pain is such a common condition that affects so many people and will only get worse if you don’t get it treated in the early stages. As I have said before in previous articles as my mum says ‘you need to be your own doctor’ and find what is triggering this problem. Then you are halfway there to solving the condition if you can avoid repeating the cause(s). Then find a remedial therapist that uses a treatment that works for you.

I have successfully helped many people with elbow pain. Depending on the extent of damage unfortunately it is often not a quick fix as the elbow attachment needs time to repair, but I can accelerate the healing by making sure the flexors or extensors of the forearm are loosened up which is frequently the root of the problem.