When you hear the name Tennis Elbow injury, it would not be uncommon to think to associate it with a tennis or racquet sport injury. However, typically patients with this injury are rarely tennis players or racquet sport players. Instead, many of our clients with this condition are downtown Toronto office workers who spend countless hours in front of a computer at work.
What is Tennis Elbow?
Tennis Elbow (aka Lateral Epicondylosis or Tendonosis of the elbow) is a painful condition of the elbow that is caused by overuse of the forearm muscles through repetitive actions. The pain and symptoms of tennis elbow are a result of inflammation at the tendon that attaches the forearm muscles to the outer part of the elbow bone. The tendon is a tough, ropey structure that connects muscle to bone. Physiotherapy, chiropractic treatment, or massage therapy can all be effective for treating tennis elbow.
What are the Symptoms of Tennis Elbow?
Common symptoms of tennis elbow include tenderness on the outside of your elbow bone and pain with gripping, pushing, pulling or carrying objects with your hand/wrist. It is common with office workers in Toronto’s Financial district to get this condition as a result of using their computer mouse excessively while positioned in poor wrist postures. Elbow pain can also be caused by dysfunctions of the neck or the nerves that travel down your arm. This is why it is best to have a professional such as a trusted physiotherapist or chiropractor conduct a thorough assessment to determine if you actually have tennis elbow or if the pain is a referral from the neck or a combination of the two conditions.
How do Physiotherapists, Chiropractors or Massage Therapists Treat Tennis Elbow?
The specific management for tennis elbow will depend on a few factors such as what caused it, how long it has been going on for, how much pain you are experiencing and what your treatment goals are.
Typically, Physiotherapy and Chiropractic treatment will involve soft tissue release such as ART® to release the muscles and decrease the pull on the tendon, stretching exercises, strengthening exercises and possibly acupuncture or dry needling. Your therapist might also suggest extracorpeal shockwave therapy. Shockwave therapy uses a form of sound energy to break down scar tissue and help to stimulate an accelerated healing response. Research demonstrates great results for shockwave therapy especially when it is used in combination with exercise, activity modification and education. For best results from treatment, it is advisable to be regular with your home exercise program.
Massage therapy is another treatment approach that can be used in conjunction with Physiotherapy and Chiropractic treatments to help release the soft tissues in the forearm and possibly the upper arm, neck and upper back as well.
How Can I Treat Tennis Elbow at Home?
Sometimes it is difficult to rest your arms from the aggravating activities that contributed to the injury in the first place. Each time you use your arm to the point that pain is produced, a cycle of re-aggravation and further tissue damage occurs. Wearing a brace can help with this issue. A tennis elbow brace, if used properly, can limit the amount of tension transmitted through the tendon with everyday activities. This allows the tendon to get the rest it needs for appropriate healing.
At home, you can also work on your exercises that were prescribed by a trusted physiotherapist or chiropractor. You may also try to gently massage your forearm at home to see if you are able to gradually decrease the tightness that caused this injury in the first place.
What are the Best Exercises to Help with Tennis Elbow?
- Forearm muscle stretching to perform these exercises you will do this with your wrist and hand in two positions. In both, straighten your elbow with your arm out in front. To stretch the back of your forearm, palm faces the ground, make a closed fist and bend your wrist downwards. For the front of the forearm, palm faces the ceiling, splay your hand open and bend your wrist and hand down to the ground. In both positions use your other hand to apply overpressure. Make sure the stretch does not feel painful or shaky, just like a gentle pulling sensation.
- Tyler Twist exercise for eccentric strength in the forearm
- Eccentric forearm strengthening exercises using a dumbbell. The focus of this exercise is to perform the muscle shortening portion of the exercise with assistance from the other hand (ie lift the weight up and extend the wrist) and then perform the lowering of the wrist in a slow and controlled fashion, taking the wrist all the way down past neutral. This exercise should be done in a pain free manner by using light weights or doing few repetitions and gradually building your tolerance.
- Forearm muscle endurance strengthening “Wrist curls”. To perform this exercise take a light weight and do repetitive slow controlled curls in both the flexion and extension. When training for endurance you want less weight and high number of reps. Try 20-30 repetitions 3xday. The amount of weight depends on what you can tolerate without pain, we suggest using a soup can or a slightly heavier 2-5 lb dumbbell.
How Long Does it Take to Recover from Tennis Elbow?
Tendon injuries can be stubborn to manage without active treatment plans such as those offered by qualified physiotherapists and chiropractors. If you wait too long you can also end up with permanent cell damage in parts of the tendon. It is best you have this issue looked at if it is not resolving on its own in 2-4 weeks with rest. A straight forward tennis elbow should take 6-8 weeks to fully recover but can take months when there are a combination of factors that need to be addressed.
If you are suffering from this condition, avoid waiting too long before you seek treatment. Contact us today to book an appointment with one of our trusted physiotherapists, chiropractors or registered massage therapists.
Heather Imrie, FCAMPT Physiotherapist
Heather Imrie is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.