(Originally published as an article for Imbue Pain Relief Patch)
Ok, so tennis elbow – AKA lateral epicondylitis – has never been just an affliction of tennis players. They’re just especially prone to it because the shock of whacking a tennis ball (especially backhand) tends to get transmitted to this part of the elbow. Repetitively twisting the wrist – as in turning a screwdriver, chopping vegetables, painting, making espresso, and many other occupational motions – can also lead to this condition. Even subtle movements, if they are repeated for hours a day, over a course of months or years – such as using a mouse or keyboard – can cause “tennis elbow.”
Lateral epicondylitis technically means inflammation of the lateral epicondyle of the humerus, that is, the outer aspect of the upper arm bone where it meets the elbow. Actually, not all tennis elbow is lateral epicondylitis. It’s really any of several conditions that cause pain in this general area. (The red region in the diagram.)
Most often, tennis elbow is a muscle problem. Several muscles of the forearm attach to the bone here, and they are prone to strain or tears at the tendon. Trigger points are probably implicated in the majority of cases. These are hyperirritable zones within muscle fibers that make the muscles tight and produce broad and persistent pain.
The trigger points most often implicated in tennis elbow are an inch or two down the forearm from the elbow in the bulgy part of the muscle (several of the extensor muscles are here, which extend the wrist and fingers). Less often, pain in this region can be referred from the triceps – the muscle that covers most of the back of the upper arm. The chart to the right shows, at the X’s, the most common sites of trigger points in the triceps. The X’s of each color produce the pain pattern shown by the shading of the same color. As you can see, the yellow and blue X’s can produce pain in the tennis elbow region, and unless you knew to look for them, you might never suspect any involvement of the upper arm. It’s also possible, though even less likely, that pain at this part of the elbow could be referred from trigger points in the muscles of the back of the shoulder. You can visit our web site, click on the Pain Expert button, and then click on the elbow of the model to see more.
Get Some Massage
Examine all these areas by methodically and firmly pressing over the whole region. If you find tight, tender spots, do some massage on them (or better yet, have a friend do it!). Work slowly, pressing deeply into the tender spot and then moving the skin slightly toward the hand – as if trying to lengthen the muscle. If you can handle it, while pressing in the tender affected muscle, you can slowly rotate your hand (palm up, palm down, palm up, palm down…) or alternatively flex and extend your wrist over and over. Spend a minute or two on each point, then move to the next tender point.
Chill the Inflammatory Response
Generally, I don’t recommend ice for pain, except right after an injury. However, tennis elbow is usually a Repetitive Strain Injury – AKA Repetitive Stress Injury, Repetitive Motion Injury, or Cumulative Trauma Disorder. Notice that all these terms contain the word “strain,” “injury,” or “trauma.” Therefore, the use of a cold pack right after or even during a period of prolonged use can be helpful. Five to ten minutes is usually sufficient.
Good Form Is Everything
Figure out what tasks are contributing to the repetitive strain of this area, and, if at all possible, improve your form. If you use a jackhammer all day, better form isn’t going to make much difference, but if you type all day, there are definitely ways to alter the ergonomics of your work station to reduce the strain on your forearms. Try a squishy lift under your wrist, check out one of those wide “split” keyboards, and speak to an ergonomics expert or occupational therapist.
When athletic activity leads to lateral epicondylitis, there are often changes you can make to your technique that will eliminate or improve the problem. I have spoken to tennis players who have told me they’ve only ever had tennis elbow when their technique was flawed. When they were coached and refined their form, the pain stopped. However, it could have nothing to do with your technique and everything to do with your equipment. Get it checked out by a professional.
Give it a Rest Already
The hardest part of managing a repetitive strain injury is to stop repeatedly straining the area, since the repetitive strain is usually associated with a task you either love to do (like playing tennis) or have to do (like work), and therefore do quite a lot of. Nobody likes to be out of the game, but the benefits of even modest periods of rest are well worth the improved performance and reduction of pain you will enjoy when you return to your usual activity level. While resting, apply heat to the affected area for 20 minutes twice a day. If you can stand to rest the area for two or three weeks, this will give the tissues the best chance to heal.
Use the Imbue Pain Relief Patch
I’m not plugging it just because it’s my product. I’ve used the Imbue patch on dozens of patients with pain in this area, and every single one reported relief. Usually the pain went away completely, or almost completely, for 8 to 12 hours or more at a time. Some patients reported that with successive applications of the patch, the duration of relief got longer.
Stretch for Maintenance
Although I haven’t seen stretching make a huge difference in actively painful cases of tennis elbow, it can be really helpful at preventing the development of this condition. After you rest and your arm has settled down, stretch before, during, and after working or playing to keep these tissues in good shape.
Brace it if You Need To
I’m not a huge fan of braces. They’re mostly just a band-aid that lets us keep doing the injurious motions that got us into trouble. But sometimes they help – especially if you can’t stop doing the injurious motions. A brace that squeezes this part of your forearm may help you get through the day with less pain.
Try Acupuncture and Acupressure
Acupuncture usually works exceedingly well for tennis elbow. Needles inserted in the area (and complementary points elsewhere on the body) do a great job of releasing trigger points and alleviating inflammation.
Meanwhile, you can employ some acupuncture principles for self-treatment. There are a number of acupuncture points that can be pressed to help alleviate tennis elbow. First check out the knee. The knee and the elbow are complementary joints, since they’re in the same place relative to the limb each one is on. Usually you’ll get the best results by working on the knee of the opposite leg from the side you have elbow pain on. (If you have right sided elbow pain, check out the left knee first.) If you don’t find anything that helps on the opposite side, try the knee on the same side of the body. The main treatment point in the knee area is just above the joint, on the outside of the knee (see the red X in the diagram). Along the side, toward the back, you’ll feel a cable-like tendon (one of your hamstrings). Come just forward of this tendon (toward the top of your thigh) and press firmly all around here. If you find a tender spot, massage it deeply while moving the affected elbow and wrist.
If you don’t find anything tender in the region of the red X, search all around the knee. Any tender spot in the vicinity of this joint may benefit elbow pain. There are two other regions to examine. One is the forearm on the good side. If you have lateral epicondylitis in both arms, then you won’t have a good side. But if it’s just on one side, press around the outside of the unaffected elbow and work down the whole upper third of the bulgy (hairy) part of the forearm, searching for tender spots. Massage them deeply; especially if you find one or more that makes the affected elbow feel better.
The last acupressure point to check out is near the web of skin between the thumb and index finger, on the same side as the painful elbow. If you spread these fingers apart, looking at the back of your hand, you’ll see that the bones form a V. The point is inside the bottom of the V, right in the nook where the bones come together – at the red dot in the diagram. Feel around here, right up against the bones, for a tender spot. Then, while massaging this spot, move your wrist/elbow around, so as to feel the tennis elbow region.
With all of these acupressure techniques, it is often helpful to try to elicit the pain in the elbow while pressing on the point. You’ll then be able to tell if the point is working, since the pain in the elbow will fade. Alternatively, you could have a friend press on both the tender area at your elbow (with one hand) and one of the acupressure points (with their other hand). They can even just hold the two points and pretend to be a bridge between these points. Often, the treatment point acts to “neutralize” the pain at the elbow.
I hope these approaches give you relief from your pain. Use the comments section to let me know what you try and how it works. Or if you have another approach that has worked for you, I’d love to hear about your experience.
Copyright 2012 by Peter Borten. No reproduction allowed in any form without permission.