Friday, August 24, 2012

Elbow Pain - Tennis Elbow

Most of us had random jobs growing up, and for me it was building tennis courts for my uncle's company out in the Berkshires (if you only vacation on the Cape, the Berkshires is that green part of the map 2 hours west of boston and a beautiful part of our state).  Piretti Tennis was a great place to work and, for the few of you who have never actually built a tennis court, it's actually pretty difficult.  And it's amazing how many people can afford their own private tennis court!  It didn't matter if we were in Lenox or up in Dalton, people just loved to have their own courts... it always amazed me... But that's not really relevant here now is lets try to stay focused :)

Building these courts was not only grueling work that caused me to go home with random aches and pains, but it was also a good place to learn about something called tennis elbow.  Since I was around tennis players from time to time (and since my uncle was a coach) I learned a lot about elbow injuries.  So let's talk a little bit about what tennis elbow is, and how to prevent this nagging injury.

If you turn your hand over, palm facing the ceiling, and look down at your elbow you'll see a bump on the inside that sticks out a bit.  That bump is called the medial epicondeyle of the elbow and on the opposite side of that bump is another smaller bump called the lateral epicondyle.  Both spots are attachment points of the forearm muscles.  The medial epicondyle is where the flexor muscles attach (the ones that flex your wrist in a "come here" motion) and the lateral epicondyle is the attachment point for the extensor muscles of the wrist (which would pull your wrist back if you suddenly touched a hot stove).  Both areas can cause pain, but Tennis elbow is referring to the Lateral Epicondyle of the elbow.

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It's referred to as tennis elbow because of a one-handed backhand.  Now I'm not an expert when it comes to tennis but when you hit a one-handed backhand you're using the extensors of your wrist.  Not only that, but when you  hit a forearm you have to use your extensors to pull the racket back before you hit the forehand.  Overuse of these muscles, as seen in tennis, can cause inflammation at the point where these muscles attach to the bone... the lateral epicondyle.  But it's not just seen in tennis.  It can be seen after typing too much, using a mouse too much, using a hammer, twisting a screw driver, basically anything that is a repetative motion can cause "tennis elbow."

The question is why does it effect one person and not another?  You can take two carpenters and one may have tennis elbow and one may not.  The primary reason is that one person probably has a tightness in the extensor muscles which pulls the muscles too tight, and then they pull at the point where they attach to the bone.  Another reason is simply overusing the muscle and not resting.  If you bang a hammer day in and day out, and your extensor muscles are too tight, you'll probably develop some elbow pain.  A third reason is just doing too much too fast, as seen with a "weekend warrior" tennis player who wakes up, after a day playing tennis, with elbow pain.  But the main issue is usually a tightness of the extensor muscles that predisposes people to this problem.

To prevent tennis elbow you have to make sure the extensor muscles are nice and loose, through self massage, stretching, or actually getting a massage.  Second, make sure the muscles are strong by using some form of weight training.  Third, don't do too much too soon, take it slow and give the muscles time to build strength and hopefully stay loose at the same time.

If you already experience tennis elbow you've got a bunch of options for treatment.  First is rest, ice and anti-inflammatories.  This is the first line treatment because tennis elbow is an inflammatory condition, just like any tendonitis.  So anything that gets rid of the inflammation will get rid of the pain.  If that doesn't work some people get a cortisone injection, this is like crumpling up a bunch of advil and shooting it directly into the elbow (not the most accurate analogy but it's close enough).  These typically help, but don't come without risks.  Cortisone, since it's a type of steroid, can decrease bone density and may decrease tendon strength... so they aren't the best option although they do usually work.

The best treatment option is to first have someone evaluate the extensor muscles of the forearm for tightness and weakness.  If you figure out why the elbow is actually hurting then you can fix the problem and prevent the elbow from hurting in the future.  A good massage therapist or physical therapist will be able to evaluate the forearm and work out any tight or spastic muscles, thus decreasing the pressure on the elbow and decreasing pain.  Then they will give exercises and stretches to do at home so that it doesn't come back.

So if you've got elbow pain there are a few options, but there's really only one good option, and that's to have it truly fixed.  You can pop advil and ice it but the pain will probably come back and become a chronic issue.  It's not something that anyone should have to live with, and if you find someone who knows how to treat this problem it may be a quick fix.

Doctors Note:

1. Tennis elbow can be seen in any form of repetitive work, not just tennis, and is caused by tight or weak muscles in the forearm that pull on where they attach to the elbow, which causes inflammation.

2. Anti-inflammatories and cortisone injections, although effective, won't cure the underlying problem and the pain may return later in life

3.  A good Chiropractor, massage therapist or physical therapist should be able to loosen the tight muscles, and strengthen the weakened muscles, which will decrease the elbow pain and provide permanent relief.

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