The Ultimate Guide to Tennis Elbow: Causes, Symptoms, and How to Treat Tennis Elbow at Home
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What is Tennis Elbow
Tennis elbow, also known as lateral epicondylitis, is a painful condition that occurs when the tendons that connect the forearm muscles to the outer part of the elbow become inflamed.
The lateral epicondyle is a bony prominence located on the outer side of the lower end of the upper arm bone called the humerus. It is part of the elbow joint and serves as an attachment site for several muscles and tendons, including the muscles responsible for wrist extension (bending the wrist backward) and supination (turning the forearm so the palm is facing up).
Despite its name, tennis elbow is not limited to tennis players and can affect anyone who engages in activities that involve repetitive gripping and twisting motions of the wrist and forearm, such as carpentry, gardening, or using a computer mouse.
By BruceBlaus - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44923322
The Symptoms of Tennis Elbow
The symptoms of tennis elbow include
Pain and tenderness on the outer part of the elbow
Weakened grip strength
Pain may also radiate down the forearm
Pain worsens with movements, such as lifting objects, gripping a tool, or turning a doorknob.
Risk Factors for Developing Tennis Elbow
The risk factors for developing tennis elbow include:
1. Repetitive motions. Activities that involve repetitive gripping and twisting motions of the wrist and forearm, such as playing tennis, typing on a computer keyboard, or using hand tools, can increase the risk of developing tennis elbow.
2. Age and Gender. Tennis elbow is most common in adults between 30 and 50 years old, affecting both men and women equally.
3. Occupation. Certain occupations that require repetitive arm and wrist movements, such as carpentry, plumbing, painting, and extensive work on the computer, can increase the risk of developing tennis elbow.
4. Sports activities. Besides tennis, other sports that can increase the risk of tennis elbow include racquetball, squash, and weightlifting.
5. Poor technique. Incorrect technique while performing sports activities or using tools can increase the risk of tennis elbow.
6. Muscle weakness and imbalance. Weak forearm muscles or muscle imbalances can increase the risk of developing tennis elbow.
7. Medical conditions. Certain conditions such as rheumatoid arthritis, lupus, or nerve entrapment can increase the risk of developing tennis elbow.
By understanding the risk factors, one can take measures to reduce the risk of developing tennis elbow.
If left untreated, tennis elbow can progress to the stage where there is calcification and fibrosis of the tendon attachment. At this stage, pain may become constant and require surgical intervention.
Trigger Points Mimicking Tennis Elbow: Understanding the Role of Forearm and Shoulder Muscles
Pure tennis elbow, where the symptoms are solely attributed to inflammation or damage in the tendons attached to the lateral epicondyle, is a relatively uncommon occurrence. In many cases, elbow and forearm pain can involve multiple muscles, tendons, and structures.
The forearm is a complex region with numerous muscles and tendons that work together to enable various movements and actions. Overuse, repetitive stress, or trauma can lead to dysfunction or injury in multiple structures, resulting in a range of symptoms.
Trigger points, muscle imbalances, or strain in these muscles can cause localized discomfort and refer pain to other areas, including the elbow.
Various muscles in the forearm and shoulder region can develop trigger points, leading to symptoms that mimic tennis elbow. Understanding the effects of trigger points in these muscles is crucial for accurate diagnosis and effective treatment.
Effects of Trigger Points
A trigger point refers to a localized area of muscle tightness or knots that can cause pain, discomfort, and referred pain in other parts of the body. These points are highly sensitive and can be felt as tight bands or nodules within the muscle tissue.
One characteristic feature of trigger points is referred pain, which means that the pain is felt in a different area of the body than where the trigger point is located. For example, a trigger point in the shoulder muscle may cause pain that radiates down the arm or into the neck.
Some trigger points in the forearm and upper arm muscles can refer pain to the elbow, wrist, and hand, and can mimic the symptoms of tennis elbow.
Supinator. The supinator muscle is located in the forearm and plays a crucial role in the forearm and wrist movements. It is a relatively short muscle that runs diagonally across the forearm, starting from the lateral side of the humerus bone (upper arm bone) and attaching to the radius bone (one of the two bones in the forearm).
The main function of the supinator muscle is to supinate the forearm, which is the motion of turning the palm to face upward or in an outward direction.
By Connexions - http://cnx.org, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=29624332
Supination allows for movements such as holding a barbell with the palms facing upward or turning a doorknob.
Trigger points in the supinator muscle can refer pain to the lateral elbow, causing symptoms similar to tennis elbow. Pain may worsen with activities involving gripping and wrist extension.
However, tennis elbow symptoms involve pain over the lateral epicondyle, while a painful knot in the supinator will be further down the forearm, and, in addition to pain with gripping and wrist extension, it causes pain with pronation (action of turning palm down).
Brachioradialis. The brachioradialis muscle is located on the forearm and connects the upper arm bone (humerus) to the forearm bones (radius and ulna). It helps to flex the elbow joint and rotate the forearm. Overuse or strain of the brachioradialis muscle can cause pain and tenderness in the forearm, particularly near the elbow. This may occur as a result of activities that involve repetitive or prolonged use of the muscle, such as playing sports that require repetitive elbow and wrist movements, or doing manual labor that involves lifting or carrying heavy objects.
Trigger points in the brachioradialis muscle can also produce referred pain to the lateral elbow, mimicking tennis elbow symptoms. Gripping and forearm movements may exacerbate the pain.
Triceps. Triceps is the muscle on the outside of the upper arm that extends the elbow. Trigger points in the triceps muscle can refer pain to the elbow, including the lateral (outside) elbow area. Trigger points in the triceps may develop with forceful elbow extension activities, such as bench presses, shoulder presses, or triceps push-downs.
Supraspinatus. Although not directly related to the elbow, trigger points in the supraspinatus muscle, located in the shoulder, can refer pain down the arm, potentially causing discomfort that may be mistaken for tennis elbow.
Home Treatment Program for Tennis Elbow
It's important to note that this program is not intended to replace medical advice, and if you are experiencing severe or persistent symptoms, please consult with a healthcare professional for an accurate diagnosis and appropriate treatment.
Here's a comprehensive program that will help alleviate tennis elbow symptoms:
Rest. Continuing to exercise or engage in activities that provoke the symptoms will make the condition worse.
Cold Therapy. Applying cold therapy to the affected area can help reduce pain and inflammation. You can use a cold pack or ice wrapped in a towel, and apply it to the affected area for 15-20 minutes, several times a day. You can also use ice massage (see the article on knee pain to learn how to do ice massage).
Electrical Stimulation. Electrical stimulation therapy may also help to reduce pain and promote healing. You can use a TENS (transcutaneous electrical nerve stimulation) unit or a similar device.
Use a tennis elbow brace. A brace or a strap will compress the painful area and decrease pain.
Trigger Point Release. Use your fingers or a massage ball to apply pressure to the tender spot in the muscle. Apply steady pressure for 30-60 seconds or until the muscle relaxes. Repeat this process several times a day.
When your pain decreases substantially you can start gentle
Range-of-motion Exercises
The next step, if still pain-free, is to start
Progressive Strengthening Exercises
The mistake many people make is starting to exercise too soon.
I have made this mistake many times only to be frustrated with the need to start the rehab anew.
Tennis Elbow Exercise Program
It's important to start with low-intensity exercises and gradually progress to more challenging exercises to avoid overstressing the injured extensor tendon.
Below is a progression of exercises for tennis elbow:
Range-of-motion Exercises: Start with gentle range-of-motion exercises involving moving the affected arm without resistance. This can help to improve blood flow and mobility in the affected area without putting too much stress on the extensor tendon.
Wrist Extensor Stretch
WRIST EXTENSOR STRETCH
Courtesy of HEP2GO
Stand or sit with your arm in front of you at shoulder level with your elbow straight and your palm facing down
Flex your wrist downward pointing your fingers to the floor
Use your other hand to apply a gentle stretch
Hold the stretch for 2 seconds
Return to the initial position
Repeat 10-12 times
Wrist Flexor Stretch Step 1
WRIST FLEXOR STRETCH STEP 1
Courtesy of HEP2GO
Stand or sit with your arm in front of you at shoulder level with your elbow straight and your palm facing down
Extend your wrist and fingers backward
Use your other hand to apply a gentle stretch
Hold the stretch for 2 seconds
Return to the initial position
Repeat 10-12 times
Wrist Flexor Stretch Step 2
WRIST FLEXOR STRETCH STEP 2
Courtesy of HEP2GO
Stand or sit with your arm in front of you at shoulder level with your elbow straight and your palm facing up
Extend your wrist and fingers backward
Use your other hand to apply a gentle stretch
Hold the stretch for 2 seconds
Return to the initial position
Repeat 10-12 times
Wrist Supination
WRIST SUPINATION - NEUTRAL TO
SUPINATED
Courtesy of HEP2GO
Sit or stand with your elbow bent and by your side with your palm facing inward
Rotate your hand and forearm so that the palm of your hand points upward
Hold the stretch for 2 seconds
Return to the initial position
Repeat 10-12 times
Wrist Pronation
WRIST PRONATION - NEUTRAL TO
PRONATED
Courtesy of HEP2GO
Sit or stand with your elbow bent and by your side with your palm facing inward
Rotate your hand and forearm so that the palm of your hand points downward
Hold the stretch for 2 seconds
Return to the initial position
Repeat 10-12 times
Wrist Supination Pronation
WRIST SUPINATION PRONATION - FULL
Courtesy of HEP2GO
Sit or stand with your elbow bent and by your side with your palm facing upward
Rotate your hand and forearm so that the palm of your hand points downward
Hold the stretch for 2 seconds
Rotate your hand and forearm so that the palm of your hand points upward
Hold the stretch for 2 seconds
Return to the initial position
Repeat 10-12 times
Triceps Stretch
TRICEPS STRETCH BEHIND HEAD
Courtesy of HEP2GO
Start with arms at the sides and your feet shoulder-width apart. Alternatively, this stretch can be done seated.
Bend your elbow.
Keeping your elbow bent, start lifting your arm up
Keeping your elbow bent, keep lifting your arm up while reaching your palm towards the shoulder blade as far as possible.
Grab the back of your elbow with the opposite hand and gently assist the stretch.
Hold for 1-2 seconds and return to Initial Position.
Repeat 8-10 times.
Brachioradialis Stretch
BRACHIORADIALIS STRETCH
Courtesy of HEP2GO
Sitting, straighten the elbow of the affected
side (right arm in the picture)
Rotate the arm inwards so that the back of
your hand is facing toward the outside of
your leg
Bend your hand downwards at the
wrist, using the opposite hand to help
as shown in the picture
Isometric exercises: Isometric exercises involve contracting the muscles without moving the joint. These exercises can help to build strength in the affected area without putting too much stress on the extensor tendon.
Isometric Wrist Extension
ISOMETRIC WRIST EXTENSION
Courtesy of HEP2GO
Place your unaffected hand over the back of your affected hand.
Using ~30-40% of your strength, attempt to press down on the affected hand with your unaffected hand. Do not allow your affected wrist to move as you resist the pressure.
Hold for 5 seconds
Repeat 8-10 times
NOTE: You can do this exercise with your affected wrist in various degrees of extension, from neutral to full
Isometric Supination
ISOMETRIC SUPINATION
Courtesy of HEP2GO
Place your affected forearm on a table with the palm
pointed to the side
Use your unaffected hand to grasp the wrist of your
affected hand
Attempt to rotate the affected forearm to point the palm
of your hand upward but resist the motion with your unaffected
hand.
Hold for 5 seconds
Repeat 8-10 times
NOTE: You can do this exercise with your affected forearm in various degrees of supination, from neutral to full
Eccentric exercises. Eccentric exercises involve gradually lengthening the muscle while it's under tension. These exercises can help to build strength in the affected area while putting less stress on the extensor tendon than concentric exercises.
Eccentric Wrist Extension
ECCENTRIC WRIST EXTENSION
Courtesy of HEP2GO
Place your arm, palm side down, on a table
with your hand over the edge holding a free
Start by using your unaffected hand to lift up
your affected hand and free weight
Hold this position with your affected hand as you release
your unaffected hand
Next, use only the affected hand that is
gripping the free weight to lower the free
weight as you bend at the wrist
Return to starting position by lifting with your
unaffected hand again
Repeat 8-10 times
Concentric exercises: Concentric exercises involve contracting the muscle while it's shortening. These exercises can help to build strength in the affected area but may put more stress on the extensor tendon than eccentric exercises.
Wrist Extension (Reverse Wrist Curls)
WRIST EXTENSION CURLS
Courtesy of HEP2GO
While holding a small free weight/dumbbell, place your forearm on your thigh
Bend your wrist up and down with your palm face down as shown.
Repeat 10-12 times
Wrist Flexion (Wrist Curls)
WRIST CURLS
Courtesy of HEP2GO
While holding a small free weight/dumbbell
and resting your forearm on your thigh
Bend your wrist up and down with your palm face up
as shown
Repeat 10-12 times
Progressing slowly and listening to your body throughout the exercise program are important. If you experience any pain or discomfort, reduce the intensity or duration of the exercise, or stop the exercise altogether.
It's also important to warm up properly before exercising and cool down afterward and stretch the affected area gently to help improve mobility and flexibility.
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