Mississauga Chiropractor Presents: Tennis Elbow

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Here`s another blog from a Mississauga Chiropractor…

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Lateral Epicondylitis or Tennis Elbow is lateral elbow pain at the muscle-bone junction of the common extensor tendon & lateral epicondyle of the humerus.  It is the most common overuse injury of the elbow.

 

Risk Factors: 

a)      Very common in tennis & racket sport players (usually associated with back hand swing)

b)      Also seen in: carpenters, plumbers, mechanics, office workers (typists/ computer operators), cashiers & bowlers

c)      May also occur in the leading arm of a golfer (but this is not the same as golfer’s elbow)

d)      It an be associated with rotator cuff pathology or imbalances (the rotator cuff may refer pain to the elbow)

 

Common Predisposing Activities (general overuse activity)

a)      Repetitive eccentric wrist flexion (tennis racket, badminton, racket ball, hammer)

b)      Concentric wrist extension & Supination (screw driver)

c)      Repetitive finger flexion & extension (typing) or ulnar & radial deviation (grocery scanner)

 

History:

  • Gradual onset of intermittent pain in the elbow (morning stiffness or after rest)
  • Often describes pain & weakness on grasping (like lifting a book or turning a door knob)
  • Pain immediately following sustained elbow flexion
  • May wake the patient from sleep

 

Presentation:

a)      Local tenderness around the lateral epicondyle & tendon attachment

b)      No visible swelling in the elbow; no signs of inflammation

c)      Normal active and passive elbow ranges of motion

d)      Pain at the end of wrist flexion when the elbow is extended

e)      Pain when gripping & sometimes decreased grip strength

 

Management:

a)      Initial Presentation (1st week)

  1. Rest – until the pain subsides – avoid aggravating/repetitive activities (i.e. opening car door; avoid carrying brief case or lifting milk cartons)
  2. Ice
  3. Soft tissue therapy, ART – Active Release Technique or massage of the forearm (light cross fibre, graston)
  4. Electrotherapy of the forearm extensor muscles
  5. Acupuncture

 

b)      Post Acute (up to 2-3 months)

  1. Mobilization of the wrist, elbow, shoulder & spine as needed
  2. Soft tissue therapy, ART – Active Release Technique or massage of the forearm muscles
  3. Ice after aggressive massage

 

c)      Home exercises

  1. Isometric exercises of the biceps, triceps and rotator cuff (every other day)
  2. Wrist flexion & extension resistance exercises;  elbow pronator & supinator resistance exercises
  3. Finger flexion/extension exercises (silly putty, squeeze ball, rubber band)

 

d)      Tips for Tennis Players

  1. Adjust tennis stroke – Use a 2-handed back hand instead of a 1-handed back hand; improved technique
  2. Stretching & Strengthening exercises – use a long warm-up
  3. Use a brace
  4. Rest/ice after activity
  5. Change the racket – avoid high string tension i.      Larger hand grip is better than smaller – proper grip sizing:  Middle finger to palm crease or one finger width gap between finger tip & heel of the hand when gripping the handle

    ii.      Mid-larger head size – larger “sweet spot”; using string dampers will help

    iii.      Avoid graphite because it transfers too much of the impact to the hand

vi.      More handle weight

v.      Play on slower surfaces to slow the ball speed

 

e)      Tips for Hammer Users

  1. Use padded larger handles
  2. Use shock absorbing handles
  3. Avoid steel handles
  4. Use padded gloves

 

Prognosis:

a)      Excellent for complete recovery in less than 3 months with appropriate treatment

 

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