In this article we’ll look to dispel some myths from the physiotherapy world regarding tennis and golfer’s elbow. We’ll look to give you more of a whole body idea of why you feel the pain where you feel the pain and then give you some hope with some ideas of what you can do about it.
At it’s worst Tennis Elbow and it’s near cousin Golfer’s Elbow can be hugely debilitating. It can leave you unable to carry shopping, unable to carry a cup of tea and generally feeling pretty grumpy. It leaves you wondering if you’ll ever be able to regain your previous quality of life. Whether that’s being able to play your favourite sport or simply enjoy a nice brew without fear of dropping it over yourself!
The complete irony is that Professional Golfers are more likely to get tennis elbow and Professional Tennis players are more like to get golfers elbow. How amusing! The categorisation is more for us mere mortals. Your good to average or weekend warrior sport types. And of course just to finish the hilarity in naming convention we see it most in people who either do no sport at all or neither golf or tennis.
What Is Tennis / Golfer’s Elbow?
Tennis elbow is lateral epicondylitis and golfers elbow is medial epicondylitis.
What Does Epicondylitis Mean?
Well as with all these labels not a lot really! As some of you may know or have worked out lateral on means on the outside of the elbow (when standing in anatomical position) and medial means on the inside of the elbow. Epicondyles are the lumpy bits of bone that the muscles attach to around your elbow. The inside one (medial) is very easy to find on most of us.
The “itis” bit means inflammation. Which is funny, because the condition is now thought not to be inflammatory. A while back it got changed to more of “tendinosis” which means degeneration of the tendon. Which is also unfortunate as that doesn’t seem to be the case either!
Then is was re-categorised as a tendinopathy which simply means that there is something wrong with the tendon – not that it was known what was wrong with the tendon. Which is unfortunate as in the vast majority of cases that are imaged there’s absolutely nothing wrong with the tendon. And even if there is something wrong with the tendon that doesn’t mean to say you can’t be completely pain free with an imperfect tendon.
In there interests of balance there can of course be conditions where the state of the tendon is pretty bad on imaging and surgical intervention is the best ways to go But in our experience this is a very small minority of cases that we see.
What’s The Latest Tennis Elbow Theory?
We prefer a more generalised diagnosis. The way your body works has caused a variety of structures, some of which may be around the site of the pain, to feel pain in or around your elbow and / or down your forearm. This may, or may not, be associated with nerve type symptoms – numbness, tingling or pins and needles.
Vague enough for you? What we’ve released over the many years we’ve been practicing is that the reason for the pain in the elbow is completely unique for every person we see. There are some common themes we’ll explore here but people fare much better when we work out just how their body is working, or not, for them specifically. Not some theoretical text book case.
It’s not as straight forward as going off and doing a bunch of exercises. The “standard” exercises for these conditions can just make things worse. Perhaps if you’re reading this that’s you. It’s our job as therapists to work out exactly where your body is not working and come up with innovative treatment and ideas you can implement in your day to day life to enable you to be able to carry shopping, play tennis, golf and make cups of tea pain free.
What Causes Tennis / Golfer’s Elbow?
Ah. Now I’ve asked myself a tricky one again. The truth is that it can be a compensation from any part of your body. Commonly it’s your opposite hip (no really!) which can be an important factor in sorting the pain out. Or closer to home the same side shoulder.
This tightness in the shoulder affects the brachial plexus (the trunk nerve which gives sensation down your arm) which in itself can give pain – especially if you have associated nerve type pain with your tennis / golfers elbow. Even if it doesn’t there can be an affect on the nerve where by the muscles down the arm get tired too quickly, overwork during relatively menial use, get tight, stay tight and cause pain.
Similarly the pectoral (the muscles of your chest) can have a large role to play in pain of tennis elbow. This is because the pectorals are continuous with the nerve which runs down to the elbow. Often we find releasing pectoral tension helps alleviate tennis elbow type symptoms.
Of course sheer overuse can be an overriding factor. The more you’re using your forearm muscles the less your biomechanics have to be out to give you pain. This is why we see so many people who’ve simply started doing ‘too much too soon.’ A lot of the time around Wimbledon time when everyone dusts off their tennis rackets! Or perhaps suddenly doing lots of DIY at home.
Why Do I Have Tennis / Golfer’s Elbow?
Well either you just plain used your forearm too much – high standard racket sports players and bricklayers for example – your biomechanics are a bit out, there’s been an increase in sensitisation due to an increase in stress levels or a heady mix of all three of these!
What Can You Do About Tennis Elbow?
Firstly calm down and don’t fear it. The more you worry the more pain you will feel. See one of our previous posts here for the psychological aspect of pain. In a nutshell stress leads to an increase in pain sensitivity, we simply feel more pain when we’re tired, run down, ill or stressed out.
Secondly, if you’re wearing a strap around your elbow to try to make it better, please don’t! Any positive effects that can occur are thought to be psychological in origin and we often find people reporting it has made their symptoms worse, not better. Possibly as there is a constant reminder, visual and sensation, for the brain to pick up on the fact there is something going on in that area. This adds to the amount of attention the brain pays to this part of the body and can increase the sensitisation further.
The following are some stretches you may find beneficial. Before you attempt them some rules of engagement. They are in no way a replacement for being individually assessed by a professional. Whether that is by us or anyone else. Never stretch to pain. Not even close. Stretching should be pleasurable. Less is more and use your breathing to relax into the stretches rather than trying to fix yourself by forcing things. Start with 30 seconds and build the duration of the stretch up to in the region of 3 minutes. We say 3 minutes as it gives the body time to let go of tension and for the nervous system to start to accept this new more relaxed muscle. We can’t rally change the length of your muscle fibres. What we’re trying to do is bring more relaxation into them.
And of course the obligatory disclaimer. Any attempts you make to fix yourself without consulting a professional in person you do so at your own risk. All of the below are tried and tested and you’d have to be ignoring all of the advice above and doing something pretty silly to cause problems off the back of these. We especially recommend caution to those with severe symptoms.
If you’re in anyway unsure about what to do about your tennis or golfers elbow then pleaee give us a call on 01273 921831 or mail us at info@BrightonSportsTherapy.co.uk. So many of these types of conditions are easy to remedy and not to be feared. You can be smashing serves down at the kids or driving the golf ball further before you know it. Back laying as many bricks as you like or back able to sit at your desk pain free.
How Long Does It Take To Fix Tennis Elbow?
How long is a piece of string? Each condition we see varies. It can depend on how long you’ve had the condition and how sensible or not you’ve been with it. But not always. Sometimes it is a very quick solution. Sometimes it takes a bit longer. We find the best way is to be completely thorough and address all possible causes to get you back in action as quickly as we can.
If you’re not able to come and see us hopefully the stretches above will start you on the path to redemption and if they don’t work or are too painful to get any benefit from will encourage you to seek professional help.