Tennis elbow

Thanks to everyone who requested a topic for the blog on the MobilizeMe Facebook page!

So, your elbow started hurting a couple weeks ago, just a dull ache on the outside of the arm. Nothing major, just a bit niggly after lifting. So you ignore it and keep on lifting. A couple months goes by and the pain gets a bit worse and now hurts when trying to open a jar at home. You try doing a few stretches here and there and consult Dr. Google to try and figure out the problem. You’re pretty sure it’s tennis elbow; satisfied with a “diagnosis” you buy a brace, wear it sometimes and keep on doing all your normal activities, maybe supplement your diet with a few painkillers or anti-inflammatories to dull the pain. Next thing you know, you can’t shake someone’s hand without pain and you have to ask someone else to open that jar for you.

 Sound familiar??

Tennis elbow or lateral epicondyalgia  is a repetitive “strain” injury (or RSI) that affects the lateral (outside) part of the elbow and is not limited to those who play tennis. It is an injury that limits your ability to grip with the hand, extend the wrist and pick up objects even as light as a cup of coffee and can last for a couple of weeks up to a couple of years.

Lateral epicondyalgia is commonly caused by chronic, non inflammatory changes in the extensor carpi radialis brevis (ERCB) tendon. This muscle of the forearm is responsible for extension of the wrist and its tendon attaches to the lateral epicondyle of the humerus.

Signs & Symptoms of Lateral Epicondyalgia:

·         Pain over the lateral part of the elbow that may or may not radiate down the forearm

·         Pain with gripping or shaking hands

·         Pain with wrist extension

·         Pain with extension of the 3^rd finger

·         Pain with lifting, especially with the palm pointing down

·         Reduced grip strength when compared to non-affected arm

Causes of Lateral Epicondyalgia

·         Repetitive gripping, typing, twisting movements of the forearm (using a wrench/hammer)

·         Repetitive wrist extension (such as in the backhand in tennis)

·         Trauma/direct blow to the outside of the elbow

·         Compression/constriction of the radial (C5/6) nerve

·         Tightness of wrist extensor muscles

·         Cervical pathology – C6/7 disc injury/radiculopathy may be associated with tennis elbow

Management of Lateral Epicondyalgia

·         Conservative management  has been shown to improve symptoms in 90% of patients (Hay et al., 1999)

·         Modification of activity: avoiding movements/activities that aggravate symptoms is necessary for treatment success.  This means that returning to Crossfit and continuing on with your daily WODs will NOT get rid of the problem...!!!

·         Stretching of tight muscles

·         Eccentric strengthening of extensor muscle group

·         Manual therapy

·         Acupuncture/Dry Needling

·         Deload Taping

·         “Tennis elbow” brace worn distal to lateral epicondyle

·         Neural glide exercises if indicated

·         Corticosteroid injections       

·         Autologous blood injections or Prolotherapy

 

All the gripping and lifting we do in Crossfit can cause lateral epicondyalgia and ignoring the problem will not make it go away. The longer you leave initiating treatment, the longer you will suffer.  Most cases of tennis elbow can be managed conservatively (without surgery) so get it sorted before it keeps you out of training.