Dr. Anthony describes tennis elbow and shares how it is treated.
Tennis elbow is another overuse injury except for the elbow rather than the other parts that we talked about. Tennis elbow comes about because we are overdoing the tendons that insert upon the elbow. We are using more strength or more force on that than what they can tolerate, and so that tendon that attaches on the bone get stretched and gets little micro tears that cause the inflammation, and then it contracts down and that causes the pain.
So tennis elbow is where you have pain on the outside of the elbow that usually comes from some type of overuse activity. Things like playing tennis can cause it, especially your backhand; with carpenters where they are doing a lot of screwing, then that can cause it. I have seen it in women that are breastfeeding or they are pumping their breast, and they are pulling the pump and as they do that, then that can cause it. So any overuse type of activity where we are bringing the wrist up or we are bringing the elbow out can cause tennis elbow.
The way we treat tennis elbow is similar to any type of tendonitis. So we want number one, we ice right over the area where the discomfort is, and again, the ice decreases the inflammation there. It decreases the pain and decreases the spasm and thirdly, it increases the deeper circulation there to help the healing process. So ice is number one.
Number two is stretching, and I see a lot of people come in and say, “Well, doc, I am stretching. See, I am doing this,” and this is only half of it. Remember the tennis elbow, the tendon attaches above the elbow so if we don’t extend the elbow and then bring the wrist down, then it’s not actually stretching it. So with stretching the tennis elbow, you need to keep your elbow straight and then you bring you wrist down; with the opposite hand you pull your wrist towards you, and as you do that you will feel a tightness right on top of your forearm and into where the tennis elbow is.
If you have a severe tennis elbow, as you do that that will really hurt. So what we do is we back off. We ice it, and then we easily stretch it until you can tolerate more of a stretch. So number one is icing it; number two is stretching it with your elbow straight.
Number three is we want to decrease the things that make it worse, so if you are playing tennis a lot, we want to decrease on your backhand. We could do forehands, but we want to reduce the aggravating activity which is your backhand. If you are doing things where you are on a Ten Key where you are using your forearm a lot, then we want to decrease that or we want to get a palm pad or we want to change to the other side. So somehow we want to reduce the trauma on that elbow to allow it to get better.
Number three is that we can get a tennis elbow sleeve, and you can buy this over the store. They are about 15 to 20 bucks, and it’s a sleeve that fits right around your forearm. Now you don’t want to put it right around where your pain is, and that pain is right over your lateral epicondyle. It’s a bone on the outside of your elbow, and if you put the splint right over that elbow bone then it’s going to cause more discomfort. So we put it two finger widths below or distal to or away from your pain.
So your pain is right here, put two fingers, that’s where we put the brace. We put that brace on, and I am always asked how tight to do it. You do it so it’s snug, not too tight so your hand turns blue, but tight enough so it displaces some of the force. You can tell by putting that brace on, then you go grab a gallon of milk and see if it still hurts. If it doesn’t hurt, then that’s about the right tension. If it still hurts, then it probably needs to be a little bit tighter. So we put that brace around the forearm, two finger widths below where your pain is, and that brace will help to decrease the force that operates off the lateral epicondyle.
About Dr. Anthony, M.D.:
Dr. Anthony joined our practice in 1987 and is Board Certified in Family Practice and Sports Medicine. He is a Team Physician for the US Olympic Training Center, San Diego Christian College and Santa Fe Christian High School. He is an Assistant Clinical Professor at the University of California, San Diego School of Medicine, adjunct professor at San Diego State University, and the primary care physician for the Alvarado Spine Institute.