Tennis elbow problems baffled me in my early career. I had been taught to use electrotherapy (ultrasound, heat, interferential therapy), massage and exercises. It all seemed very sensible, but in practice my patients didn’t make very rapid progress and often I wondered if I made any difference at all! Then I discovered a new treatment, which was easily adaptable to doing at home. Brian Mulligan, another therapist from New Zealand, had developed this system, where a patient is actively involved in the process. I was delighted to find that pain could be abolished in one treatment, and although it would creep back between sessions (although to a lesser extent), relatively few treatments were needed for a complete cure.
While I was working in Saudi Arabia, one of the contractors from another town complained to me about his elbow pain. He and his wife lived in another compound, and he was not eligible for any medical treatment. After a few questions it was evident he’d been suffering for months from a tennis elbow. I asked him if he’d like me to have a look at his elbow, and he was very happy to let me do so. Both he and his wife were French, with a delightfully strong accent. I used the following treatment on his elbow and he was ecstatic when the pain disappeared in one session. “It’s magique! It’s magique!” he repeated over and over.
What causes Tennis Elbow?
Tennis isn’t the only cause for a Tennis Elbow! Any strong or repetitive use of the hand can do the damage. Pain starts on the bony bump on the outside of the elbow, and can spread down into the upper fore-arm and wrist.
Muscles that bend the wrist back (extend it) hold the wrist stable while you use your hand. They attach, via a tendon, on that little bony bump shown above (the lateral epicondyle of the humerus). Tendons are tough, fibrous tissue designed for taking strain, but even the strongest tendon has its limits. When a tendon is over-stressed it can become inflamed. There isn’t a good blood flow to tendons, which is why they take so long to heal. When tendons begins to heal, scar tissue can thicken and cause pain as well, delaying the process.
Damaged tendon at attachment
Usually people seek help when the condition is well established, and other methods they’ve tried have failed to ‘fix’ it. Physiotherapy has typically focused on relieving the pain and inflammation, and on prescribing exercises to gradually strengthen the muscle again. But progress is painfully slow (pardon the pun).
How do you know if you have a Tennis Elbow?
•You will feel pain in the area shown above, when using your hand – as in lifting a pot off the stove, gripping anything or bending the wrist backward.
• It will be painful when you press on that little bump on the outside of the elbow (excruciatingly so, in many cases). It may also feel warmer to the touch than the other side, if it is inflamed.
•Straighten your elbow, and press the back of your hand upward under a table. If that doesn’t produce pain, try pressing the tips of your open fingers up under the edge of a table as shown here, to see if that hurts.
A test for tennis elbow: press tips of the middle fingers upward under a table edge.
If you have pain with all of these tests, you probably have a tennis elbow.
How do I treat the painful elbow?
I’m about to show you a method which works well for many people, and which can easily be done by yourself at home. Chronic cases, which have been present for weeks or months, seem to respond best. Perhaps the scar tissue which has already developed is tugging at the inflamed surface as you try to use the muscles affected.
Before starting, establish a baseline for your pain. Straighten your elbow, and squeeze something firmly in your hand. Note the level of pain you feel – perhaps give it a rating from 1 to 10, with 1 being the slightest amount of pain you could feel, and 10 being the greatest amount of pain you could imagine..
Note the level of pain that you feel as you squeeze an object in your hand.
1/ Now, find a spot beside a doorway or wall, where you can rest your shoulder and upper arm on a solid surface, with your elbow just over the edge. With your other hand you will need to apply a firm but comfortable sideways force just below your elbow joint. Do this while you are squeezing an object in your hand, like this:
With the upper arm resting against a wall, press outward just below the elbow joint with your other hand.
Keep the pressure on with your unaffected hand, while you’re squeezing. You should feel no pain while squeezing the object in your hand, as long as you are performing the glide on your elbow joint. If you do feel pain, don’t continue – adjust the pressure and/or the angle of your opposite hand against your elbow. When you find the position that relieves the pain completely during the squeeze, proceed to do ten slow contractions in the same way.
Saying to yourself slowly, pressure on…pressure off…pressure on…pressure off… will help to give you the rhythm for the exercise.
[Hint: If you find the pressure of the wall against your upper arm irritating, throw a folded towel over your arm, just above the elbow. You may look like a butler, but it will be more comfortable!]
2/ Now bend the elbow halfway up. Repeat the ten squeezes in the new position. Make sure that you apply enough sideways pressure from your other hand to relieve pain during the exercise. Don’t get discouraged if there is some pain – adjust your angle and amount of pressure until it disappears.
Elbow halfway bent, sideways glide with hand squeeze.
Relax after each contraction. If you feel pain coming on during the treatment, stop and adjust the position of the treating hand. If your muscles begin to shake or feel fatigued, stop and rest a moment. (The aim is to relieve pain, not aggravate it!)
3/ Now bend the elbow all the way up, and repeat the ten squeezes in this new position, continuing to apply the sideways glides with the other hand:
Elbow fully bent, sideways glide with hand squeeze.
Remember – there should be no pain during the exercise if you are doing it correctly. Adjust the position of your other hand if there is pain.
After the third set of exercises, test your elbow for pain. Do the same movement you did in the beginning, stretch out your arm and squeeze something in your hand. Note the level of pain now. Is it better than it was? If you’ve done the exercises exactly as described above, chances are it will be significantly better, if not gone completely.
If you are up to doing the sequence again, you may do another two sets of ten squeezes in each of the three positions. If you are fatigued or feel discomfort though, stop and rest before finishing the set.
Repeat the treatment session two or three times per day, until the condition is gone. You should feel significant relief with each treatment if the method is working for you. The pain will probably gradually come back between sessions, although to a lesser extent each time.
It is hard to say how many treatments you’ll need – each person responds a little differently. Healing should progress a lot faster than it would naturally.
Other things that may help:
• If pain is constant (all the time, even when not moving the arm) try ice packs. Crushed ice in a towel, a purchased cold pack, or a bag of frozen peas will do (The bag of peas may be reused as a cold pack, but don’t expect to eat the peas later!). Leave the pack on for about 20 minutes until the area goes numb. Caution: don’t use ice therapy if you have diabetes or your circulation is poor.
•Heat can stimulate healing in later stages. A hot water bottle may give relief (don’t burn yourself though!). Caution: don’t use heat therapy if you have diabetes or your circulation is poor.
•Wear a Tennis Elbow support during activities which produce pain.
•Try wearing a wrist splint during the night. Either purchase a splint (pharmacies should have them), or bandage a folded hand towel on the palm side of your hand and lower forearm. It will help to prevent the wrist flopping forward and stressing the tendon at your elbow.
•If you need physiotherapy, you will probably be given ultrasound and/or other forms of electrotherapy, deep massage and strengthening exercises.
•You can do some local massage yourself, right on the spot where the pain is. Place the tip of your middle finger over the index finger(on the other hand). Press the index finger firmly (not hard enough to cause bruising though) on the skin at the point on your elbow, then firmly rub the tissues under the skin to and fro. Don’t rub the skin itself . Only do this for a minute at a time, once or twice a day.
•Don’t be afraid to use an occasional Panadol (Tylenol), or other pain reliever, especially if your pain has only recently come on, or if you’ve done something to stir it up.
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