Tennis elbow is a painful and disabling condition that is said to develop through overuse, but why does it then refuse to heal and defy treatment? The reason is that there is an often overlooked issue that creates stress on the elbow. This contributes to the condition developing, then prevents it from healing.
In this article we discuss what that is, and what you can do about it.
What is tennis elbow
The overlooked cause
Do you have this problem
What to do about it
Tennis elbow is inflammation or injury to the outside of your elbow where many of your forearm muscles attach.
As this diagram shows a large number of forearm muscles are attached to a small bony bump at the side of your elbow called the lateral epicondyle. Pull from these muscles (blue arrow) creates an area of high stress. If this stress is repeated or prolonged the attachment can become inflamed. This pull from the muscles can be either intermittent or constant.
Intermittent pulling results from repetitive activities where the forearm muscles are used. Because of this tennis elbow is often called an overuse injury. These muscles are heavily used when playing a single handed backhand shot in tennis, hence the name tennis elbow. However, there are many other activities that can cause this, such as many tasks performed by tradespeople, or even using a keyboard.
Constant pulling results from those forearm muscles being tight. The most common cause of these muscles being tight is those tender lumps massage therapists find called (myofascial) trigger points, or trigger points for short. These are are parts of the muscle that have spasmed or cramped, pulling the muscle tight. For more information please see Your Complete Guide To (Myofascial) Trigger Points .
A much more severe injury such as a broken bone can heal in 6-8 weeks, so why can a simple inflamed muscle attachment be still hurting after months of treatment? The simple answer is that medics too often only consider the intermittent pulling (repetitive usage) and ignore the constant pulling (tight muscles due to trigger points). Let us look at what happens as a result.
Medics usually prescribe rest, +/- anti-inflammatory drugs, believing that this will relieve the stress and enable the elbow to heal. However, with the constant pull remaining the condition will not heal properly.
When the elbow will not heal doctors and therapists too often wrongly believe the problem is with the elbow. They will do things such as massage or stick needles into the injured part. This of course will not relieve the abnormal tension, and will potentially cause further damage or scar tissue formation.
The inflammation or injury is caused by overuse, yet doctors and therapists will prescribe exercises which create more stress on the attachment.
This totally illogical but far too common tennis elbow treatment and management is responsible for huge numbers of people suffering un-necessarily and paying for huge amounts of ineffective and often counter-productive therapy. The solution is to eliminate the cause of the abnormal constant tension as well, then the inflammation will settle down, or at least become much easier to deal with.
To help you do this we will show you simple tests to determine whether you have tennis elbow and the constant tension is preventing it from healing. If it is we will refer you to our article How to treat tennis elbow at home where we show you the simple effective way this can be treated effectively.
In this section:
Video: demonstration of examination and techniques
Do you have tennis elbow
Are overlooked trigger points causing muscle tightness
What to do if they are
Standard disclaimer: this is for general information to enable informed discussions with your chosen professional, not specific advice.
In this video we demonstrate all of the examination and treatment techniques mentioned.
You will likely have pain at the outside of your elbow that gets worse when you grip or twist.
If you have tennis elbow it will be tender at the bony bump at the outside of your elbow, and for about 1-2cm towards you wrist (the tendon of the muscle).
Doctors do two simple tests that stress the injury. These are pictured below. If they cause pain that is a sign of tennis elbow. When you do them you want just enough stress to confim that it produces pain. If you do too much you can further injure it.
For this we use a simple two step procedure.
To do this you simply examine your muscles as shown in the video. You start using the pads of several fingers to systematically examine the muscles looking for general tenderness and tightness. If found you then use one or two fingers to examine more deeply looking for:
Often when you press on the trigger points they will cause pain in your elbow. This is because, as this example shows trigger points in forearm muscles often shoot pain to to your elbow. This usually adds to tennis elbow pain, and sometimes can actually mimic tennis elbow.
Rest exercises and sticking needles into your elbow will not help trigger points. This is another reason why too often medical treatment fails.
If you have trigger points in your forearm muscles it is very simple to see if the tension they cause contributes to your tennis elbow. To do this you:
This test (temporarily) relieves any abnormal tension in your forearm muscles. If after doing that your elbow is less tender to touch and/or the stress tests cause less pain this means the abnormal tension is pulling on the inflamed/injured attachment preventing it from healing.
If you do have abnormal tension in your forearm muscles we have an excellent step by step home treatment and manage plan that should help immensely. Please see our guide: How to treat tennis elbow at home or check out the video below.
DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.
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