Tennis Elbow: Understanding and Treating the Overuse Injury

Lateral Epicondylitis, or more commonly known as Tennis Elbow, is a common workplace and sport injury, but what actually is it? Tennis Elbow is classified as an overuse injury, which affects the tendons in the forearm, causing pain and discomfort in the outer part of the elbow. In this blog post, we will delve into the causes, symptoms, and treatment options for tennis elbow.

Causes and Symptoms:

Tennis elbow is caused by repetitive stress and strain on the forearm muscles and tendons, often due to repetitive upper limb activities such as computer use, lifting heavy loads , repetitive vibrations, and forceful wrist movements. Surprisingly, you don’t actually have to play tennis to get tennis elbow. Only 5% of people with the condition relate the injury to tennis. More commonly we see the injury in patients with repetitive one-sided movements in their occupation, such as mechanics, carpenters, electricians, gardeners, and office workers.

The primary symptom of tennis elbow is pain and tenderness on the outer side of the elbow, which can radiate down the forearm. The pain may worsen with activities that involve gripping, lifting, or wrist movements. In some cases, individuals may also experience weakness in their grip and difficulty performing everyday tasks.

Clinically, the most common complaint patients have when experiencing tennis elbow is elbow pain when lifting their purse or backpack, lifting a coffee mug, or gripping and using the steering wheel while driving.

Benefits of Physiotherapy Exercises for Tennis Elbow:

Physiotherapy exercises and treatment play a crucial role in managing and alleviating symptoms of tennis elbow. There is a lot of evidence to support gradual loading of the tendons in the elbow and wrist in combination with manual therapy such as elbow mobilizations, massage, and dry needling for clinical and cost effective outcomes. More recently, research has shown that shockwave and prolotherapy may also be effective at treating tennis elbow. If symptoms are resistant to physiotherapy treatment, surgery may be indicated.

In cases where a patient needs to use their upper limb for work purposes or performance and is unable to rest, a tennis elbow brace may also be effective. A tennis elbow brace essentially helps to offload the tendons in the elbow so they are not repetitively strained while the patient continues to complete work tasks or training. The placement of a tennis elbow brace is very important in order for it to be effective. If you are planning on using one, it may be beneficial to speak to your physiotherapist to review proper placement. 

Out of all the different treatment methods, a combination of exercise, stretching, and manual therapy seems to be the most effective. Exercises aim to strengthen the affected muscles and tendons allowing them to respond better to load, decrease inflammation, and promote healing of the injured area. As with any exercise regimen, it is essential to consult with a qualified physiotherapist or healthcare professional to ensure the exercises are appropriate for your specific condition and stage of healing. Here are some entry level and effective exercises to try at home to get started: 

1. Isometric Wrist Extension:

Rest your forearm on a table with your palm facing down.

Press your palm into the table as if trying to lift it off the surface, but keep your wrist still.

Hold this contraction for 10 seconds, then release.

Repeat 10 times on the affected side, complete 2-3 sets as tolerated

2. Eccentric Wrist Extension:

Sit on a chair with your forearm resting on your thigh, palm facing down, and your wrist hanging off the edge.

Hold a lightweight dumbbell or a resistance band in your hand and allow your wrist to drop downwards.

Then, slowly raise your wrist back to a neutral position.

Perform 3 sets of 10-15 repetitions on each side.

3. Pronation and Supination:

Hold a lightweight dumbbell or a soup can in your hand, with your forearm supported on a table.

Start with your palm facing down, then slowly rotate your forearm to bring your palm facing up (supination).

Return to the starting position and repeat the movement in the opposite direction (pronation).

Perform 3 sets of 10-15 repetitions on each side.

5. Wrist Extensor Stretch:

Extend your affected arm straight in front of you, palm facing down.

Use your other hand to gently bend your wrist downwards until you feel a stretch along the top of your forearm.

Hold the stretch for 30-45 seconds, repeating 3 times on each side.

Complete after your strengthening exercises

Tennis elbow might be a common injury, but with proper knowledge and early diagnosis, you can recover relatively quickly. Many factors contribute to the outcome and speed of recovery such as age, occupation, and consistency with exercises; However, the key lies in listening to early warning signs, gradual progression in activity, and seeking professional help when needed.

If you suspect you have tennis elbow or want to improve your technique to prevent it, consult with a qualified physiotherapist by clicking on the BOOK NOW button below. With the right approach, you can enjoy your favourite activities or bounce back to work with good outcomes. 

Benefits of Dry Needling and Intramuscular Stimulation

You may have heard the term Intramuscular Stimulation (IMS) or Dry Needling (DN) when talking about physiotherapy and rehabilitation, but what actually is it and how is it beneficial? This blog will go through the differences between the two needling practices and how they may benefit you. In the end, the hope is you’ll gain more knowledge and decide whether either form of these needling practices are right for you in your recovery journey.

Dry Needling (DN)

Dry Needling (DN) or Trigger Point Dry Needling (TPDN), is the use of a small dry needle that is inserted into a taut band of muscle or trigger point to release tension. 

Trigger points are taut bands of muscle that may occlude blood flow causing a radiation of pain in a distinct pattern. Common areas for trigger points are the postural muscles around the neck and shoulders and your glute and quadriceps muscles. At their worst, you may feel a sharp pain or severe tightness that radiates outward. 

During a Dry Needling treatment the needle may go in and out of the targeted muscle or your practitioner may move it around slightly. The goal is to accurately target a trigger point, causing a muscle “twitch” when the needle is inserted. This response will effectively cause muscle relaxation (lengthening), pain relief, and increase blood flow.

Intra- Muscular Stimulation (IMS)

Intramuscular Stimulation or IMS is a form of intramuscular dry needling focused on relieving chronic pain. This method was developed by Dr. Chan Gunn and is taught at the University of British Columbia. Dr. Gunn worked for the Worker’s Compensation Board of BC. It was here he noticed patients with taut bands of contracted muscle that stayed shortened causing chronic stress on soft tissues, nerves, and joints ultimately leading to hypersensitivity. These areas of hypersensitivity would exist well past the successful healing of an injury causing, what Dr. Gunn referred to as neuropathic pain. 

IMS was developed to target neuropathic pain by addressing the area of discomfort, but also the dysfunction of the nervous system. During IMS treatment, a sterile dry needling is inserted into taut or tender muscles at the site of pain or near the spine where the nerve that is associated with the affected muscle originates. 

Accurate insertion of a dry needle will elicit a muscle “twitch” or a dull ache, while healthy muscle will feel painless. The ache or twitch response leads to three physiological effects; muscle relaxation (lengthening of the muscle), a healing response due to the microtrauma from the needle insertion, and improved nerve signaling due to a generation of an electrical potential.

The Difference Between IMS and Dry Needling

The main difference between IMS and DN is in the approach to treatment. The method of IMS focuses on chronic pain by addressing the area of pain and also the dysfunction of the nervous system, which is why you may have needles inserted in painful muscle as well as the corresponding nerve region of your back. While dry needling, looks more at muscle trigger points and aims to release radiating muscle tension. Is there overlap of these techniques? Very much so, however one may work better for you depending on the cause of your pain.

The Benefits of IMS and Dry Needling

The benefits of these two needling practices are similar in that they:

• Reduce Pain: This can take many forms. In many cases, the deactivation of trigger points alone can reduce pain locally; however, by improving muscle extensibility this can, take pressure off joints to reduce joint pain, or nerves to reduce radicular pain. Additionally, chemical changes within the muscle and associated nerves can block or influence the transmission of pain messages to the brain

• Improve Muscle Extensibility: The deactivation of trigger points is mostly to thank here. By releasing taut bands found within muscle, muscled spasms can be decreased, seeing an increased range of motion. Improved joint mechanics and using the “twitch response” to our advantage can allow for improved recruitment and activation of appropriate muscles.

• Promote Healing: By using a needle., we are creating tiny injuries in a dysfunctional muscle. The body then has an inflammatory response in the area. This is a natural healing process which stimulates healing through collagen and protein formation and can help to restore muscle function.
  
  

• Promote Blood Flow: Trigger points cause tightness in muscles which can occlude blood flow, restricting oxygen delivery. This lack of oxygen can contribute to pain in the affected area. By using DN or IMS to deactivate trigger points in the muscle, we can reduce the barrier to blood flow and improve oxygenation.
  
  

• Provide a Window of Opportunity: Using Dry Needling or IMS is kind of like pressing the RESET button on a muscle and nervous system. It provides a window of change where a muscle can be recruited more effectively and help re-establish movement patterns.

It is important to note, that you don’t want rely on dry needling as a stand alone treatment, but instead pair it with other physiotherapy techniques as well as appropriate home exercises to help reinforce movement patterns and repaired function.

If you are interested in either of these treatments, we have clinicians that are qualified in IMS and Dry Needling and are happy to help! Book an appointment with us online or by phone.