Lateral Epicondylitis

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About

Lateral epicondylitis, also known as tennis elbow, is a common problem among physically active people and, as the name suggests, tennis players in particular. Anyone who performs repetitive movements of the elbow, like a carpenter or painter, or who repeatedly moves the wrist forward and backward, such as tennis players on their backhand stroke, is susceptible. Such motions can strain tendons in the arm. Over time, the strain causes inflammation of the muscles and soft tissues around the elbow, and can also cause muscles in the arm to become unbalanced.

Ideally, extensor muscles, which pull the wrist up, work with equal force to flexor muscles, which pull the wrist down. But when one group is weaker than the other, problems can develop. With tennis elbow, the extensor muscle group on the outside of the forearm often becomes weak or relatively weaker than the flexor muscles on the inner forearm, leading to a muscle imbalance and ultimately inflammation and pain.

Tennis elbow can also develop in people who have good muscle balance but overuse their wrist extensor muscles. This is commonly referred to as a repetitive strain injury, and also leads to inflammation. Regardless of the cause, however, your healthcare practitioner can decrease inflammation, restore proper muscle balance if necessary and help improve your pain-free range of motion.

Anatomy

To understand lateral epicondylitis (tennis elbow), you must understand that the elbow does not and cannot function alone. The elbow is a joint that is a connection between the upper and lower arm, and problems in either area can cause elbow pain.

As mentioned in the About section, tennis elbow develops when you overuse your extensor muscles, or when the extensor muscle group on the outside of the forearm is weak or weaker than the flexor muscles on the inner forearm, which may lead to muscle imbalance, inflammation and pain.

The extensor muscle group normally allows you to extend your wrist and point your fingertips upwards, the way you would when waving to a friend. To feel it working, grip one of your forearms just in front of the elbow. Now extend the hand on the gripped arm, bringing your fingertips toward the ceiling.

If you have tennis elbow, even this simple motion can be painful. Everyday wrist movements, like the one you just did, make use of your extensor muscles, particularly the extensor muscle carpi radialis brevis.

This extensor is also necessary for wrist supination, which involves rotating your wrist outwards, away from your body. Activities that combine extension and supination, like using a paintbrush or hitting a backhand stroke, put you most at risk of getting tennis elbow, and can be the most painful when you already have the condition.

Chiropractic Care

If you're a tennis player with lateral epicondylitis (tennis elbow), your game may suffer for a while. But there is no reason you have to, because your chiropractor can offer several methods of care that can decrease pain, decrease inflammation around the tendons and restore proper muscle balance and range of motion in your arm.

Initially, your chiropractor may perform adjustments and range-of-motion procedures. Adjustments, which involve returning joints to their proper position, can help to restore proper mobility, which can lead to better function and flexibility. Soft-tissue mobilization, which may involve the use of a variety of hands-on techniques, help improve movement between connective tissue layers.

Concurrently, your chiropractor may choose to perform various physiotherapeutic techniques, like friction massage, ultrasound, laser and electrical stimulation.

Friction massage involves the application of pressure directly onto forearm extensor tendons, and usually the underlying soft-tissue structures, to remove scar tissue and allow healthy tissue to grow in its place. Ultrasound delivers heat and vibrations deep into the muscles, helping to decrease pain and loosen tight muscles. Laser treatment concentrates heat on the affected area, breaking down scar tissue and any underlying adhesions. Electrical stimulation sends a mild current through the injured area, helping to promote healing and strengthen the weakened tissue.

While all these treatments can be helpful, however, they only address the symptoms. Tennis elbow will likely recur unless you rebalance the muscles in your forearm. As mentioned in the About section, the condition occurs when the extensor muscle group on the outside of the forearm is weak or relatively weaker than the flexor muscles on the inner forearm. To alleviate this muscle imbalance, chiropractors often prescribe a series of exercises and stretches. These exercises also restore flexibility and remind the body of the range of motion the arm should move through.

While your body is healing, you may also want to use an elbow brace to protect your arm. Elbow braces help the healing elbow by supporting weak muscles, preventing further inflammation and recreating muscle balance.

Because even the slightest movements can cause pain in those suffering from tennis elbow, you may be worried about picking up a hand tool or a racket again. But with good treatment and the right rehabilitative exercises, you'll soon be back to work or back in the game.

Lateral Epicondylitis

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