Getting to the bottom of nagging elbow pain takes patience, persistence and an understanding of the repetitive motion that overtaxed the muscles and tendons of your forearm in the first place.
It may be referred to as tennis elbow, golfers elbow or a common strain injury stemming from repetitive motions of the wrist and arm. Either way, lateral epicondylitis (let’s just call it tennis elbow here) is a painful condition that affects millions of Americans each year.
Dr. Kevin Sherman, sports chiropractic doctor and director of the Scottsdale, Ariz.-based Ironcare Sports Therapy, says it’s one of the most common injuries he sees among patients. “It happens to everyone, from golfers to tennis players to frequent travelers pulling suitcases through the airport.”
He describes the pain associated with tennis elbow as sharp pain radiating from the outside of the elbow, nearest the bone where the tendons insert above the joint. “Patients will experience pain doing the simplest things. It may be lifting up a cup of coffee or a jug of milk from the refrigerator, . It hurts any time they grip something.”
Attention to self-care early in the process can alleviate much of the pain and related symptoms. The key is to exercise patience, as recovery can be a weeks- or months-long process, depending on the severity of the strain.
Dr. Sherman recommends taking the following at-home steps to ease the pain of tennis elbow:
- Rest is essential. Take up to two weeks off of the activity that aggravated the condition.
- Expedite healing with compression. Elbow compression sleeves made of thin compressive material (not the thick neoprene sleeves) will be most effective. Wear the compression sleeve for two to three hours at the end of the day to push accumulated fluid away from the injury. Do not sleep in the sleeve.
- Apply a cold pack. Use a cold pack from the refrigerator. Never use a frozen ice pack on the thin skin of the elbow, as it can easily cause frostbite injuries. Apply the cold pack for 10 minutes at a time, two to three times a day. Never use heat!
- Take over-the-counter anti-inflammatory medication. OTC medications will help to temporarily ease nagging discomfort.
- Strengthening and stretching. “Eccentric exercises are the most effective,” says Dr. Sherman. This means the movement is in the release. Start with a soup can or a 1-pound dumbbell and work up. Use your opposite hand to assist with the lift, and slowly release. Do three sets of 10 reps to begin.
When to See the Doctor
In most cases, tennis elbow will resolve with proper self-care. However, for others, a visit to a sports or orthopedic doctor may be the only avenue to relief.
“The tendons are not very active, metabolically speaking.,” Dr. Sherman explains. “That means they don’t have a good blood supply and, as a result, heal very slowly. A full-blown case of tennis elbow can last from three to six months.”
Dr. Sherman’s go-to treatment for his patients is Active Release Technique therapy, or ART. ART is a soft-tissue therapy designed to target overuse injuries in muscles, tendons, ligaments fascia and nerves by breaking down restrictive scar tissue and restoring proper motion to the injured area.
“Tennis elbow is certainly one of the most challenging repetitive stress injuries to treat. I tend to get the best results with my patients using ART combined wtih other types of therapy,” says Dr. Sherman. From time to time, he adds dry needling therapy to the treatment plan to stimulate tiny micro-trauma and healing.
Another promising therapy is platelet-rich plasma injection, or PRP. During PRP, platelets loaded with human growth factors from the patient’s own blood are injected into the site, stimulating the body’s natural healing process. “It’s a very promising therapy, but is still considered experimental and generally not covered by insurance,” says Dr. Sherman.
He explains that with tennis elbow, the tendons can easily graduate from a state of acute injury – or tendonitis – to tendonosis, which is a state of failed healing in the absence of inflammation. Tendonosis occurs over time, after repetitive micro-trauma to the tendon. Tendonosis is more difficult to treat than tendonitis. “So many people who have this ignore it at first. They have it for months before seeing a doctor.”
The key to preventing tennis elbow from crimping your lifestyle again – or leading to surgery – may be in addressing biomechanical and/or muscle imbalance deficiencies.
If you play a sport that involves repetitive movements like tennis or golf, you should consider getting coaching to help improve your technique and form. Often times, bad form is placing stress on the tendons.
Also, take the time to warm up properly and gently stretch the muscles before diving into your workout.
Strengthening exercises specifically for the forearm muscles will also help prevent future instances of tennis elbow. A physical trainer or therapist can advise on proper exercises for gradually building forearm strength.