Outer Elbow Pain? You may have Tennis Elbow.

Could you be suffering from tennis elbow and not realise it?

The most common kind of elbow pain is a condition known as lateral epicondylalgia – or tennis elbow. Ironically, you also don’t need to be a tennis player to get tennis elbow. Many who have suffered from tennis elbow, actually do not play tennis. It’s also important to point out that recovery from tennis elbow requires a proactive approach involving diagnosis, treatment and strengthening. Through rest alone, your recovery will be very slow.

The causes of tennis elbow

This type of problem can occur at any age, but is most common between the ages of 35 and 50. Predictably, it is more common in your dominant arm but can affect both. The biggest misconception about this type of elbow pain is you don’t have to be a tennis player to get this condition. In fact it is just as common in people who repetitively overuse their forearm muscles such as office workers or tradespeople.

Referred Pain
A huge contributing factor to this condition which can be easily forgotten is referred pain from the neck or shoulder. This can either mimic symptoms of tennis elbow, or most commonly there is a combination of elbow and neck, shoulder or thoracic spine issues. You will need to have a thorough examination by a physiotherapist to determine if you have any referred pain from your neck and shoulder or if your elbow pain is isolated. This will assist in a more direct approach to your problem and a speedier recovery.

Tennis elbow and it’s symptoms

Typically, this condition presents as pain at or just below the lateral epicondyle- that is, the pointy part on the outside of your elbow. Generally people experience pain with gripping, lifting or wringing activities which cause tension over the tendon (see above picture). Clinically, we as physiotherapists often find people suffering this condition have weak and/or tight forearm muscles and stiff elbow and wrist joints.

There is a wide variation in the severity of this condition and how long the symptoms may last for. As with any injury, it is best that we see you as soon as possible to start you on an injury management plan. On assessment, your physiotherapist will be able to give you a guide as to how long your injury may last.

6 Steps to treating tennis elbow pain

Initial management of this condition is through pain relieving techniques such as soft tissue massage, joint mobilisations, stretching tight nerves and muscles, dry needling, heat and/or cold therapy and taping. We also sell tennis elbow braces to our clients that are effective in relieving pain in some people. I’ll cover these methods in more detail;:

1. Soft Tissue Massage: A massage therapist can use a range of techniques to release soft tissue, break down tension and realign the fibres. These techniques include myofacial release and transverse friction techniques.

2. Joint mobilisation: this management may include massage around the problem area or gently mobilising the joints of your neck and elbow.

3. Stretching: As soon as your pain allows, start stretching the area. Extension exercises of the wrist will be the most important stretches you can do to improve your range of motion and to increase the amount of load on the tendon.

4. Dry Needling: Dry needling is a technique that is fast gaining appreciation within the physiotherapy world, with many practitioners throughout Australia now trained in the use of acupuncture needles to assist with their client’s pain and rehabilitation. The insertion of needles at varying lengths and points are thought to alter the way pain signals are transmitted by nerve pathways.

5. Hot/Cold therapy: Apply ice to the elbow regularly to reduce the pain and inflammation will be a good start, particularly at the early onset of pain.

6. Kinesio Taping: Kinesio taping may help decrease the pain and can reduce the likelihood of injury aggravation.

Another exercise option is the ‘The Tyler Twist”, where clients are asked to perform an exercise using a FlexBar®. The experiment consisted of a group of 22 subjects who suffered from tennis elbow. These subjects were then split into 2 groups. The first group were asked to perform the FlexBar® exercise as well as receive standard physiotherapy. The control group received physiotherapy alone. It was found after 7 weeks of therapy that the first group had significantly more improvement than the group receiving only standard physio; in particular, the eccentric exercise group improved their pain level 81% vs. 22% in the standard group.

Ongoing management and prevention of tennis elbow.

Of utmost importance in managing this condition is a progressive strengthening program. Tendons require gradual load in order to heal correctly, so it is very important to continue to strengthen your muscles even if your pain is gone. At this phase of your rehabilitation, it is also important to look at contributing factors such as workstation setup and your posture. If you have some referred pain, assessing your pillow may also be necessary to ensure that your whole body is always in optimal alignment.

Sometimes patients are recommended by their GP to consider a cortisone injection into the elbow. The most recent research regarding this shows that it actually makes you worse in the longer term. Cortisone assists in settling inflammation, which may help in the short term, but generally this condition is not an inflammatory condition.

Recovery from tennis elbow pain

Typically, tendon overload injuries such as this can take anywhere between 2 and 24 months to be back to normal. No, this doesn’t mean you will be in pain for that long or that you will necessarily need one on one treatment for that long. It means that the healing process of tendons is longer than any other tissue in the body so you may need to continue with an exercise regime in the longer term- even after you stop seeing your physiotherapist. This will ensure that your pain stays away.

Remember, tennis elbow is not the same as Golfers elbow which we’ll be covering in a later post. If you are experiencing elbow pain, even if you’re not sure if it’s tennis elbow, it is important to seek treatment as soon as possible to reduce your recovery time. 

This article originally appeared on sportandspinalphysio.com.au and was written by Craig Honeybrook

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Video: Understanding Different Types of Back Pain

Are you having trouble treating your back pain? This video explains why back pain can be so difficult to diagnose and treat.

When you learn about your body, you are in control of how to support it well & correctly.

Click the photo to watch a short educational video!

The Busier You Are, The More You Need Quiet Time

In a recent interview with Vox’s Ezra Klein, journalist and author Ta-Nehisi Coates argued that serious thinkers and writers should get off Twitter.

It wasn’t a critique of the 140-character medium or even the quality of the social media discourse in the age of fake news.

It was a call to get beyond the noise.

For Coates, generating good ideas and quality work products requires something all too rare in modern life: quiet.

He’s in good company. Author JK Rowling, biographer Walter Isaacson, and psychiatrist Carl Jung have all had disciplined practices for managing the information flow and cultivating periods of deep silence. Ray Dalio, Bill George, California Governor Jerry Brown, and Ohio Congressman Tim Ryan have also described structured periods of silence as important factors in their success.

Recent studies are showing that taking time for silence restores the nervous system, helps sustain energy, and conditions our minds to be more adaptive and responsive to the complex environments in which so many of us now live, work, and lead. Duke Medical School’s Imke Kirste recently found that silence is associated with the development of new cells in the hippocampus, the key brain region associated with learning and memory. Physician Luciano Bernardi found that two-minutes of silence inserted between musical pieces proved more stabilizing to cardiovascular and respiratory systems than even the music categorized as “relaxing.” And a 2013 study in the Journal of Environmental Psychology, based on a survey of 43,000 workers, concluded that the disadvantages of noise and distraction associated with open office plans outweighed anticipated, but still unproven, benefits like increasing morale and productivity boosts from unplanned interactions.

But cultivating silence isn’t just about getting respite from the distractions of office chatter or tweets. Real sustained silence, the kind that facilitates clear and creative thinking, quiets inner chatter as well as outer.

This kind of silence is about resting the mental reflexes that habitually protect a reputation or promote a point of view. It’s about taking a temporary break from one of life’s most basic responsibilities: Having to think of what to say.

Cultivating silence, as Hal Gregersen writes in a recent HBR article, “increase[s] your chances of encountering novel ideas and information and discerning weak signals.” When we’re constantly fixated on the verbal agenda—what to say next, what to write next, what to tweet next—it’s tough to make room for truly different perspectives or radically new ideas. It’s hard to drop into deeper modes of listening and attention. And it’s in those deeper modes of attention that truly novel ideas are found.

Even incredibly busy people can cultivate periods of sustained quiet time. Here are four practical ideas:

1) Punctuate meetings with five minutes of quiet time. If you’re able to close the office door, retreat to a park bench, or find another quiet hideaway, it’s possible to hit reset by engaging in a silent practice of meditation or reflection.

2) Take a silent afternoon in nature. You need not be a rugged outdoors type to ditch the phone and go for a simple two-or-three-hour jaunt in nature. In our own experience and those of many of our clients, immersion in nature can be the clearest option for improving creative thinking capacities. Henry David Thoreau went to the woods for a reason.

3) Go on a media fast. Turn off your email for several hours or even a full day, or try “fasting” from news and entertainment. While there may still be plenty of noise around—family, conversation, city sounds—you can enjoy real benefits by resting the parts of your mind associated with unending work obligations and tracking social media or current events.

4) Take the plunge and try a meditation retreat: Even a short retreat is arguably the most straightforward way to turn toward deeper listening and awaken intuition. The journalist Andrew Sullivan recently described his experience at a silent retreat as “the ultimate detox.” As he put it: “My breathing slowed. My brain settled…It was if my brain were moving away from the abstract and the distant toward the tangible and the near.”

The world is getting louder. But silence is still accessible—it just takes commitment and creativity to cultivate it.

This article originally appeared on Harvard Business Review & was written by Justin Talbot-Zorn.

The Great Ice vs. Heat Confusion Debacle

There is soooo much confusion about this issue. It’s a shame because therapeutic icing and heating — cryotherapy and thermotherapy — are rational, cheap, easy, safe self-treatment options for many common painful problems.

What ice and heat are for

Ice is for fresh injuries, and heat is for stiff, aching muscles. Roughly. But the devil is in the details, and there are a lot of them.

Ice is for injuries — calming down damaged superficial tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process … that also happens to be incredibly painful and more biologically stubborn than it needs to be. Icing is mostly just a mild, drugless way of dulling the pain of inflammation… we hope. Examples: a freshly pulled muscle or a new case of IT band syndrome (which is more likely to respond than the other kind of runner’s knee, patellofemoral pain, because ITBS is superficial and PFPS is often a problem with deeper tissues).

Heat is for muscles, chronic pain, and stress — taking the edge off symptoms like muscle aching and stiffness, which have many unclear causes, but trigger points are probably one of the usual suspects. Chronic pain often involves lots of tension, anxiety, hypervigilance, and sensitization, and comfortable heat can soothe a jangled mind and nervous system. Stress and fear are major factors in many painful problems, of course.

What ice and heat are not for

Both ice and heat have the potential to do some minor, temporary harm when used poorly. Heat can make inflammation significantly worse. Ice can aggravate symptoms of tightness and stiffness; it can also just make any pain worse when it’s unwanted.

Both ice and heat are pointless or worse when unwanted: icing when you’re already shivering, or heating when you’re already sweating. The brain may interpret an excess of either one as a threat, but icing is more threatening — and when brains think there’s a threat, they may also amp up the pain. Ice seems to be feel more threatening to most people.

Be especially wary of icing muscle pain — and it may not be obvious. You may think your back is injured, for instance, but it may “just” be muscle pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain — the very conditions people often try to treat with ice.

Heat and inflammation are the other particularly bad combination. If you add heat to a fresh injury, watch out: it’s going to get worse! A physician once told my father to heat a freshly injured knee, and wow — it swelled up like a balloon, three times bigger than it had been before. And three times more painful.

What about injured muscle? Muscle strains?

If you’re supposed to ice injuries, but not muscle pain, then what do you with injured muscles (a muscle tear or muscle strain)? That can be a tough call, but ice usually wins — but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury usually involves obvious trauma during intense effort, causing severe pain suddenly. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat.

Is ice better than heat? Is heat better than ice?

Ideal uses of ice and heat are roughly equal in potency — which isn’t very potent. Neither is strong medicine. Some experiments have shown that both have only mild benefits, and those benefits are roughly equal in treating back pain. The reason to use them is not that they are highly effective treatments — they rarely are — but because they are so cheap, easy, and mostly safe, especially compared to many other popular treatments.

The bottom line

The bottom line is: use whatever feels best to you! Your own preference is the tie-breaker and probably the most important consideration. For instance, heat cannot help if you already feel unpleasantly flushed and don’t want to be heated. And ice is unlikely to be effective if you have a chill and hate the idea of being iced!

If you start to use one and you don’t like the feel of it … just switch to the other.

This article originally appeared on Pain Science & written by Paul Ingraham.