Having tennis elbow doesn’t necessarily mean that you play tennis!  In fact, it is medically known as lateral epicondylitis.  A painful elbow can affect almost all activities you perform throughout your day.  From shifting your car to lifting a gallon of milk our of the refrigerator, nearly every motion that involves grasping something while moving your arm and elbow will result in pain.

There are four muscles along the back of your forearm that extend (or straighten) the wrist and fingers and they all come together into one tendon called the common extensor tendon.  This tendon attaches these four muscles onto the lateral (outside) epicondyle (bony bump on the outside of the upper arm at the elbow.  This group of four muscles is responsible for stabilizing the wrist while gripping a tennis racket and absorbs more strain when doing this while performing a backhand stroke.  Inflammation (swelling) in this tendon is called lateral epicondylitis or tennis elbow

These muscles function similarly in many activities, such as in lots of keyboard work (typing), carpentry, heavy construction, factory jobs, yard work, etc.  There are several keys to addressing problems with tennis elbow.  First, as accurately as possible, you need to try and pinpoint what the cause of the pain or problem has been.  Once you have a good idea what activity was responsible, you should try to determine what movements both your whole body and your arm were going through, no matter if it were one time or repeatedly.  If poor mechanics were present or there was weakness somewhere other than the elbow, your body could have compensated and the elbow just happened to break down because it was the weakest link. 

Discovering possible causative factors might be easier when you consider the following questions:  Are there any other areas of discomfort that you have noticed, even if only mild soreness, around the same time as your elbow soreness?  Were you performing an activity that was very repetitive?  Was the area you were working, exercising, playing in cramped or awkward?  The answers to these questions may help determine whether the elbow area is the problem or if it was just the weak link.  Information gleaned from these questions can also help in designing a more effective rehabilitation plan.

Second is the flexibility of the forearm muscles.  Many times, overuse will cause tightness and stiffness which can lead to increase tension and strain on the common tendon.  There are four stretches that address most of the flexibility your will need in your forearm:

1. Flexor Stretch
2. Extensor Stretch
3. Pronation
4. Supination

Third, the muscles in the forearm and wrist need to be strong enough to handle any strain placed upon them.  It is common for these muscles to work in a stabilizing fashion, that is stationary and with little or no movement.  Because of this, there are little or no contraction and relaxation phases with appropriate gliding of the tendons.  The following exercises will strengthen the main muscles

1. Elbow straight, wrist extension
2. Elbow straight, wrist flexion
3. Elbow bend pronation/supination

When there is an injury in your body, a natural response is triggered that begins with inflammation.  Specialized cells (phagocytes and macrophages) come to the injured area and begin removing the inflammation and dead tissue left over after the injury.  Once the damaged tissue has been removed, the body begins work on laying down new cells that will repair the injured area.  Sometimes your body gets stuck in the inflammation phase (like a broken record that keeps skipping) and needs a little ‘jolt’ to knock it back on track.  So, the fourth piece you should consider is a massage technique called cross-friction massage (CFM) directly to the tendon.  This can be slightly uncomfortable but is typically useful in both kicking the inflammatory process back on track and also in re-aligning the scar tissue to help improve its mobility and extensibility.

CFM is performed by finding the painful area of the tendon and determining the direction of the tendon fibers.  You then take your thumb or forefinger and middle finger together and, with firm pressure, slowly move across the fibers without causing too much discomfort.  This can be performed for 2-4 minutes at a time, several times per day.  Each time, you should follow the massage with either 10-15 minutes of ice or an ice massage.  See our article on properly using ice to insure you don't cause more damage!