The majority people that are diagnosed with tennis elbow, didn’t get it from playing tennis.
Tennis elbow has a more technical name – lateral epicondylalgia. The former term is far more user friendly. At times it seems, however, that names such as clarinet elbow, pruning elbow, or pulling-the-trigger-on-the-cleaning-spray-bottle elbow may have been more suitable. Nevertheless, tennis elbow is our habitual moniker, and an identifiable term.
Tennis elbow is caused by overload on a muscle group in the forearm. Repeated hand movements usually cause this overload. It is a very stubborn condition to treat, because the forearm is easy to overload, and difficult to rest – we all use our hands so much.
Anatomy Made Easy
Our hands have many moving parts. This allows us to do delicate things like thread a needle, do up a button, or perform microsurgery. All of these movements are co-ordinated by a myriad of tendons. The tendons, in turn, are controlled by muscles in our forearm.
Think of a marionette puppet – strings move the puppet around by being attached to a controller up above. Likewise, muscles in our forearm contract, pulling on ‘strings’ (tendons) that run through our forearm and into our hand, making one or more of our fingers move when we want them to. Our hands are used to perform fine and delicate movements, so our fingers must also be fine and delicate in size. There is no room for muscle bulk, which would turn fingers into fat clumsy clubs. The bulky muscles are therefore stored up in our forearm, leaving skinny tendons to translate the movements into our hands.
The tendons that are in charge of bending our wrist back and bringing our fingers open, all merge into a common muscle belly in the forearm, which then attaches to the lump of bone (the lateral epicondyle) on the outside of the elbow. This muscle unit is called the extensor muscle group, due to it’s role extending the wrist and fingers.
If you do any small movement with your hands – even just playing with a pen, you will notice that your wrist is bent backwards slightly. This wrist position puts our fingers in the optimal position to activate, and is a large requirement for normal hand function. It is the extensor muscle group that performs this wrist extension movement.
What Goes Wrong
Sometimes the extensor muscle group is made to do more than it has built up the capacity to tolerate. If we suddenly perform a large volume of hand activity that requires wrist extension, the muscle group becomes overloaded and ‘something has to give’. That ‘something’ tends to be the point where the extensor muscle group attaches onto the lateral epicodyle. The irritation of this muscle/bone attachment site is tennis elbow (or lateral epicondylalgia).
The cause is often a new activity that is repetitive on the hands, for example:
- Carrying out a large volume of pruning
- Hammering a lot of nails
- Commencing squash
In situations such as these, it is a case of ‘too much, too soon’ –the extensor muscle group does not have time to build up the strength to cope with the new activity.
Sometimes, it is simply the accumulation of load that leads to tennis elbow. This is common in people who do a lot of typing, or play a musical instrument. Over time, the extensor muscle group gets used excessively, which causes the muscles to progressively tighten (without the person even being aware). One day, the muscle is too tight to activate in the normal way, and a ‘niggle’ begins, at that attachment point onto the lateral epicondyle. The ‘niggle’ can build up progressively, and become very painful.
Once tennis elbow has set in, every hand activity can become accompanied by tremendous pain in the elbow area. This causes the sufferer to lose grip strength, develop other compensations, and ultimately lose function. This can go on for months and months. It is very hard to get the balance correct between rest, use and recovery.
Take Action Before You Break
Our forearm muscles are among our most used muscles. Despite this, they are the least commonly stretched, and yet they are some of the easiest stretches to do!
For just a few minutes, 2 or three times a day, the stretch listed can dramatically reduce your risk of tennis elbow.
If you pair these stretches with the ‘10%’ rule of starting any new activity, you will be much more injury proof. Start any new activity with a small session, don’t do it on consecutive days to begin with, and increase load or volume by no more than 10% each week.
Injury Proof Toolkit:
1) Change Your Environment
- If your computer mouse is too low, bring it up to elbow height, and make sure it glides properly and has room to move
- Check any equipment you are using with your hand/s:- Do your pruning shears need oiling to decrease resistance of use? Is your trigger spray cleaning bottle too full and heavy? Is the grip on your tennis or squash racquet too big or small? Does your shoddy backhand shot warrant a technique lesson?
2) Change Your Habits
- If you are starting a new hand based activity from scratch, or increasing an activity you already do, start gradually. As a rule of thumb make your first few sessions about 70-80% of what you think you could maximally do.
- Increase the activity by no more than 10% volume (time and/or intensity) each week
- Perform the new or increasing activity on alternate, not consecutive days, at least for the first 4 to 6 weeks
- If you get an ache in your elbow or forearm, take a few days off, then return to the activity at a decreased intensity, provided this is painfree
3) Add This Exercise
- Take one arm out in front of you, palm down
- Using the other hand, curl the hand and fingers down and in
- You should feel a stretch over the back of your wrist or forearm
- Hold for 20 seconds on each arm