Tennis Elbow / Golfer's Elbow

Tennis Elbow is a very popular form of acute tendonitis that is most prevalent in tennis players over 40. Up to 50% of racket sports players develop this condition at some stage. It is a degenerative condition where tendon fibres attach the muscles of the forearm to the elbow. Sufferers generally complain of a severe, burning pain on the outside of the elbow, which gradually worsens and is exacerbated by gripping or lifting things.

When treating tennis elbow, rest the area (meaning do NOT play racket sports) and apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for 1 to 3 days. Moist heat may be used after the acute swelling has improved and rest prevents further muscle injury. Ice reduces initial inflammation and swelling while the moist heat circulates blood through the area to speed the healing process. Accelerate healing with the use of ultrasound applications over the affected area as it reduces swelling quickly and increases blood flow to the area. If the patient gradually starts flexing and mobilizing the area, the muscle may heal completely.

However, this is not what typical person does; they may ice once or twice and rest a bit, but most often just take some Advil or Tylenol then continue their racket sports. If the strain was minor their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions (scar tissue). This is a normal defensive response, which prevents further damage to the injured area.

The patient should apply ultrasound treatment on the area up to three times daily. Ultrasonic energy naturally "works" the tendon, increasing its flexibily while softening and breaking down scar tissue; which is not something you want in your tendon. Scar tissue is inflexible (non-elastic), and can quickly lead to reinjury of the tendon down the road. If you choose to use steriod injections or are using steriod injections, do NOT treat the area with ultrasound until 30 days after the last injection. Steriod injections break down the tissue in the treated area in an attempt to get it to re-heal properly. Applying ultrasound over areas injected with steriods may increase the damage and can potentially tear the tendon.

The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something the MendMeShop Ultrasound is great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of reinjury down the road is much lower than average, which is well over 50%.

The most common cause of an tendon inflammation (tenosynovitis or tendonitis) is overuse of the affected tendon. Rest of the affected tendon is all that is required in some cases. Other treatments such as anti-inflammatory drugs or a steroid injection are sometimes needed. Infection of a tendon is an uncommon cause but needs treatment with antibiotics if it occurs.

What is tenosynovitis and tendonitis?

• Tendonitis means inflammation of a tendon. (It is sometimes spelled as tendinitis.)
• Tenosynovitis means inflammation of the sheath that surrounds a tendon (the sheath is called the synovium). Tenosynovitis can be caused by calcium deposits, repeated strain or trauma, high levels of blood cholesterol, rheumatoid arthritis, gout, or gonorrhea.

Tenosynovitis and Tendonitis often occur together.

Tennis Elbow Symptoms and Golfers Elbow Symptoms

Lateral Epicondylitis (tennis elbow)

The onset of tennis elbow pain is normally gradual with tenderness or a dull ache felt in the tendons of your forearm muscles on or below the bony bumps on your elbow.

If you have tennis elbow, you will feel pain or discomfort when performing repetitive movements such as grasping, carrying objects (a tray, a baby or books), or twisting with your hands or wrists. Pain can also be experienced when your wrist or hand are straightened, when your palms are facing the ceiling, when you flex your wrist and fingers backwards while straightening your elbow, or when you rest your wrists on a tabletop or desk.

Pain will start on and around the bump on the outside of your elbow (lateral epicondyle). As time goes on this pain will start to radiate from the outside of your elbow down to your forearm and wrists.

Medial Epicondylitis (Golfers elbow)

If you have golfer's elbow, you will feel discomfort and pain when performing repetitive movements such as holding, squeezing, twisting with your hands or wrists, or curving your fingers as they hit a computer or piano. Pain can also be experienced when you try to pick something up with your palm down, when you flex your wrist and fingers forwards while extending your arm, or when you rest your forearms on a surface (while typing or grasping for something).

Pain will start on and around the bump on the inside of your elbow (medial epicondylite), and will eventually radiate from the inside of your elbow down to your forearm and wrists.

General Symptoms of Epicondylitis

In the beginning, this pain will often go away within 24 hours after an activity. However if not dealt with immediately, your pain and stiffness will get worse over weeks or months, to the point where you may feel soreness even when your arm is still. You can also experience a severe burning pain and atrophied forearm muscles (loss of muscle mass), which results in a weakened grip. If left untreated, you may experience extreme loss of motion and function of your elbow and forearm.

Should you seek medical attention?

This is up to your discretion; however any continued discomfort in your elbow should be investigated, as it can lead to long term damage. If you experience any of the symptoms below and have tried the initial conservative treatments (see tennis elbow treatments and golfer's elbow treatments), it is recommended that you seek professional medical attention:

• You are unable to carry objects, participate in activities or work due to the pain
• You have limited range of motion and are unable to bend, straighten or move your arm at all
• You are experiencing redness, heat or swelling in your elbow (swelling rarely occurs with tennis elbow, however it may indicate another condition)
• Your elbow looks deformed or you have significant bruising around that area
• You've experienced a traumatic accident and may have broken a bone
• You experience elbow pain that occurs at night while resting or persists beyond a few days
• Any other unusual symptoms

Tennis Elbow and Golfer's Elbow Treatments

Once your medical professional has diagnosed your condition, they will be able to recommend the most effective treatment for your tennis elbow or golfer's elbow injury. There are a variety of options available depending on the severity of your injury.

During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your elbow area until your pain and inflammation settle. Scar tissue will often develop as a result of a tennis elbow or golfer's elbow injury once acute inflammation begins to decrease. As your damaged arm tissues heal this dead, fibrotic tissue will develop instead of forming brand new healthy tissue. This tissue adheres to your muscle fibers, tendons, ligaments, fascia, nerves, and joints causing pain and preventing them from moving properly (this limits your range of motion, flexibility and strength).

Often you will notice a great improvement within 6 to 12 weeks; however it can take months to return to normal. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results. If you start using your arm before it has a chance to heal properly (even though it may feel better), you can end up doing a lot more damage than good!

Conservative Tennis Elbow and Golfer's Elbow Treatment

Your initial treatment should involve relieving any pain and stress on your elbow, decreasing any swelling, and correcting any biomechanical dysfunction. Then you can focus on restoring strength and mobility to your injured elbow. It is very important to follow any instructions you receive from your physician.

To decrease inflammation and relieve pain for a chronic or diagnosed tennis elbow injury, adhere to the URICE philosophy within the first 48 – 72 hours:

• Ultrasound around your injured elbow for 5 minutes, 3 times per day. This is best accomplished with a personal, therapeutic ultrasound device.
  
  
• Rest your arm and limit your activity (if you are able to move your arm)
  
• Ice the area 2-3 times/day for approximately 15 - 20 minutes at a time (do not apply ice directly on your skin, rather wrap it in a cloth or towel) to reduce blood flow to the injured area.
  
• Compress the area if possible by adding light pressure to minimize swelling (make sure the compress is snug; if too tight it could cause numbness, tingling or more pain).
  
• Elevate the injured area above chest level to relieve the pressure from swelling and allow fluid to drain from the injured part.

If you do not have access to ultrasound therapy, or you have experienced an acute injury and/or have not been diagnosed, adhere to the RICE philosophy within the first 48 – 72 hours.

Ultrasound therapy is a great therapeutic option to decrease pain, inflammation and soft tissue (muscle, connective and nerve tissue) damage experienced with a tennis elbow or golfer's elbow injury. This can be received using a portable, home ultrasound device (self-administered) or by seeing a physiotherapist. The treatment is safe, easy, painless, and generally requires between 5 – 10 minutes. It is based on a form of deep heat therapy which is generated through high frequency sound waves (that we can not hear). These waves send vibrations deep into your body and raise the temperature of your soft tissue. The waves are delivered through a hand held transducer and medicinal conductive gel that are used together in a slow, circular motion on your skin over the injured area. You may experience a slight tingling or warm sensation during the process as a result of the gel; this enhances the therapeutic effects of ultrasound (Phonophoresis).

Ultrasound therapy increases collagen and tissue elasticity, which in turn promotes circulation (blood flow) and brings oxygen and nutrients to your injured area. This cleans your tissue by getting rid of cell waste products and allows your injury to heal correctly. If not treated properly injured tissue can heal with a weakened state, which can lead to scar tissue or calcification. If used on an ongoing basis, ultrasound will help to improve your range of motion by breaking down any scar tissue that may form in the injured area. Ultrasound waves penetrate deep into your tissues, relax your muscles, decrease chronic inflammation and accelerate your recovery rate, so you can return to your daily activities as soon as possible.

Radiant Energy Therapy, one of the most helpful tools for an elbow injury. Through the absorption of infrared thermal energy, tissues are safely and gently heated - increasing blood flow within the internal elbow area. Your body's natural response to this increased temperature is to try to maintain a condition of homeostasis - a balanced environment or state of equilibrium throughout the body. To do this, your body responds with a rapid increase in blood flow to the area (this is known as vasodilation), increasing the supply of nutrients to injured cells and flushing out toxins (including lactic acid, commonly found in trigger points) to promote healing. Our Platinum Radiant Energy Therapy Device provides effective, non-invasive, non-addictive pain relief with no side effects.

Pain and anti-inflammatory medication (NSAIDs - Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties. Some health professionals have also recommended natural supplements supplements such as Glucosamine, MSM or Hyaluronic Acid to help strengthen the injured tissue. The use of ultrasound in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal your tennis elbow quicker.

Once the initial inflammation has decreased, you can provide pain relief and improve your arm function by alternating a cold and hot compress to increase the blood flow to the area. Gentle massage around the injured area or small flexing or extending elbow movements (if not painful) will also help increase blood flow, oxygen, nutrients and will prevent stiffness.

To increase your comfort and prevent further damage, you may want to use a tennis elbow strap or counterforce brace which will help support the area and reduce stress on the injured tissue; this is worn just below the elbow, around your forearm. These bands should only be used until the tennis elbow or golfer's elbow is gone, as they can cut off circulation and impede healing or development of your muscle tissue.

If pain and inflammation persist, you can see your physician to investigate cortisone/steroid injections or topical medications, which may help reduce swelling and inflammation. However, these should be used with caution and never in conjunction with ultrasound therapy.

Physical Therapy is a beneficial way to help decrease pain in the soft tissues, restore atrophied muscles and improve elbow, forearm and wrist strength and mobility. The type of physical therapy and the duration will be dependent on the extent of your injury.

Once your pain starts to diminish, a physiotherapist will also set up an individualized arm and shoulder strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return to performing your normal routines. Individuals will often lift weights on their own, to try and build up their strength, however, in doing so, they can do more damage. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is effective. For best, long term results use ultrasound in conjunction with physical therapy and an exercise program.

Once you return to your activities, it is beneficial for you to evaluate how you use your arm in these activities to determine if you can decrease stress on the injured tissue. This may involve changing your technique, for example using a two-handed backhand instead of a one-handed backhand in tennis, which will take stress off your forearm muscles. Or, it could also mean implementing ergonomically correct practices, structures and equipment to help you perform tasks more effectively and safely, such as using a properly weighted racquet, or taking more frequent short breaks at work to rest your wrist when using a hammer or screwdriver. Speak with a professional in the specific activity or work setting to ensure you are using correct procedures and tools.

More Information

Tennis Elbow / Golfer's Elbow-Type Ailments

Lateral Humeral Epicondylitis (Tennis Elbow)
Tendonitis
Tenosynovitis

We encourage you to contact our office directly with any questions you may have regarding MendMeShop Therapeutic Products. We will do our best to answer your questions in a thorough and courteous manner.

Feel free to email us at service@mendmeshop.com. Emails will be answered promptly during business hours.

Alternatively, for those located within the US or Canada, you may contact us on our toll free number 1-866-237-9608. If you live outside of these countries, call our local number at 1 (705)445-3505

Our Office Hours

Monday and Tuesday 8:00am to 9:00pm (Eastern Standard Time)
Wednesday and Thursday 9:00am to 7:00pm (Eastern Standard Time)
Friday 8:00am to 5:00pm (Eastern Standard Time)
Saturday 12:00pm to 5:00pm (Eastern Standard Time)

Please contact us for more information. Will this product be able to control my pain and inflammation? There is a great possibility it can. All you need to do is call or email.

We wish you a great day and we look forward to hearing from you.