Tennis elbow, called lateral epicondylitis, is a condition characterized by pain of the lateral elbow that is provoked by extending the wrist or fingers. It is the most common cause of elbow pain and is classified as an overuse injury of the forearm muscles. Pain originates at the insertion of the forearm muscle tendon at the lateral bony prominence, the lateral epicondyle, of the elbow. It is thought that micro-tears occur at the tendon-bone junction due to tendon breakdown and muscle weakening. Research shows very little inflammation with tennis elbow. The injury is more mechanical in nature than inflammatory.
Causes of Tennis Elbow
Any activity that over stresses the involved tendon, the extensor carpi radialis brevis, can cause the disorder. Here are some causes of tennis elbow:
The most common cause of tennis elbow is repetitive strain. This can occur due to an acute or gradual cause. When a person performs many wrist extension over a short period of time, such as swinging a hammer all day shingling a roof, the tendon can have an acute overuse reaction and get injured at the elbow.
Secondly, a person can gradually injure the tendon insertion by creating prolonged irritation over days of work. This is common with jobs involving a lot of wrist movements, gripping, holding, pulling, or using a knife when cutting meat.
The tendon can become acutely injured and painful when the lateral elbow is struck by blunt force trauma directly at the tendon insertion.
3. Weakness in the mechanical Chain
There is an old song that says: "the wrist bone is connected to the elbow bone, and the elbow bone is connected to the shoulder bone....." There obviously isn't an elbow bone, but the song tells us that everything is connected and everything works together. It is very common to see weakness in the shoulder girdle causing pain into the elbow. It is important to have stability and strength with coordinated movements involving the entire mid-back, neck, shoulder, and arm. Research shows that if the neck and mid back is not functioning at their optimal ranges, arm movements are compromised.
4. Neck Dysfunction
The lower nerves of the neck go down the arm to provide sensation, muscle control/strength, and reflexes. Sometimes when a nerve is irritated in the cervical spine, the pain radiates to the lateral elbow. This cause can mimic tennis elbow pain. Another cause is the fact that decreased nerve flow to the muscle can cause weakening and therefore make you more susceptible to injury.
Gunn and Milbrandt investigated the effects of treatment directed to the cervical spine on 50 patients with lateral epicondylitis whose symptoms did not improve after 4 weeks of elbow treatment. Cervical spine treatment included 1 or more of the following: cervical traction, mobilization, isometric cervical exercises, and ultrasonography and heat. In an average of 5.25 weeks of cervical treatment, 43 patients (86%) experienced good or satisfactory relief of the elbow symptoms. (10. Gunn CC, Milbrandt WE. Tennis elbow and the cervical spine. Can Med Assoc J. 1976;114:803-809.
How to Fix Tennis Elbow
The first thing you should do is to try to avoid the repetitive activity that is aggravating your elbow. Less stress can be put on the muscle by also lifting with your hand in a palm up position so you are flexing your wrist rather than extending your wrist with your hand in a palm down position. Lessening the frequency and the weight on the elbow can also help.
Research shows that you can decrease the discomfort with a properly fitted tennis elbow brace. These can be purchased at most pharmacy stores and should be worn during the activities that aggravate the elbow.
Heat and Ice
"Heat for hurt and ice for injury": Ice is an effective way to treat an acute tennis elbow or to help calm down an aggravated chronic tennis elbow. Ten to fifteen minute intervals of ice every hour over the lateral elbow is effective. Heat is more appropriate with chronic tennis elbow that hasn't been aggravated or "flared up".
Get Your Spine Checked
There are many studies that show a link between nerve irritation in the neck and tennis elbow. A thorough examination of the cervical spine can reveal that there is dysfunction contributing to your elbow pain. The shoulder girdle and mid back spine can also be involved in tennis elbow. Shoulder dysfunction causes weakness down the chain to the elbow.
Strengthening the elbow is a priority but you should be strengthening the entire arm and shoulder. Strength training should not aggravate the elbow and light resistance with high repetitions (15 to 20) is the best method. Three sets of the exercises once a day will help you to avoid over training the area. Always remember to stop doing the exercise if it is painful and consult a professional for further advice.
Some tennis elbow exercises are:
- squeeze an object such as a sponge ball
-swirl a glass half full of water in both directions
-draw the alphabet out with your pointer finger achieving large wrist movements
-place your wrist at the edge of a table with the palm down (hanging over the edge), and with a soup can in your grasp, lift your hand up fast and then lower it slowly.
-ring out a towel both ways
-strengthen biceps, triceps, and shoulder girdle musculature
If you are worried that you might have tennis elbow, visit a trained healthcare provider to get a proper diagnosis and then establish a treatment plan. Most work can be done at home with simple tools and can be very effective.
Activity fact: Most cases of tennis elbow heal with conservative therapy with only 10-15% needing surgery at the elbow.
There is a lot of confusion regarding whether to use heat or ice when you have pain. Both therapies are inexpensive and effective when used properly. This article will reveal when it is appropriate to use either option.
The Effects of Ice
A good saying to remember is: "ice is for injury". If you sprain an ankle, twist a knee, or acutely injure another area of the body, ice is your treatment choice.
Applying ice to an injured area helps to manage swelling, decrease pain, and lower muscle spasticity. The largest physiological effect of ice is contraction of the surrounding blood vessels, called vasoconstriction. When injured, the body often over-compensates and drives blood flow to the injured area to cause swelling. The reason for this is to ward off any potential pathogen in the area, and also to promote healing. Ice is a great short-term way to calm down this over-reaction.
Ice therapy can also be applied to the entire body in the form of an ice bath or submersion. This technique is often used by athletes after rigorous exercise. Some studies show that this technique allows the athlete to recover faster by helping to control joint swelling and muscle tightness. One of the major effects of this technique is the release of endorphins, natural pain killers, for an extended period of time after the ice bath.
Ice should be applied as soon as possible after an injury and used for only 10 to 15 minute intervals per hour for the first 24 hours of the injury.
Common Icing Mistakes
1. Ice should never be placed directly on bare skin. This leads to a risk of frostbite. 2. Do not leave the ice on for over 15 minutes, even though it numbs the pain. 3. Don't apply ice to stiff and achy muscles, as it can cause spasm and pain. 4. You must rest and elevate when icing. The RICE rule is "rest, ice, compress, elevate.
Avoid using ice if you have hypersensitivity to cold, cold intolerance, peripheral vascular disease, cardiac disease, or over a re-generating nerve.
The Effects of Heat
A good saying to remember is: "heat for hurt". If you have achy muscles, pain that has been present for over three days, or chronic pain, heat is the best option for you.
The physiological effect of heat is the opposite of ice. It causes dilation of the blood vessels, called vasodilation, and therefore promotes blood flow to the tissues. This benefits an injured area because increased blood flow carries healing agents and oxygen to the injured site, and carries away byproducts of the injury. Heat therapy works very well on muscles, as there is a large blood supply in these tissues. Lactic acid is a common reason for muscle stiffness and can be decreased with the application of heat. Heat should be applied for 20 to 30 minutes per hour at a moderate temperature.
Total body heat such as spas and saunas have similar effects to applying a heat pack. Research also shows that by stimulating the cardiovascular system, saunas can lower cardiovascular risks, improve brain health, and increase lifespan.
Common Heating Mistakes
The biggest risk of using heat is getting burnt. 1. Never place heat directly on the skin, and make sure your heat pack is not too hot. 2. Always use a heating pad that has an automatic shut off. 3. Only use heat on an injury over three days old and never jump into a sauna or hot tub after vigorous exercise.
Avoid using heat to areas that are red, hot and swollen, such as an acute joint injury. Heat should not be used on areas of inflammation or on open wounds. Hot tubs and spas should be avoided if you have cardiovascular disease.
A general rule is "ice for injury and heat for hurt". Like every rule there can be exceptions. Some research shows with chronic back pain, heat and ice therapy have the same ability to reduce pain depending on the user. Also, some people just respond better to heat or to cold.
Using heat or ice can be an inexpensive and effective way to treat pain. There are many different products on the market that can be both frozen or heated. Remember to always wrap up the pack and then place it on the skin and follow the recommendations that are provided.
Activity Fact: We have proteins in our body that are activated by heat and by cold and we have an amazing ability to use these to adapt to different climates.
Pregnancy is a very exciting time for a woman. However, it can come with many physical changes that can cause back pain. It is estimated that 50 percent of pregnant women will experience an episode of back pain during pregnancy.
The rapid changes in a woman's body over a relatively short amount of time during pregnancy causes changes in hormones, changes in mechanical forces on the ligaments, and changes within the body as it accommodates the fetus. These changes, along with added weight gain, contribute to the possibility of back pain.
Relaxin is a hormone that is essential throughout pregnancy. Relaxin levels are highest in the first trimester and it acts on the uterus and blood vessels to better support the pregnancy. At the end of the pregnancy, relaxin plays a role in preparing for delivery. It acts on the ligaments to loosen and increase their flexibility. The flexibility in a woman’s spine increases the lumbar curvature, called lordosis, to shift the center of gravity forward, keeping it over the pelvis. This prevents her from falling forward as the fetus grows. This increase in lordosis also helps minimize the force acting on the muscles and ligaments. Due to the extra mobility in the ligaments, a woman is more likely to have a hyper-mobile spine and pelvis. This can also be more common after having multiple children and it increases the probability of back pain.
Spinal Pain and Pregnancy
Spinal pain can be divided into two categories: Pelvic Girdle Pain and Lumbar Pain. Pelvic girdle pain arises from the back (sacroiliac joints) and front (pubic symphysis joint) of the pelvis. Lumbar pain occurs from the five lower vertebrae. Pain commonly arises with rolling over in bed, climbing stairs and walking. If one has back pain in their first pregnancy, their chances of back pain in subsequent pregnancies increases. There is also evidence that weakness in the gluteus medius muscles will predispose to pregnancy related low back pain.
Pregnancy-related back pain and pelvic girdle pain are often exacerbated with movement and activity, and improve with rest for short periods. If you are experiencing severe back pain, or it is ongoing for more than two weeks, or it does not subside with rest, then consultation with your medical professional is important.
Early intervention can be helpful in preventing and managing discomfort. Seeking conservative care with someone who specializes in the treatment of pregnant women will be helpful in addressing any imbalances with the bones, muscles and ligaments. There is no reason to have to put up with this pain through pregnancy when there are health care providers available.
Postural changes and exercise can be helpful to prevent and manage back pain. Try the following:
* Make sure that you are walking daily.
* Avoid prolonged sitting. Move around frequently
* When sitting, keep your knees below your hips, with an angle greater then 90 degrees in your hip joints.
* Sit backwards on a kitchen chair.
* When on an exercise ball, keep your knees below your hips.
* When seated, keep your back upright, not leaning backwards.
* When standing, swing your hips in a figure-of-eight motion.
* Avoid carrying another toddler on your hip.
These postural habit changes may also help support the positioning of baby to facilitate less potential for painful back labor, or necessity for birth interventions.
It is very important to maintain cardiovascular and strength conditioning activities. If you were exercising regularly prior to pregnancy, you should be able to continue moderate intensity exercise. Moderate intensity exercise is classified as being able to maintain a conversation while exercising. If you are not able to maintain a conversation, you are working too hard. If you were running before pregnancy, you should be able to continue running while pregnant. Pregnancy is not the time to take up running. You should avoid exercises that have the risk of falling, contact sports, heavy resistance training and exercises that require lying on the back after the first trimester. (https://www.myvmc.com/pregnancy/exercises-to-do-and-avoid-during-pregnancy/). Studies of women who maintain exercise throughout pregnancy have decreased risk of gestational diabetes, decreased Cesarean section rates, and improved postpartum recovery time. If you are experiencing low back pain or pelvic girdle pain, water exercise is great alternative.
Activity Fact: Studies show that by the third trimester, the baby moves about 30 times each hour! Babies know before they are born how important it is to move!
(This article was written by: Dr. Melendy from the Neepawa Chiropractic Centre)
Back pain will effect 80% of the population at some time in their life and is the leading cause of disability and absenteeism from work. The majority of back pain is due to mechanical causes including sprains, strains, instability or degeneration.
However, there can be times when your back pain is caused from internal structures of your body rather than from joints and muscles.
How Pain Works
Pain is our signal to tell us that something is wrong with the body. We have many types of sensory nerves giving us information about temperature, vibration, touch, stretch, pain, smell, sound, taste, and sight. A common example of this can be found with back pain. When a joint is not properly stabilized by the surrounding muscles, the force going through the joint causes a strain of the surrounding tissues. There is an extra stretch to the the muscles and ligaments, provoking a pain signal to the brain. This type of pain mechanism is easy for the brain to localize in the body.
Referred pain is a different type of signal, and there are several theories of how this works. One theory is that many organs have sensory nerves that work through complex pathways, and these signals can converge at the same spot as sensory nerves from the skin, muscles and joints. The body reads sensory information from the periphery more often than the organs, and therefore assumes the pain is from this area and referred pain occurs. A common example of this is the heart. Cardiac pain in is often felt in the chest, arm, jaw, mid-back, and neck. A kidney infection may be felt as a mid back ache. You may have shoulder tip pain after having laparoscopic surgery.
The most common organs of the body to cause spinal pain are the following:
Head - brain aneurysm, tumor, or lesion
Neck and shoulder - heart, lung, diaphragm, and thyroid gland
Mid back - stomach, pancreas, gall bladder, liver, and heart
Low back - kidney, bladder, colon, reproductive organs
How to Determine the Source of Pain
When uncertain if your pain is coming from the back, there are four general rules to consider:
1. The mechanism of the injury is the most obvious tool to tell you if pain is from muscles and joints. If you have a trauma or repetitive strain injury, the pain is most likely from the muscles and joints.
2. If it hurts when you use the joints and muscles around the sore area, it is most likely joint or muscle pain as the cause. Pain when activating and/or stretching a muscle is a sign pain is not coming from the organs. (i.e. If the pain is originating from an internal structure, such as your kidney, you should be able to move about and not provoke or make the pain worse.) Often muscle and joint pain is characterized by being "sharp" and "pulling". Referred pain is characterized by being a "deep and achy" pain.
3. If you are experiencing abnormal activities with one of your body systems along with back pain it might not be the back causing your problems. (i.e. If you have low back pain and are noticing that the color of your urine is more red than normal and that it hurts to urinate, you might have kidney problems, not back problems.) You should think about your own medical history, and consider whether a previous issue is recurring, or possibly progressing.
4. If your pain does not subside with rest and lasts longer than usual, you need to consider a secondary source to your back pain. Most uncomplicated muscle and joint problems heal within 6 to 8 weeks. Persistent pain is a sign that the pain can be more than just a nagging back.
There are circumstances when your back pain may be coming from an internal structure. Listen to your body and use the information provided to determine if your pain is originating from the back or from the internal organs. Always consult a trained health care provider to help determine the cause of your pain.
Activity Fact: Women are 3 times more likely then men to experience throat and jaw symptoms when having a heart attack.