How to beat tennis elbow

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:
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1. Overuse 
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. 

2. Trauma
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

Change Activities
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. 

Brace it
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.

Stretch and Strengthen
This is the most important step to take after the pain has calmed down.  Stretching involves having the arm stretched out straight, palm facing down, and the other hand pulls down the wrist. Do not stretch into pain and only hold the stretch for 30 seconds.

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

Conclusion:
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.