MY ELBOWS HURT,
BUT I DON’T PLAY
TENNIS!
By Karena Wu, PT,
MS, CSCS, CPI, CKTP
O
uch! That pain
on the outside of
the elbow – it comes
and once it’s there, you
feel pain when you use
your hands. It’s hard
to get rid of so you
go see a healthcare
professional and they
title it ‘Tennis Elbow’,
but you say, “I don’t
play tennis! I work in
the kitchen way too
many hours to be out
playing tennis. I’m
measuring,
mixing,
lifting,
kneading…
using my hands all day
so why do my elbows
now hurt? What is this
thing they call Tennis
Elbow?”
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Tennis elbow is the layman’s term
for Lateral Epicondylitis. It is an
inflammation of the tendon of the
wrist extensor muscles, which sits on
the outside of the elbow (the lateral
epicondyle). Specifically, it is the
Extensor Carpi Radialis Brevis that is
usually the primary muscle involved.
It is a condition which makes the
outside of the elbow sore and tender,
and makes movements of the wrist
and activities of the hand painful and
difficult.
A longtime client of mine, Wylie
Dufresne, was afflicted with this
injury for years. In fact, when I first
met him in his kitchen in 2004, he
had on his elbow the aircast brace.
Immediately after shaking his hand
(the one with the brace), I diagnosed
him and told him ‘You’ve got tennis
elbow.’ And he said, “Yes!!!” I then
proceeded to explain the mechanism
of injury, what happens in the
joint and why it becomes a chronic
condition so easily. He let me do a
joint mobilization on him, test his
handshake grip and then was amazed
at how the strength increased and
the pain decreased after that one
mobilization. I have been working
with him ever since.
The wrist extensor muscle group
is responsible for extending the wrist
(backward bending) and is important
in using the hand. It is the muscle
group that allows you to generate a
strong grip. Which means working
in the kitchen can be excruciating.
Holding a measuring cup, pouring a
pitcher of milk, gripping an electric
mixer, lifting baking trays, or even
pulling the oven door open can
become painfully difficult. It is usually
caused by overexertion or repetitive
stress. The pathophysiology of it is
degenerative, which means
you should take care of it
right away because this is an
injury that can last for years.
With overuse/repetitive
stress injuries, persistent
microtrauma can cause small
tears in the tendon. Over
time, this can lead to pain
and swelling in the tendon
which attaches to the bone. Twisting motions of the
nighttime where we pull
the sheets back and fluff the
pillows for bed.
Signs and symptoms of
tennis elbow include: lateral
or outside elbow pain with
use of the wrist or hand,
tenderness on the outside
of the elbow, swelling, and
weakness in hand use,
especially gripping. There
can be pain at rest if the
as ibuprofen, naproxen and
aspirin) are taken to reduce
inflammation. You can also
do some self-massage into
the extensor muscles and
the extensor tendon to
loosen up the tightness in the
muscle belly as well as bring
blood flow into the tendon to
promote tissue healing.
You may also want to
invest in an arm brace. It
wrist, gripping of awkwardly
shaped or large items, and
even constant computer and
keyboard usage can cause
tennis elbow. In the kitchen,
the motions associated with
elbow pain can be holding the
sauté or saucepan, whisking,
kneading and lifting heavy
or large baking trays. We use
our hands all day, from the
moment we open our eyes
and we turn off our alarm
clock, all the way into the
injury is more severe. X-rays
are usually not needed,
and diagnosis can be made
by your physician or other
healthcare provider.
Home treatment can be
successful if the symptoms
are mild (pain only with
use). You will need to rest
the inflamed tissue, which
means avoiding aggravating
activities. Ice application 2-3
times per day as well as oral
anti-inflammatories
(such
is appropriately titled, a
‘tennis elbow brace’ and
can be picked up at almost
any drugstore or medical
supply store. The purpose
of this external brace is to
offset the tensile forces that
cross through the tendon.
When the muscle contracts
and pulls on the tendon,
the tendon then pulls on the
bone to produce movement. The brace applies pressure
on the muscle tissue which
displaces the amount of
force that crosses through
the tendon thereby reducing
pain when the muscle and
tendon contract.
Treatment
for
this
injury includes a variety of
therapies. You can go the
traditional route of physical
therapy, which will include
modalities to reduce pain
and inflammation, as well
as gradually strengthening
and
stretching
of
the
forearm
muscles.
Your
physical
therapist
will
also review your activities
and
suggest
possible
ergonomic correction of your
movements or activities.
Acupuncture is another
therapy that is helpful
in loosening up the tight
muscle tissue and bringing
bloodflow
and
energy
healing into the area. It is
more of a passive therapy
and you will have to learn
the appropriate exercises
once the inflammation has
reduced enough.
Call
your
healthcare
provider if home treatment
does not help, or if this is
the first time you have had
these symptoms. They can
guide you in the appropriate
treatment for your case. Chronic cases can include
cortisone injections as well as
Platelet Rich Plasma (PRP),
which your physician will
administer. At worst case,
surgery may be warranted,
but it is based on your history
and progression with this
injury so ask your physician
for a recommendation to
speak with an orthopedic
surgeon.
Karena Wu is a New York State
licensed physical therapist, a
graduate of the program in
Physical Therapy at Columbia
University and owner of
ActiveCare Physical Therapy,
located in midtown Manhattan.
She has advanced training in
manual therapies, specifically
in Maitland Joint Mobilization
and
Myofascial
Release.
Karena is certified as a Strength
and Conditioning Specialist,
Kinesio Taping Practitioner
and
Pilates
Instructor.
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