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Tennis elbow, clinically known as lateral epicondylitis, is a tendonitis of the forearm extensor muscles. This group of four individual muscles attaches to the outer part of the elbow via a common tendon. They work together to extend the wrist and fingers and assist in forearm flexion. The most commonly affected muscle of this group is the extensor carpi radialis brevis (ECRB). Pain from tennis elbow is most acutely felt along the outer part of the elbow, known as the lateral epicondyle of the humerus. Pain and tenderness usually comes on gradually and can be present even at rest. It can also be further aggravated by simple tasks such picking up objects or opening doors. In chronic cases, your grip may weaken and you may feel the pain radiate down the forearm and into the wrist, or up into the shoulder.

 

 

 

 

 

 

 

 

 

 

 

Tennis elbow is considered a repetitive strain injury. Think of a tennis player repeatedly hitting the ball with a backhand stroke. The repetitive loading and pull of these muscles over time creates micro-tears in the muscle and tendon, which ultimately leads to inflammation. Poor conditioning and poor mechanics can greatly increase your chances of developing the condition. But tennis elbow is not limited to only tennis players. Basically anyone who uses their hands in a repetitive way such as musicians, chefs, painters, writers, carpenters and even massage therapists are all at risk. Writers for example may develop what’s known as “writer’s cramp.” The constant contraction of the forearm extensors in addition to the cocking of the wrist, will over time lead to muscle exhaustion and eventually irritation of the tendon.

Recent studies have also shown that a single event, such as a direct blow to the elbow or a sudden overloading of the muscles, can precipitate a sudden onset of tennis elbow. The counterpart to tennis elbow is golfer’s elbow, also known as medial epicondylitis. By contrast, golfer’s elbow causes pain along the inner part of the elbow where the tendons of the forearm flexors attach. A common diagnostic test to confirm the presence of tennis elbow is to extend the wrist and fingers back with an out stretched hand. Think of doing the “police stop sign.” If maintaining this position is painful or uncomfortable, you may have lateral epicondylitis.

Treating tennis elbow may involve a two-week period of rest and a complete cessation of the offending activity. Massaging the area with ice 2-3 times a day for approximately 15-20mins will help decrease inflammation. Some find using a compression brace on the forearm just below the elbow helpful in preventing a further pull on the epicondyle. After the acute stage has passed, gentle range of motion exercises along with myofascial release and trigger point work to the forearm muscles can be done. If after several weeks of rest one can perform ten pain free isometric contractions of the extensors muscles, one can begin resuming regular activity.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, Certified Thai Yogi, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

There are certain aches and pains that arise over time due to repetitive movements that can occur on the job, at the gym, or even at home. And whether we realize it or not, these aches and pains can be the result of a multitude of micro-tears to muscle, fascia, or tendon. These soft tissue structures become comprised from over use and eventually lead to inflammation. Let’s take a look at some of the contributing factors involved in this syndrome.

A lot of overuse injuries occur on the job. They can affect just about anyone from a manual laborer to an office worker. Whenever we perform repetitive actions such as in typing at the keyboard, lifting heavy objects, standing or sitting for prolonged periods, we run risk of overtaxing the soft tissue structures involved in those actions. Carpal tunnel syndrome for example can be the result of faulty mechanics, such as in prolonged extension of the wrist and hands while at the keyboard. It can also occur from micro-trauma due to repetitive movements done over time, such as in those who use power tools, paint, play an instrument or racquet sports — the list can be extensive. The median nerve which passes through the carpal tunnel of the wrist becomes compressed and inflamed, which can then lead to tingling, numbness, weakness and pain in the finger and wrists.

Another place where over use injuries can occur is at the gym or while playing sports. Athletes are notorious for developing tendonitis and stress fractures due to repetitive movements and over use. Runners for example are prone to developing conditions such as Achilles tendonitis, plantar fasciitis, and shin splints, especially in those who are poorly conditioned. People who play racquet sports or golf are susceptible to developing shoulder tendonitis in any of the rotator cuff muscles, golfer’s elbow (which is tendonitis of the forearm flexors attaching on the inner part of the elbow), or tennis elbow (which is tendonitis of the forearm extensors attaching on the outer part of the elbow). People who play soccer, basketball, volleyball, or any sport that requires starting and stopping, cutting movements, sprinting, or jumping can see overuse injuries ranging from patellar tendonitis (i.e. jumper’s knee, runner’s knee), to ITB friction syndrome which is caused by a tight iliotibial band frictioning the outer part of the knee. Chondromalacia Patella or Patellofemoral Syndrome occurs when the patella does not track properly in the patellar groove when the knee is extended under load. Think of doing squats or climbing stairs. The articular cartilage eventually gets worn away, resulting in pain and inflammation along the inner part of the knee.

These types of repetitive use injuries are not limited to the job or the gym. Most of us have hobbies that involve repetitive movements. Playing an instrument is a good example. Think of the muscles involved in playing the piano or the violin. Hours and hours of practice can eventually lead to pain and inflammation of the fingers, wrists, elbows and shoulders. How about gardening? Pulling up weeds or potting flowers can require us to maintain certain positions which can stress our knees, hips and low back. There’s even a condition known as blackberry thumb or gamer’s thumb. De Quervain’s syndrome, its clinical nomenclature, is a tenosynovitis (a tendon sheath inflammation) and repetitive use injury (RSI) of two key tendons attaching on the thumb. It usually results from an over use of the thumb and wrist while texting or playing video games.

Now that we’re familiar with some of the most common manifestations of repetitive use injuries, here are some of things we should consider as part of a preventative care plan:

  • Most over use injuries stem from muscle imbalances. Are we pushing ourselves too far, too fast in our training before we’re properly conditioned? Are we using good form when performing certain movements?
  • Certain jobs may require us to perform repetitive movements at work. If this is the case, are we taking periodic breaks? Can we switch sides so we’re not using the same hand, arm, or shoulder? Are we using faulty equipment to perform these tasks? Developing an awareness of these mitigating factors can go a long way in preventing an injury.
  • Warm ups and stretches. Whether we’re going out for a run or getting ready to play an instrument, a little warming up goes a long way. Gentle range of motion of the joints and targeted stretching of key muscles will help reduce the likelihood of a strain by increasing blood flow and oxygen to the area.

Signs and Symptoms:

If you think you may be dealing with a repetitive use injury, here are some common signs and symptoms:

Localized pain: Whether its Achilles pain, knee pain or shoulder pain, you’ll feel it acutely at the site of inflammation. The pain may be brought on from use of the inflamed muscle or tendon, as in an isometric contraction. It can result from stretching the inflamed tissue. And in advanced cases, the pain may be constant even while at rest.

Tenderness: Minimal pressure to the area can often induce pain. In cases of acute tendonitis, the whole muscle may feel sore to the touch.

Limited ROM: Your mobility of the affected area may be limited and painful. Lifting your arm above your head for example may be hard to do in certain cases of shoulder tendonitis.

Swelling: Inflammation can lead to swelling and heat in the affected area.

Crepitus: Clicking or creaking sounds may be heard during certain movements of the affected area.

Treating over use injuries can require several approaches, not least of which is time to heal.

Treatments:

R.I.C.E.: If you’re not familiar with this acronym, then it maybe one of the only things you should remember when dealing with acute injuries.

  • Rest: In some cases as much two weeks may be indicated. The body needs time to mend the damaged tissue.
  • Ice: applying ice is a great way to reduce inflammation.
  • Compression: wrapping the injured area with and ACE bandage or brace will provide added support and help keep you mobilized.
  • Elevation: In cases of acute trauma and inflammation, elevating the area will help to reduce the swelling.

Proximal massage: Massaging the area directly above the injured site, for example the calf muscles in cases of Achilles tendonitis, will help to increase circulation and drainage to the injured site.

Range of motion exercises: Moving the affect area in a pain free and gentle way after the acute phase has passed, will prevent muscles and tendons from tightening up from under use.

Ice massage/Contrast bathing: Depending on where you are in the healing process, ice massage to the affected area will help reduce pain by decreasing inflammation. Later on in the healing process, heat can be introduced in conjunction with cold applications to create a pumping affect. This is excellent for removing waste byproduct trapped in the affected area.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

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