Sunday 16 November 2008

Tennis elbow

Tennis Elbow is a troublesome condition. The pain is caused by inflammation of tendons that anchor muscles of the forearm to the outer side of the elbow. Pain in the inner side is called golfers elbow. Let's try and understand what is happening. Take a look at your hand. You notice the hollow palm that allows you to grip. Your hand is cleverly designed by the way the muscles are placed. The muscles that operate your little finger and thumb are mainly in the hand itself. (There are two muscles that lift your thumb outwards). The muscles that operate your three middle fingers would take up too much space if they were in your hand. They run from your elbows down into the hand through long tendons. Gripping a racquet tightly, cocking the wrist, constant small movements of a computer mouse, typing with the wrists too low lead to shortening of these muscles. The constant tiny amount of pulling on the elbows inflames the tendons. The elbow and triceps muscle (chicken wings on some people) are served by a nerve from the neck called the radial nerve. Sometimes golfers cannot rotate their upper bodies far enough on the back swing. They compensate by cocking the wrist to make for the lack of rotation. That can lead to golfers elbow. The solution is to work on rotation or twisting of your rib cage.
Treatment includes stretching and exercising the muscles in your forearm. Stretches are hard to describe, but try opening your hands wide, spreading your fingers at frequent intervals. Try a loose drumming action with your wrists. 
Acupuncture helps, so does deep massage along the muscles of your forearm. They feel quite fibrous when you or someone else starts to work through them. Ultrasound or laser help, short frequent treatments work more effectively. The muscles on the outside of the forearm are attached mainly to the bone called the radius. The radius rotates around the ulna which is underneath. Sometimes the muscle contraction pulls the head of the radius slightly out of alignment. Treating this is very satisfying. If this is the cause I have seen tennis elbow improve dramatically after only one session. Treatment will also include decompressing the motor nerves (especially the radial nerve), as they emerge from your lower neck. This is not painful but helps to raise the potential of your nerves to increase energy to your muscles.
Avoiding recurrence
The most important thing that you must do is to identify what aggravates your tennis elbow and change what you are doing. Using a roller ball or tracker mouse, changing your mouse hand once a week, exercising your shoulders, improving your posture, using a gel pad or lowering your keyboard, fitting a sleeve on the handle of your tennis racquet, changing to a lighter racquet are all positive changes that you can make. 
If the condition is left untreated it becomes a repetitive strain injury or syndrome (a syndrome is a set of symptoms).