Tuesday 18 December 2012


How to heal Tennis Elbow?

With my personal experience and bit of research on this subject, I came up with the following rehabilitation routine that helped me in healing my chronic tennis elbow agony.

Tennis Elbow may take a very long time to cure, or in fact the condition may just sit without getting better for months. It is absolutely imperative to be proactive and act accordingly to rehabilitate.

One can follow these routines in conjunction with the profession help, to ensure a rapid recovery. Please note that this guide does not substitute professional treatment.  These monthly routines include: initial home remedy, DOs & DON’Ts and effective rehabilitation tips & techniques.


1st and 2nd month:

·         RICE: Rest Ice Compression Elevation
o   Rest: especially no movements of fingers and wrist joint of affected hand, not even writing or using keyboard or a mouse. Try swapping your arm for all tasks (you can do it even if you are not ambidextrous).
o   Ice: Apply ice pack, this could be useful as it reduces internal swelling, it is recommended to apply ice right after exercise. Ice reduces inflammation however also reduces blood flow, therefore should only be applied at initial stage and use warm/hot massage techniques at later stages for better blood flow in affected area.
o   Compression & Elevation: these help in reduction of inflammation. However similar to ice, these also reduce blood flow hence can be skipped after initial stage.
·         Massage: very light / soft massage with anti-inflammatory (Caution: at this initial stage, do not massage harshly aggravating the condition.)
·         Elbow support strap: wear an elbow support in all situations when you have to inevitably use the affected arm. Carefully choose the the support strap, make sure that it does not obstruct the blood flow in arm, one with gel pad tends to work effectively (I used Epi-clasp). Tie it about 1-2 inches below the elbow, ensuring the soft muscular portion of forearm gets pressed well.
·         Ingest: increased intake of: celery, turmeric and omega-3 sources such as flaxseed oil (these are natural anti-inflammatory agents with no side effects). Also ensure that your body has enough Calcium and Vitamin D. 

 Cautions for initial stage:
  1. Avoid the wrist flexion (bending the wrist inwards).
  2. Do not rush in starting exercise & stretching at this stage. It is strongly recommended that a FULL rest is given to the affected arm as soon as the condition is diagnosed (see "What are symptoms?" section under the FAQ below).


3rd month:

·         Eccentric Exercise: start eccentric exercise using very light weights (such as small water bottle). Method: with palm facing down, rest your hand on a table, pull the fingers up using other hand, now hold a light weight (in affected hand), then slowly lower it back down (without help). Now use the other hand to lift it back up. You can call these "one-way" sets. Repeat this routine. You can use "exercise elastic band" instead of weight for resistance. (See also: "Super 7 rehab exercises for tennis elbow", link under References section.)
·         Massage: bit stronger massage (but not too strong) with anti-inflammatory.
·         Ingest: continue taking all three natural anti-inflammatory agents.
·         Stretching: start light stretching with soft pulls (do not stretch harshly) only do the wrist joint extension (avoid flexion).
·         Elbow support strap: don't forget to wear elbow support, during stretching or exercising.


Notes for best results with rehabilitation exercise:
  1. Drink lot of water (pure water not sugary drinks please). Extra hydration helps recovery (another benefit of drinking lot of water). It's a good idea to drink 3-4 glasses of (lukewarm) water first thing in the morning, which not only keeps you nicely hydrated but also clears up your digestive system, improving overall health.
  2. Taking few supplements in a moderate quantity does help with rehabilitating exercise. These include: Calcium along with Vitamins D (for bones & tendons). If you are vegetarian, do take Creatine before exercise and Whey Protein afterwards (take less than recommended portions if you are sceptical).

4th month:

·         Exercise: Continue with eccentric exercise. If you feel confident, increase the weight (but not too heavy weights yet).
·         Stretching: moderate pulls.
·         Massage: Very stronger massage with cream / oil, applying maximum tolerable  pressure on the affected area. This will temporary aggravate the pain, however pain must subside in about one minute.
Note: This massaging technique is called "Cross Fibre Friction Massage", this massage ensures that when the tendon heals, it remains flexible (rather than too brittle to get damaged again). This also helps stimulate the growth of lost tissues in the affected area.
Caution: This massage must not be  be given at too early stage of injury. One way to find out (if it's too early), is to check after half a minute of massage, whether pain is subsiding or worsening! Discontinue the massage if pain is worsening and go back to the previous routines.

5th month:

·         Exercise:
o   With both arms straight parallel to the ground, palms facing each other, hold weights (a long sticks or light-dumbbells) also held parallel to the ground, then raise the weights back and forth (10 sets) followed by twists or rotations.
o   Squeeze the stress-release soft ball.
o   Expand fingers within a rubber / elastic band looped around your fingers.
·         Stretching: strong pulls. Start doing full body yoga.

6th month onwards:

·         Exercise:
o    You can now start advance weight training for strengthening wrist & elbow joints, along side the previously mentioned exercises.
o   Start weight training for whole body, with focus on arm strengthening routines.
·         Stretching: continue with full body yoga and general rehabilitation for at least a year (even if you feel the symptoms no longer exist, do NOT discontinue yoga and exercise).

Note: One infamous yet extremely helpful tip is to practice meditation (proven technique that speeds up healing) along with leading a stress free - modest life (bkwsu.org).



Quick FAQ

What is tennis elbow anyway?

  • In general terms it's a pain in the ...., I mean pain near the elbow that takes time & effort to heal, and is caused by repetitive (back hand) movements.
  • In medical terms, tennis elbow (a.k.a. Lateral Epicondylitis) is a condition caused by inflammation in the common extensor tendon due to microscopic tears in the insertion of this tendon into the lateral epicondyle on the lateral humerus (near radial head).

What are symptoms?

  • Pain in elbow ranging from minor aches to acute stings, often accompanied with burning sensation.
  • In chronic cases, pain often propagates all the way down to the wrist joint.
  • Tender / over sensitive outer elbow bone (lateral epicondyle),  this is often noticed when it gets bumped into something causing sudden excruciating pain.
  • Lifting middle/ring finger while hand kept on a flat surface with palm facing down, aggravates the pain in outer elbow. This technique is often used in the diagnostics.

How long it takes to heal?

Full recovery may take up to one to two years, unless injury gets re-occurred. Tennis elbow is considered to be a self-limiting condition, i.e. it gets better itself eventually, however inadequate rehabilitation significantly increases the chances of recurrence.

Which of the therapies are effective?

Different people may find different therapies useful, these therapies may include:
Ultrasound, Taping, Cross Fibre Friction Massage, Isolated Eccentric Training, Chiropractic therapy, Acupuncture (and acupressure), Heated Wax therapy, General Massage therapy, Herbal therapy, Corticosteroids injection and finally operation.
Note: Not all the therapies mentioned above are medically proven.


References:




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