Tennis Elbow

tennis-elbow-intro

What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is characterized by pain, soreness and tenderness of the elbow. Pain is typically felt around the lateral epicondyle – a bony bump on the outer side of the elbow where the extensor muscles of the forearm insert. But it’s not just tennis players that come up against this condition. Any activity that involves repetitive use of the extensor muscles of the forearm can cause acute or chronic tendonitis under certain circumstances. Tennis elbow symptoms are usually associated with muscle dysfunction that has its origin at the upper back and shoulder.

How can it occur?

The causes of tennis elbow symptoms are often complex. The general opinion is that the condition is due to tendon overuse and failed healing of the forearm extensor muscles.
Muscle dysfunction plays an important role in this overuse process as it affects the tension and flexibility of the involved muscles. Muscle dysfunction on the arm often has its origin in an altered function of the shoulder blade (scapula), also known as scapula dyskinesia. The socket of the shoulder joint (glenoid) is a part of the scapula that serves as its mobile platform. Embedded in major muscle groups, the scapula moves on the thorax in 3 different planes positioning the glenoid in a wide range of locations. Full range of motion of the arm is only achieved if the movement of the scapula and the arm are perfectly coordinated. This coordination may be affected for several reasons. Most often, an involuntary reaction to pain or muscle fatigue stands at the beginning of scapula dyskinesia. If the scapula fails to return to normal function, false movement patterns can lead to muscle dysfunction of all muscle groups that have to compensate for it. Muscle dysfunction can extend down to the forearm and cause tennis arm symptoms.

What are the typical symptoms of tennis elbow?

The symptoms of tennis elbow develop gradually. In most cases, the pain begins mild and slowly and worsens over weeks and months. There is usually no specific injury associated with the start of symptoms. Common signs and symptoms of tennis elbow include pain or burning around the lateral epicondyle. You may also notice weak grip strength or a pain with the extension of the wrist. The symptoms are often worsened with forearm activity. The dominant arm is usually affected.

How can tennis elbow be diagnosed?

Correct diagnosis of this issue demands a thorough functional clinical examination of the shoulder girdle, arm, hand and wrist including specific tests to identify joint and muscle dysfunction. An ultrasound or MRI scan may be necessary to reveal structural damage of the extensor tendons in chronic or very acute cases of tennis elbow.
Your doctor may also order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression may be similar to those of tennis elbow.

tennisarm

This MRI scan of the elbow shows an inflammation around the extensor muscle insertion on the lateral humeral epicondyle. All liquids appear white in this picture. Inflamed soft tissue contains a higher amount of liquid. You can see that not only the tendon but also the surrounding soft tissue is inflamed.

What treatment options are there?

If you have severe or constant elbow pain, you should take a break from your ballet training. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with pain.
The RICE concept (rest, ice, compression and elevation) is an easy guideline that can be used to initially treat acute as well as overuse injuries. Please read my “First Aid” post to obtain some background information that you will need to adapt this concept successfully and learn about the use of painkillers.
In order to handle a given overuse situation successfully, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically in the rehabilitation process. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. Tennis elbow demands intense rehabilitation including corrective exercises that address present muscle dysfunction and scapular dyskinesia. Working on false movement patterns of the scapula is often challenging and requires very specific exercises to be performed on a regular basis.
Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Restriction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run. If pain is a limiting factor to an active rehabilitation approach, the use of a pain killer or a steroid injections to the elbow may be recommended. Also, aquatic training can be a good way to start training the shoulder and arm in these situations. Surgery is an option for very chronic conditions only. Tennis elbow in dancers is usually a functional problem that demands an active rehabilitation approach.

Next steps

Do you think that you might have tennis elbow and want to have it sorted out? These are the next steps:

  • See a doctor

Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.

  • Find a specialist in manual medicine

Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.

  • Start working on your problem

There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:

Flexibility training: Back mobilization in flexion, Back mobilization in extension, Deep back releaseCervical spine rebalancing/Advanced cervical spine rebalancing

Strength training: Core training – resistance band workout

Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.

  • Talk to your ballet master or dance teacher

Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.


 

 


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