Blog: Top 5 tips for elbow pain
In this week’s wellness blog, let’s explore the elbow.
Tennis elbow pain – not just for tennis players
What works & what doesn’t
My top 5 treatments
Joint pain can make simple tasks difficult. This is particularly true with elbow pain issues. The elbow is the complicated joint that links your arm and your forearm. It is made up of bone, cartilage, ligaments, and fluid. Muscles and tendons help the elbow joint move. The elbow joint allows you to position your hand closer to your body or move it away. This is referred to as flexion and extension.
Tennis elbow pain – not just for tennis players
The common ailment, Tennis Elbow, is not relegated to tennis players. In addition to racquet sports, it can affect golfers, baseball pitchers, volleyball players, and CrossFit competitors. Painters, construction workers, butchers and supermarket cashiers can succumb to repetitive motions involving elbow pain. While elbow overuse is seen mostly between the ages of 40 and 60, many junior players are experiencing this and wrist issues. As many as 10 million Americans suffer from this condition (1% - 3% of adults each year).
Tennis Elbow (lateral epicondylitis) is one of the most common forms of overuse injury. Tennis elbow is inflammation or, in some cases, micro-tearing of the tendons that join the forearm muscles on the outside of the elbow. Your forearm muscles extend to your wrist and fingers and attach the muscles to bone. Tennis elbow affects the outer side of the elbow including the muscles we use to bend our wrist backward and straighten our fingers. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).
Golfer's elbow (medial epicondylitis) is inflammation on the end of the inner elbow. Similar to Tennis elbow, Golfer’s elbow is also a painful condition of micro-tears, inflammation in the tendons that connect to the medial epicondyle, the bony prominence on the inside of the elbow. This inflammation of tendons affects the mobility of the muscles responsible for rotating the wrist, contracting the fingers, and gripping. Golfer's elbow can also include numbness or tingling in the fingers.
Tennis elbow occurs in athletes who power snap their wrists downward and inward as a part of the motion required in their sport. The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms. Tennis elbow can get better without treatment (known as a self-limiting condition). Tennis elbow usually lasts between 6 months and 2 years, with most people (90%) making a full recovery within a year. But there are several things we can do to aid recovery. Read on.
Tennis elbow is more common than golfer’s elbow. Certain activities may be more likely to cause tennis elbow rather than golfer’s elbow, and ironically, you don’t need to play tennis or golf to suffer from either problem. You can experience both tennis and golfer’s elbow at the same time.
What works and what doesn’t
Are you familiar with the treatment acronym, RICE? It stands for four standard elements of injury treatment: Rest, Ice, Compression, and Elevation. While RICE is sound advice for acute injury or a first-aid treatment, there may be other remedies out there. Let’s explore those through the lens of my experience.
Like most tennis pros, I’ve had tennis elbow – several times. At one point, it lasted almost two years! For those of you who know me well, you won’t be surprised that I have tried all kinds of different treatments and therapies, including the RICE method. However, in my elbow injury journey, only one of those four components worked for me.
This is not intended to be medical advice, rather I’m providing my personal experience. I found what worked and what didn’t work for me. The first time I had tennis elbow I rested it for 6 months. No play, no practice. When I resumed my first light workout on the court, I experienced pain again. So, I considered the “R” in RICE ineffective for me.
My body does not respond well to cold. The “I” in RICE left me feeling stiff and achy. And the “E” in RICE was a bit cumbersome as it wasn’t practical to keep my elbow raised for a period of time. The only RICE component that helped reduce pain and encouraged my healing was the “C”, compression. Wearing an Elbow Helix decreased the stress placed on my injured elbow during practice and play, and it helped protect the damaged tendon from further strain. And my Elbow Helix kept my arm warm in colder temperatures. It just works.
My top 5 treatments
I know what you’re thinking. Yes, my company is dedicated to compression products – so, of course, I’m going to tout compression. True. However, my reasoning may surprise you. Body helix believes in a salutogenic approach to wellbeing. And we pride ourselves in honesty in advertising. The impetus for the creation of body helix was to create high-quality, effective gear – for myself, my buddies, and my students. I boast compression as being at the top of this list simply because it is the single best treatment for these types of injuries.
The following 5 treatments have worked optimally for my body.
- Compression
- Nutrition
- Stretch + Strengthen
- Massage and other therapies
- Anti-inflammatories
Here is my discovery:
- Compression
Tendons, ligaments, cartilage, and some muscle fibers are dense soft tissue. They receive limited blood flow and, when injured, can take a long time to heal. Blood carries nutrients and oxygen to injured areas, which are needed for recovery. It also flushes away toxins and waste at the same time. Increased blood flow helps accelerate our body’s healing process.
Exercise is the best method to increase blood flow naturally. However, it is common for people suffering from tendonitis to reduce their activities. This lack of activity and mobility of the joint will reduce blood flow and slows the healing process. Long periods of immobility can lead to atrophy, which can result in re-injury or a chronic soft tissue injury cycle. The secret here is to keep moving in a controlled way without causing more injury.
Compression can help you move through it. It allows more oxygen to be delivered to muscles before, during and after a workout. More oxygen to the muscles means better performance, less fatigue and faster recovery. The body helix Form-Fit technology, with 300% stretch capacity, creates uniform compression supporting and warming the injured area.
Coach’s sidebar: Put your helix on at least 30 minutes before your activity. The compression begins to warm your muscles and tendons and increases blood flow. Also, during the cold winter months, I often wear an Elbow Helix as a precaution/preventative measure even when I don’t have any symptoms. My arm circumference measurement falls between a medium and a large size.
When I’m competing, I wear the medium size for extra support. Before and after playing I wear a large which offers less compression but is good for warmth, support and recovery. Compression reduces the heaviness and fatigue that I may experience after a grueling match. If I feel less sore, I’m more motivated to keep going.
2. Nutrition
The foods we eat play an important role in preventing and recovering from injuries. Optimal nutrition can help manage inflammation, provide key nutrients for rebuilding injured tissue, minimize muscle atrophy, and support strength preservation and gain. Training without enough nutrition can cause loss of muscle mass and muscle injury.
The Standard American Diet (SAD) is so far removed from salutogenic eating habits, I would be hard-pressed to deliver a concise salvo here. Suffice it to say, food is such a key component to health, I’ve dedicated several previous blogs to this topic. Let me distill and reinforce a few key points here.
- Eliminate (or at least limit) unhealthy foods that are high in sugars, simple carbs, and processed ingredients.
- Choose organic whenever possible.
- Drink lots of fresh, filtered water every day. (Do not hydrate with diuretics.)
- Drink sports drinks responsibly. (Coming soon Hydro Helix.)
Becoming and staying focused on healthy eating habits will go a long way toward strength and injury prevention/recovery. Here are a couple of previous blogs if you care to study this more.
Understanding Our Energy Systems
The Great American Sugar Paradox
3. Stretch and Strengthen
If your muscles, bones, and joints are prepared for intense activity, they can cope with extra strain. Stretching, before and after play or practice, helps build strength and flexibility. It also improves balance.
Stretching and strengthening the forearm muscles will minimize pressure placed on the elbow tendons. In addition to the specific extension and flexion exercises outlined below, I do grip squeezes, forearm twists (flexbar), bicep curls, and several resistance-band stretches.
Wrist Extension
- Sit in a chair holding a 5-pound smart-bell in your hand with your palm facing down and elbow resting comfortably on your knee.
- Keeping your palm facing down, extend your wrist by curling it towards your body. If this is too challenging, do the movement with no weight.
- Return to starting position and repeat until you reach a slow burn. Then add more reps. Don’t focus on counting reps, rather feel and listen to your body.
- Try to isolate the movement to the wrist, keeping the rest of the arm still.
Wrist Flexion
- Sit in a chair holding a 5-pound smart-bell (I do not use the term dumb bell) in your hand with your palm facing up and elbow resting comfortably on your knee.
- Keeping your palm facing up, flex your wrist by curling it towards your body.
- Return to starting position and repeat until you reach a slow burn. Then add more reps. Don’t focus on counting reps, rather feel and listen to your body.
- Try to isolate the movement to the wrist, keeping the rest of the arm still.
Beyond specific flexibility exercises for the elbow, performing various range-of-motion exercises helps increase flexibility and diminish stiffness. The wider the spectrum of exercises, the better. Any method of exercise that brings on slow muscle burn without sharp pain is an exercise that can strengthen. Creating a wide variety of exercises can reduce both imbalances and overuse syndrome. Unlike creatures of habit who do the same exact workout routines over and over, I have chosen to do a never-ending change-up of exercises. I continually experiment with variations. I do not believe that monotonous workouts are a healthy way to become a functional mover on a tennis court. Remember, this is what works for me.
Coach’s sidebar: When I’ve experienced elbow tendonitis, my dominant (left) forearm and grip strength are weaker than my non-dominant arm. Seems counter-intuitive to me. You would think that with all the tennis I have played and having a one-handed backhand that my dominant arm would always be much stronger. All the more reason to stay focused on controlled strengthening and stretching.
4. Massage and other therapies
Massage and other muscle-stimulation techniques, such as pulsed ultrasound can help boost your body’s blood flow and healing process. This can stimulate a quicker natural healing process. Some other practices I’ve used successfully are Rolfing, percussive therapy, cold laser, and tens stimulation.
Rolfing works on the body’s web-like complex of connective tissues. Its use of direct pressure stimulates intra-fascial mechanoreceptors (sensory neurons of the muscle nerve), which in turn trigger the nervous system to reduce the tension of the related muscles and fascia.
Percussive therapy can help relax tight muscles, break up scar tissue and adhesions, and minimize muscle soreness and tension. Percussive therapy is as effective as massage in preventing DOMS (delayed onset muscle soreness). It improves flexibility. It increases blood circulation and improves lymphatic flow.
Cold laser therapy stimulates healing using low levels of light. It has been shown to have a positive effect on acute and chronic musculoskeletal injury.
A transcutaneous electrical nerve stimulator (TENS) sends electrical pulses to release endorphins and other substances to stop pain signals in the brain.
5. Anti-inflammatories
Non‐steroidal anti‐inflammatory drugs (NSAIDs) have long been the first line of treatment for tendonitis, including that of the lateral elbow. Oral and topical NSAIDs are available over‐the‐counter and by prescription. Recognized NSAIDs like Advil (ibuprofen), are among the most frequently consumed in the developed world. Their adverse side effects are well known. Oral prescription NSAIDs have their place in conventional medicine if used cautiously.
The FDA has continued to issue a black box warning to the general public saying that prescription NSAIDs can increase the chance of heart attack and/or stroke. Even topical NSAIDS, like Voltaren, can have serious side effects if used long-term or in high doses.
I avoid consuming over-the-counter pain relievers, such as Advil, Motrin, or Aleve. And I do my best to shun almost all prescription medications. I’ve sought out what I consider to be more natural remedies. However, you should consult your physician and understand your unique needs.
Herbal oral and topical products that I use to relieve injury pain contain arnica. Arnica is a perennial herb found in East Asia, Europe, the northern US, and Canada. Its medicinal history dates back several centuries. It is used to help minimize bruising and promote the repair and growth of tissues. I like Traumacare ointment. It is a natural anti-inflammatory cream containing homeopathic arnica. Oral Arnica Montana 30c (not FDA evaluated) has also served me well on many occasions. It’s not instant relief and takes a few days to kick in, but it works effectively in my body.
Coach’s sidebar: The number one inflammatory substance consumed regularly by Americans is sugar. To reduce inflammation in your body, stop eating it – in all its many hidden forms. In fact, rather than popping the Advil, stop the sugar. Doesn’t it seem reasonable to rid your injured body of any further inflammatory agents while it is trying to heal?
I realize this is another example of what I consider ‘uncommon sense’. Another approach over ingesting medications is to simply increase your hydration with fresh filtered water. Give your body a fair chance to flush toxins (sugars). If you are consuming Fructose (think common juices, dried fruits and sports drinks), you are pouring inflammation into your body. Really bad idea. Simple carbs = Simple minds.
As a quick recap, here are my top 5 tips to promote injury healing and stay healthy:
- Compression promotes increased blood flow accelerating the body’s own ability to heal itself.
- Optimal nutrition controls inflammation and provides key nutrients for rebuilding injured tissue.
- Stretching and strengthening muscles will minimize pressure on joints.
- Massage and other muscle-stimulation techniques can help boost your body’s natural healing process.
- Choose the safest, most natural oral and topical products to relieve injury pain with the fewest side effects
In true form, I continually experiment with therapies and pay attention to what my body is telling me. If a particular remedy works, then great. If I’m not getting the results I need, I diligently Move Through It to find new solutions. I’m happy to say that I have not had tennis elbow for a very long time.
My recommendation is for you to investigate different options. Persist to find what works best for your body. Again, this is not intended as medical advice. Consult your physician as needed.
Until next week my friends, be thoughtful about your long-term potential.
Learn. Share. Inspire.
Have a thoughtful day,
Coach Fred
