This is an update to the Tennis Elbow treatment in my Sports Massage DVD.
Tennis elbow is also known as extensor tendinitis or lateral epicondylitis. It can be caused by an improper form in playing tennis, typically by flicking the wrist when doing a backhand. It also may occur as an overuse injury from too much time at a computer keyboard.
The pain of tennis elbow is often from a muscle strain of the wrist and finger extensor muscles which attach at the lateral epicondyle of the humerus. Occasionally the supinator muscle may be involved as well as it shares this muscle attachment.
A muscle strain of the extensors can be assessed by having your client attempt to extend their wrist and fingers against your resistance. If there is a muscle strain your client will be able to point with one finger to the location of the pain. If the pain is more general it is likely from muscle tightness or trigger points. To test for a muscle strain of the supinator muscle have your client attempt to supinate their forearm against your resistance.
A muscle strain causes scar tissue to form in the muscle. This scar tissue can inhibit the normal broadening action of a muscle when it contracts which will cause muscle pain upon contraction.
The standard of care for treating muscle strains was developed by Dr. James Cyriax. It involved using cross-fiber friction for 5 – 7 minutes, followed by ice, then eccentric contraction of the muscle. It was believed that the cross-fiber friction would break down scar tissue crossing the grain of the muscle and leave the scar tissue that was in alignment with the muscle fibers. Ice was then applied to relieve the inflammation caused by the 5 – 7 minutes of cross-fiber friction.
Cross-fiber friction does not realign scar tissue, it only softens it. Since scar tissue is disorganized and runs in all directions, we now do multidirectional friction instead of cross-fiber friction. We only friction the area for 20 – 30 seconds, so it does not cause inflammation and ice is not needed.
The realignment of scar tissue happens with eccentric muscle contraction. Eccentric muscle contraction causes fibroblasts to lay down collagen in the direction of the muscle fibers. This creates a more functional scar tissue that does not bind across the width of the muscle, allowing muscle contraction to occur without pain.
Protocol to treat muscle strains
Identify the location of the muscle strain by having your client do an isometric contraction of the muscle. If there is a strain they will be able to point to a painful spot with one finger. If the pain is more general it may be from a trigger point instead.
Relax the surrounding muscle then do multidirectional friction to the strained area for 20 – 30 seconds while the muscle is in a relaxed position.
Follow the friction with gentle, pain-free, eccentric contraction of the muscle. You can gradually increase the resistance for the eccentric contraction, as long as the movement is pain-free.
Please Note:
The supinator muscle also attaches to the lateral epicondyle of the humerus, so your client may have pain around the lateral epicondyle from a muscle strain of the supinator muscle. You can test for this by having your client try to supinate their forearm against resistance. If pain localizes to the lateral epicondyle it is likely from a muscle strain of the supinator.
Treatment would involve multidirectional friction then eccentric muscle contraction. For the eccentric contraction, your client would resist as you gently try to pronate their forearm.
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1 thought on “Tennis Elbow”
good technique. I plan to use this one with my clients.