Tennis Elbow, Golfers Elbow and Epicondylitis - Common symptoms of overuse and how to repair healthy tissues

Tendon overuse, tears and degenerative injuries

When someone says they have Tennis elbow - what do you imagine? For obvious reasons, we often put two and two together. But take away the obvious wear and tear and you are left with tendinopathy.

Tendinopathy usually includes inflammation and damaged tissues at the tendons. Besides Tennis Elbow, others in this category include Golfers Elbow and Biceps Tendinopathy.

The common patterns among tendinopathies include:

• Overloading

  • The tendon is unable to handle the load placed on it

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• Degeneration

  • Repetitive actions that go unaddressed lead to alterations in collagen fibers

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• Micro Tearing

  • Eventually the tendon is unable to repair itself between repetitive loading

The commonalities with tendinopathies are as follows:

• Activity-Related

  • Tendency to worsen with specific, functional motions

    • Flexing, gripping, lifting, rotating

• Conservative Treatments

  • RICE protocol

  • Eccentric drills to strengthen tendons and surrounding muscles 

• Attachment Pain

  • Localized pain, tenderness and inflammation to where tendon attaches in arm

Each of these tendon issues, Lateral Epicondylitis, Medial Epicondylitis and Biceps Tendinopathy, usually see improvements with the following mobilizations with the only difference being which area of the tendon is affected/targeted: 

1. Massage: Cross friction over tendon (infra-medial or infra-lateral) to olecranon (or shoulder)

2. Trigger Point: use tennis ball or similar to sink into belly of muscle (flexor, extensor or biceps) and hold while you slowly open and close that hand (or roll out and hold at trigger points)

Let's break down what each means in a bit more detail. 

1. Lateral Epicondylitis: Tennis Elbow; overuse/strain of Wrist Extensors

Drills

• Eccentric Wrist Flexion

• Forearm Pronation / Supination

• Finger Extension

Notes: make certain you feel each exercise at the top and outside of your arm (instead of the inside of the wrist)

2. Medial Epicondylitis: Golfers Elbow; overuse/strain of Wrist Flexors (also jointly called Common Flexor Tendon) - including Pronator Teres, Palmaris Longus, Flexor Carpi Ulnaris and Radialis

Drills

• Eccentric Wrist Flexion

• Forearm Pronation / Supination

• Towel Wring/Grip

Notes:  a mild, dull ache is okay during these drills, but beyond that you should beware.

3. Biceps Tendinopathy: Overuse/strain on biceps tendon at elbow or shoulder 

Drills

• Eccentric Biceps Curl

• Biceps Isometric Hold

• Straight Arm Shoulder Flexion

Notes: Do not continue if there is a popping or clicking at the front of your shoulder. Start with the lightest weight and do not increase the load unless there is no acute ache or pain. Interestingly, the scapulae likely need more mobility to offload the elbow and forearm. When there is an overcompensation you likely will be unable to fully reach overhead, or shoulders shift towards your ears with specific loading. To address this, scapular wall slides, foam rolling and thoracic extensions are encouraged. You can also work on Ws, Ts, and Ms in a prone or standing position.

Not any of these drills, stretches or activations should cause sharp, acute pain. For more of a visual guide and reference, check out this Golfers Elbow video here. When I watched this video I thought the wrapping at the joint was something I’d done before, but I was wrong. Voodoo wrapping looks very similar to BFR (blood flow restriction) as they both allow for hyperfusion, but the former is short duration and used for gliding movement instead of muscle activation. For Tennis Elbow I recommend this video. And nerve flossing can be as simple as this.

As always, consult a physician and physical therapist to pinpoint what the root cause is and what exercises and drills your body is ready for. And use your best judgement and intuition even with a consult.