Tennis Elbow (Lateral Epicondylitis)
Coping with Elbow Pain
One soft tissue problem that I commonly encounter is mouse elbow (a.k.a.lateral epicondylitis). Years ago this condition was coined tennis elbow, when the backhand swing in tennis was a common cause of the condition. However, nowadays computer use is one of the main culprits involved with this condition..
Let’s start with a quick anatomy lesson. Most of the muscles that create hand or wrist movement originate in our forearm. Muscles that open our hand and lift our wrist are located on the outer forearm (see figure 1). These muscles, (collectively known as our forearm extensors) are constantly working, or in a state of contraction when we are using a keyboard or a mouse. Most of these muscles attach to a bump on the outside of our elbow (at a bony prominence known as the lateral epicondyle) by way of tendons (see figure 1). Mechanical trauma to this area can occur from sports or from manual labour, but repetitive strain is the more common cause in today’s workplace. Muscles that are asked to remain in a contracted state without adequate rest cycles constrict their own blood supply, and eventually metabolic wastes build up causing a burning sensation.
If the burning feeling is ignored, the muscles usually become chronically tight, and tendonitis can develop. The classic symptom of this condition is pain near the outside of the elbow when the muscles are placed under load, or when you press on the affected area. Initially the pain may be felt along the outside of the forearm and elbow, but if allowed to fester this condition can lead to weakness of all the muscles on the outside of the arm. As with any soft tissue pain, elbow pain should be assessed by a health professional. Treatment may vary from one individual to another, however many of the following suggestions can help you with this particular condition.
- Direct soft tissue work- This is an area that massage therapists specialize in. Soft tissue work can be painful but it is usually the quickest route to recovery. When it is combined with other therapies it can be even more powerful. The following techniques can all help with this condition:
- Deep muscle stripping to forearm muscles
- Trigger point massage
- Friction massage of involved tendons
- Soft Tissue Release of forearm muscles (painful but very effective)- We see a lot of success with this modality, especially when combined with Therapeutic Ultrasound. It is a fast and effective treatment for people who need to be rid of this condition.
- Cold Treatment– A Cold pack should be used after any exertion or deep massage, or when experiencing pain in the elbow. Use a wet towel so that ice does not make direct contact with the bone. Do not leave the cold on for longer than ten minutes. If the pain continues then you can do several cycles of cold for ten minutes on, followed by ten minutes off.
- Ultrasound treatments can speed up tissue healing if combined with stretching and soft tissue work. In my experience, ultrasound on its own doesn’t work well. Ultrasound can help however if a therapist gets in there and does direct soft tissue work immediately afterwards.
- Acupuncture is another modality that can be helpful when combined with soft tissue work
- Stretching should be done with a straight elbow. Flex your wrist of the affected arm as in figure 2. The stretch can be increased gently by the other hand, but stop before wrist pain begins. This stretch should be held for 20 seconds and repeated at several times per day.
- Strengthening – Once the area has healed, you can begin strengthening the muscles and tendons involved (see figure 3). The stronger an area of the body is, the less likely it is to be injured again.
- Elbow Brace– While I am not personally big on these devices, some people do find use of a brace helpful when performing aggravating activities. These can usually be purchased at your local pharmacy.
- Anti Inflammatory Medication-This is outside of my realm of expertise, but there are natural anti-inflammatory products on the market as well as the prescription and non-prescription options. Ask your doctor or pharmacist about these options.
- Ergonomic Assessment– If keyboard or mouse use is the primary cause of your pain then you may need to look at ergonomic assessment of your workstation (home and office). Sitting with relaxed shoulders, your forearms should be parallel to the floor when using your keyboard (see figure 4). Your mouse should definitely be at the same height as your keyboard! To achieve this position most people either have to drop their desk (or keyboard tray), or raise their chair. For more on these topics check out my articles on both Workstation Ergonomics and Repetitive Strain Injury
- Regular Workplace Stretching- Apart from a good ergonomic set-up it is important to get blood flowing into your arms by taking 30 second stretch breaks at least every 30 minutes. This will go a long way toward loosening tight muscles, getting healing blood into your forearms and prevent re-occurrence of this condition. For a good .pdf file of computer and desk stretches click here.
Mouse elbow needn’t be a lifelong condition, and ignoring the pain can lead to more serious issues like numbness and tingling in the fingers and weakness of the forearm muscles. It can be a very stubborn condition though, particularly if the aggravating factors are not addressed. However if you get treatment, improve your ergonomics, and begin stretching regularly, you can say goodbye to mouse elbow.