Primitive Therapy
22691 Lambert St #520
Lake Forest, CA, 92630
949-310-4276(phone)
888-391-4236 (fax)
info@primitivetherapy.com
22691 Lambert St #520
Lake Forest, CA, 92630
949-310-4276(phone)
888-391-4236 (fax)
info@primitivetherapy.com
How Can We Help?
Neck Pain
Shoulder Pain
Elbow Pain
Low Back Pain
Hip/Pelvic Pain
Knee Pain
Foot and Ankle Pain
Neck Pain
Shoulder Pain
Elbow Pain
Low Back Pain
Hip/Pelvic Pain
Knee Pain
Foot and Ankle Pain
The Tennis Elbow Solution
Learn how to solve your pain by following simple exercises. These exercises are design for people who want to self-manage their pain from home and for those who are currently getting treatment and want to get better and longer lasting results.
Click Here
Click Here
Click Here to Schedule an Appointment or Contact Us
The Elbow Pain Solution
The most common elbow problem is Tennis Elbow (Lateral Epicondylitis/osis). We have explained our approach to treating the elbow in our article, Stop Tennis Elbow Before it Stops You, below. Golfer's Elbow (Medial Epicondylitis/osis) is very similar to Tennis Elbow except the symptoms are in a different location (but the cause is almsot exactly the same).
There are other forms of elbow pain resulting from the bones of the elbow not lining up properly. The olecranon (the large bony protuberance at the elbow) must into its fossa (a groove in the humerus of the upper arm designed for the olecranon to rest in) properly. Very commonly the olecranon is jammed out of this fossa, disrupting the proper alignment and functioning of the elbow. This can lead to all sorts of symptoms - Tennis Elbow, Golfer's Elbow, and tricep pain to name a few.
There are other forms of elbow pain resulting from the bones of the elbow not lining up properly. The olecranon (the large bony protuberance at the elbow) must into its fossa (a groove in the humerus of the upper arm designed for the olecranon to rest in) properly. Very commonly the olecranon is jammed out of this fossa, disrupting the proper alignment and functioning of the elbow. This can lead to all sorts of symptoms - Tennis Elbow, Golfer's Elbow, and tricep pain to name a few.
Stop Tennis Elbow Before it Stops You
In this article we discuss what Tennis Elbow is, why it happens, how to properly care for it when you have it, and how to prevent it. Tennis Elbow is a reflection of deeper movement dysfunctions; it’s not just about your elbow. We discuss how the body should optimally function during a game of tennis and give pointers on how to achieve this. The Tennis Optimization Program developed and offered at Primitive Therapy, a system of manual physical therapy interventions and exercises, enhances and optimizes the body’s movement for optimal tennis performance and injury prevention.
Degeneration, Not Inflammation
Tennis Elbow is the non-medical term for pain along the backside of the forearm usually intensified at the area near the elbow and often worsening with gripping activities. Until recently, it was referred to as lateral epicondylitis by medical professionals. But most cases should no longer be called lateral epicondylitis because our understanding on the nature of Tennis Elbow has advanced. Instead of calling it epicondylitis, it should be called epicondylosis. Whereas epicondylitis involves an inflammation of the tendon attaching to the outside of the elbow, epicondylosis involves a degeneration of these tissues. It is degeneration, a breakdown of the tissues, which causes the pain and weakness at the elbow. This may sound like mere semantics, but in truth this changes the way we go about treating and preventing the problem. If Tennis Elbow was an inflammatory problem (epicondylitis), we would want to rest and ice the elbow. Our primary focus would be on reducing the inflammation. But since the problem is that the tissue is weakened and degenerating (epicondylosis), we want to strengthen and enhance the blood flow to the area. This is not to say that we don’t want to rest and ice the elbow too, but that we want to emphasize strengthening and exercising the area, something avoided before this new understanding of the nature of the condition.
What Causes Tennis Elbow?
Tennis Elbow is thought to occur when the muscles and tendons of the forearm are used repeatedly to perform a task they are not prepared to perform. This could mean that the muscles are being forcefully stretched beyond their comfortable length, repeatedly contracted beyond their endurance limits, or a combination of being stretched and forced to contract with a high demand placed on them (see Figure 1).
People develop Tennis Elbow from all sorts of activities (playing golf, lifting their children all day, lifting weights), but playing tennis is one of the most common ways to get it (hence the name). The forehand and backhand in particular involve actions that are almost perfectly designed to deliver a raging case of Tennis Elbow – the forearm muscles and tendons are often repeatedly stretched beyond their limits; the grip and wrist actions involved in most strokes and volleys are beyond the capacity of many people’s forearm musculature; and the game is often played for long periods of time with long rallies allowing for little rest of the forearm muscles. For anyone, even the casual beginner, preventing Tennis Elbow should be a primary objective.
Beyond what we have already discussed, there is a deeper answer to what causes Tennis Elbow. Tennis strokes, when performed properly, are very natural motions. I said earlier that the forehand and backhand are perfectly designed to cause Tennis Elbow, but I lied. Actually, it is improperly performed strokes that are perfectly designed to cause injury. If the body is functioning properly, with no limitations in range of motion or weaknesses in stability, it should be able to play tennis all day with little risk of injury. It is only when the body is not functioning properly that the potential for injury, and specifically the potential for Tennis Elbow, becomes significant. Don’t feel bad if you fall into the category of someone not functioning optimally. Only some of the highest-level athletes have achieved this state. The rest of us have to consistently work at it and always be vigilant not to cause injury by performing activities we are not ready to do. If you have extreme dysfunction, you may be only able to play tennis for short periods of time. Most of us can probably get away with playing tennis regularly, but we must constantly monitor for small problems that have the potential to become large ones.
People develop Tennis Elbow from all sorts of activities (playing golf, lifting their children all day, lifting weights), but playing tennis is one of the most common ways to get it (hence the name). The forehand and backhand in particular involve actions that are almost perfectly designed to deliver a raging case of Tennis Elbow – the forearm muscles and tendons are often repeatedly stretched beyond their limits; the grip and wrist actions involved in most strokes and volleys are beyond the capacity of many people’s forearm musculature; and the game is often played for long periods of time with long rallies allowing for little rest of the forearm muscles. For anyone, even the casual beginner, preventing Tennis Elbow should be a primary objective.
Beyond what we have already discussed, there is a deeper answer to what causes Tennis Elbow. Tennis strokes, when performed properly, are very natural motions. I said earlier that the forehand and backhand are perfectly designed to cause Tennis Elbow, but I lied. Actually, it is improperly performed strokes that are perfectly designed to cause injury. If the body is functioning properly, with no limitations in range of motion or weaknesses in stability, it should be able to play tennis all day with little risk of injury. It is only when the body is not functioning properly that the potential for injury, and specifically the potential for Tennis Elbow, becomes significant. Don’t feel bad if you fall into the category of someone not functioning optimally. Only some of the highest-level athletes have achieved this state. The rest of us have to consistently work at it and always be vigilant not to cause injury by performing activities we are not ready to do. If you have extreme dysfunction, you may be only able to play tennis for short periods of time. Most of us can probably get away with playing tennis regularly, but we must constantly monitor for small problems that have the potential to become large ones.
It's Not Your Elbow's Fault
So far we have focused our attention on the elbow, but in reality, the elbow, like the low back, neck, and shoulder, is often an area that becomes irritated because of lack of proper movement elsewhere in the body. For instance, if you have tight hamstrings and you bend down to pick an object up from the ground, your tight hamstrings won’t allow you to bend your hips all the way and you are forced to flex your spine beyond its natural limit (see Figure 2). This sets your spine up for injury. The same type of thing occurs throughout the body.
Elbow is the non-medical term for pain along the backside of the forearm usually intensified at the area near the elbow and often worsening with gripping activities. Until recently, it was referred to as lateral epicondylitis by medical professionals. But most cases should no longer be called lateral epicondylitis because our understanding on the nature of Tennis Elbow has advanced. Instead of calling it epicondylitis, it should be called epicondylosis. Whereas epicondylitis involves an inflammation of the tendon attaching to the outside of the elbow, epicondylosis involves a degeneration of these tissues. It is degeneration, a breakdown of the tissues, which causes the pain and weakness at the elbow. This may sound like mere semantics, but in truth this changes the way we go about treating and preventing the problem. If Tennis Elbow was an inflammatory problem (epicondylitis), we would want to rest and ice the elbow. Our primary focus would be on reducing the inflammation. But since the problem is that the tissue is weakened and degenerating (epicondylosis), we want to strengthen and enhance the blood flow to the area. This is not to say that we don’t want to rest and ice the elbow too, but that we want to emphasize strengthening and exercising the area, something avoided before this new understanding of the nature of the condition.
Elbow is the non-medical term for pain along the backside of the forearm usually intensified at the area near the elbow and often worsening with gripping activities. Until recently, it was referred to as lateral epicondylitis by medical professionals. But most cases should no longer be called lateral epicondylitis because our understanding on the nature of Tennis Elbow has advanced. Instead of calling it epicondylitis, it should be called epicondylosis. Whereas epicondylitis involves an inflammation of the tendon attaching to the outside of the elbow, epicondylosis involves a degeneration of these tissues. It is degeneration, a breakdown of the tissues, which causes the pain and weakness at the elbow. This may sound like mere semantics, but in truth this changes the way we go about treating and preventing the problem. If Tennis Elbow was an inflammatory problem (epicondylitis), we would want to rest and ice the elbow. Our primary focus would be on reducing the inflammation. But since the problem is that the tissue is weakened and degenerating (epicondylosis), we want to strengthen and enhance the blood flow to the area. This is not to say that we don’t want to rest and ice the elbow too, but that we want to emphasize strengthening and exercising the area, something avoided before this new understanding of the nature of the condition.
Mobility and Stability
The body is designed to function in an alternating pattern of mobility and stability (Figure 3). The hips must be mobile so the lower back can be stable. The ankles must be mobile for the knees to be stable. The shoulder blades must be stable for the shoulders to be mobile. When this pattern of mobility and stability breaks down, as it does in most of us, problems occur. For example, if you lack hip range of motion (and most of us do), you have two options: 1) use less motion during your stroke or serve and suffer reduced power and accuracy, or 2) make up for that lack of motion by moving your lower back or your knees (or both) too much. The safe option is the former, of course. But I don’t know very many tennis players who choose to use this option. In reality, most of us choose the latter. Our lower backs are forced to move too far and injury results. The hip muscles are the strongest muscles in the body. Our strokes and serves should be generated from these powerful muscles. But if we lack the ability to move from our hips, we lack the ability to use our most powerful body parts, leaving us with, again, two options: 1) use less power for our strokes and serves, or 2) make up for that lack of power by overexerting another area of our body. What option do most of us take? The latter. And what area of the body is often the poor sap called upon to work too hard, too often? It’s the forearm musculature.
The Whole Body is Involved
One of the keys to not only preventing Tennis Elbow but for powerful and accurate strokes, is to be able to maintain a neutral (or even a slightly flexed) wrist when contacting the ball (Figure 4a). But this is virtually impossible for many people due to physical limitations in their bodies. If your hips don’t rotate enough, you have to make up the lost motion somewhere. In the game of tennis, this motion is often made-up by extending the wrist and overusing the forearm muscles to drive power into the ball. Similarly, the shoulder must rotate inwardly in preparation for the backhand. Many of us lack this important range of motion, forcing our wrists to hyperflex to position our racquet where it can deliver force to the ball, causing the dangerous and Tennis Elbow-causing combination of excessive stretch with excessive contraction on the forearm musculature. Dysfunctions throughout the body can be the cause of Tennis Elbow (Figure 4bc).
The deeper answer to what causes Tennis Elbow is really a lack of proper body movement during strokes and serves. It is important to take regular instruction from a qualified tennis instructor who can help you to use your body correctly. Qualified tennis instructors should be able to teach you the basics of how to move properly, but they should also know when you require the intervention of a physical therapist. Physical therapy can enhance and optimize the movement of the body, creating the potential for you to perform strokes and serves with minimal risk of injury and making it easier for your tennis instructor to teach you the finer points of the game.
Manual Therapy for Tennis Elbow
We’ve spent our time discussing how to prevent Tennis Elbow, but what if you already have it? First of all, begin working to prevent a recurrence now. Learn how to move properly, learn how to use your body, not just your arm, to hit the ball. Not only will this reduce the risk of further injury, but it will make you a better tennis player too. If you find that you have restrictions to your movement, seek out a qualified manual physical therapist to give you the mobility and stability you need. Take action on these important things before further injury occurs.
Now let’ discuss how to deal with your current symptoms. Find yourself a physician and physical therapist that know the difference between epicondylitis and epidonylosis and follow their instructions. Your physical therapist should be able to help retrain your entire movement patterns while also assisting your elbow to heal. Along with retraining your entire body movement patterns, your physical therapist should include optimizing the position and function of your carpal bones (the bones of your hand), your radius and ulna (your forearm), your olecranon in its fossa (the primary elbow joint), your humeral head in the glenoid (your shoulder joint), your scapulae (shoulder blades), and all the intervening muscles and fascia. Rest and ice are still important in this process. Instead of spending as much time playing tennis, take this opportunity to learn to move better. Make sure that rest is balanced with mobility training strengthening. The forearm musculature should be exercised, specifically with eccentric motions (eccentric means that the muscles are lengthening as they are contracting), and stretched through their full range of motion. The following pictures give some examples of a comprehensive approach to treating Tennis Elbow. [These activities are not being recommended for those with Tennis Elbow. You should consult your medical team before beginning any exercise or stretching program. This is not just a disclaimer – it’s true. Pain in the elbow can be caused by many things, many of which have nothing to do with lateral epicondylosis. For instance, you may have a nerve entrapment syndrome that requires medical intervention. You may have a fracture, a dislocation, arthritic changes in the joints, referred pain from another area of your body, etc. Attempting to self-diagnose and self-treat without knowing the cause of your symptoms can be harmful and is not recommended.]
Now let’ discuss how to deal with your current symptoms. Find yourself a physician and physical therapist that know the difference between epicondylitis and epidonylosis and follow their instructions. Your physical therapist should be able to help retrain your entire movement patterns while also assisting your elbow to heal. Along with retraining your entire body movement patterns, your physical therapist should include optimizing the position and function of your carpal bones (the bones of your hand), your radius and ulna (your forearm), your olecranon in its fossa (the primary elbow joint), your humeral head in the glenoid (your shoulder joint), your scapulae (shoulder blades), and all the intervening muscles and fascia. Rest and ice are still important in this process. Instead of spending as much time playing tennis, take this opportunity to learn to move better. Make sure that rest is balanced with mobility training strengthening. The forearm musculature should be exercised, specifically with eccentric motions (eccentric means that the muscles are lengthening as they are contracting), and stretched through their full range of motion. The following pictures give some examples of a comprehensive approach to treating Tennis Elbow. [These activities are not being recommended for those with Tennis Elbow. You should consult your medical team before beginning any exercise or stretching program. This is not just a disclaimer – it’s true. Pain in the elbow can be caused by many things, many of which have nothing to do with lateral epicondylosis. For instance, you may have a nerve entrapment syndrome that requires medical intervention. You may have a fracture, a dislocation, arthritic changes in the joints, referred pain from another area of your body, etc. Attempting to self-diagnose and self-treat without knowing the cause of your symptoms can be harmful and is not recommended.]
Figure 5. Self-Stretch into Shoulder Internal Rotation. Keep your shoulder from lifting off the ground, keep your shoulder below 90º, and increase the mobility of your shoulder.
Figure 6. Self-Stretch into Hip Internal Rotation with Self-Massage. This exercise will increase your hip mobility. Be careful that your knees don’t hurt during or after this exercise.
Figure 7. Soft Tissue Mobilization of the Forearm Musculature. You can, and should, do this for yourself on a regular basis. You can watch TV while you do it.
Figure 8. Functional Mobilization of the Olecranon in the Olecranon Fossa.
Figure 9. Neuromuscular Re-Education of the shoulderblade for stability of the shoulder and trunk using Proprioceptive Neuromuscular Facilitation techniques. Skilled manual therapy can teach your body to move not through words but through actions!
Figure 10. Forearm endurance developed through the Russian Kettlebell Bottom’s Up Clean. Holding the kettlebell in this position requires balance, control, and endurance and develops the necessary forearm strength for tennis performance.
.
.
Figure 11. Developing hip drive and eccentric forearm strength through the Russian Kettlebell Swing. Notice how in the first picture (the bottom of the swing) the hips are flexed while the spine maintains a neutral position, this loads the hips and allows for maximal explosive power to be generating form these strongest of muscles. In the second picture (the top of the swing) the hips have fully extended through an explosive drive, flinging the kettlebell into the air. This drill teaches the powerful hip drive necessary for powerful (and safe!) tennis performance. In addition, after swinging the kettlebell up, it must come down. Controlling this downward movement develops eccentric strength (the muscles lengthen while contracting). This eccentric strengthening is mandatory for prevention and recovery from Tennis Elbow and is the most important type of strength to develop for sporting performance. Although this exercise may look dangerous, with proper training it is very safe and teaches healthy motion, thus reducing injury potential. Not only is it safe, it makes you safer!
You Must Be Actively Involved
The only way you will ever get better is if you are actively involved in your treatment. Although our magic hands can change your body, improve your movement, and reduce your pain, you are the only one who can learn to move better, change the way you treat your body, and keep up with your exercises. We are very successful and get excellent results for our patients, but that is only because our patients know they are more than 50% responsible for their recovery. We are not into failure, and neither should you be!
