Tennis elbow and Golfers elbow are both repetitive strain injuries that arise because of the repetitive force experienced by the common forearm flexor and extensor tendons originating at the elbow. These two ailments are often the reason one experiences forearm pain. Whilst playing tennis is a common cause, other physical activities such as crossfit, jack hammering, and even gardening can also be to blame.
Initially, rest will be the best means of pain reduction. However, there are many other things one can do to accelerate their recovery. Here are a few:
Accurate diagnosis of forearm pain
Medial epicondylitis, otherwise known as golfers elbow is a common diagnosis when dealing with forearm pain. It is possible to use orthopaedic testing to confirm this diagnosis:
- Palpation assessing muscle tonicity in the forearm flexors through touch and feel.
- Handshake test often the handshake has poor grip strength
- Finger tapping merely tapping a finger at the origin of the common flexor tendons can be extremely sensitive in golfers elbow patients.
- Resisted wrist flexion a muscle test that assesses the functioning of the forearm flexor muscles.
- Arm wrestle test inability to resist opposing force in the arm wrestle position is a strong indicator for golfers elbow.
I also added two extra tests to rule out tennis elbow:
- Resisted wrist extension a muscle test that assesses the functioning of the forearm extensor muscles.
- Middle finger sign the patient will hold their hand out with fingers fully extended and palm facing the ground. Inability to resist a downward pressure on top of the middle finger will indicate damage to the common extensor tendons of the elbow.
Many recreational tennis players have no idea that the setup of their tennis rackets might be contributing to their elbow pain. There are essentially three crucial racket specifications that will influence how your body responds to hitting tennis balls.
- Weight if it is too light, the racket will not have enough mass on collision with the ball. The shock will travel straight through your racket and into your arm.
- Grip size if it is too big, you will strain your forearm musculature unnecessarily.
- String the tighter your string bed and the tougher the string (eg. Kevlar), the more shock you will experience into your arm.
Golfers elbow is fundamentally a problem with the tendinous portion of the forearm flexor muscles. It is however, vital to consider the surrounding structures involved with this condition. Simply put, this includes the elbow and wrist joints, the bellies of the forearm flexor muscles, not to mention sparing consideration for the shoulder and thoracic spine (mid back).
- Soft tissue work active release technique– is a fantastic modality for treating tendinopathies. Essentially, it is a combination of massage and stretching applied at the same time.
Joint mobilisation/manipulation the elbow and wrist joints demonstrated restricted motion. Full range of motion can be restored through the use of gentle mobilisation and manipulation techniques.
Dry needling following the above therapies, acupuncture needles introduce a different stimulus to the injured muscle tissue. This is a highly effective technique for restoring vital blood supply to the damaged tendons as well as facilitating a loosening effect within the tissues.
Taping kinesio [stretchy] tape can be used to provide some extra support to the soft tissues in between treatments keeping the forearm pain at bay. Amongst other things, this special tape is most effective in facilitating optimal muscle firing sequence patterns in the affected areas.
Take home exercises I prescribe patients with some club bell exercises. Club bells are the only effective means I have found to target the forearm flexor and extensor tendons adequately. The use of normal dumb bells to target these areas, in my opinion, simply does not work. You can see my club bell in the picture above.
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