by Paula Allia PT, DHSc, MTC, OCS

by Paula Allia

Tennis elbow is a term given as a diagnosis for a common painful elbow condition. This condition affects gripping, lifting and even the turning of the wrist. Some tennis players develop tennis elbow but not all diagnosed actually play tennis.

A person diagnosed with tennis elbow usually has pain at the outer protuberance (lateral epicondyle) of the elbow. This is where the muscles collectively attach into, commonly called the common extensor tendon. The interesting thing is that the pain typically occurs with bending the wrist backwards (extension) and gripping and using the first three digits together of the hand.

The most common muscle involved is the extensor carpi radialis brevis which attaches to the base of the third metacarpal bone which is the bone that runs from your wrist up to your finger. The radialis longus attaches to the second metacarpal near the finger. These muscles run up into the common extensor tendon where palpation of the lateral bony area at the attachment is usually tender to palpation and this tenderness can extend down into the proximal musculature itself.

In addition to tenderness upon palpation and use, I find, many times that there is some tightness into the forearm in the radial nerve distribution. The radial nerve is the nerve that innervates these muscles and the input from this nerve keeps the muscles ready to fire. This nerve originates from the brachial plexus up in the axillary area of the arm and runs down as far as into the thumb. It makes sense that if there is tightness along the route of the nerve that the nerve can become slightly bound in the tight muscle, limited its flexibility. There are other diagnoses that can be labeled in this area but many times tennis elbow is the diagnosis given.

Thorough investigation is key to properly addressing this issue. The evaluation should include range of motion and muscle testing but in addition, include neural tension testing.

This testing can reveal if there is any decreased flexibility in the nerve. It is important to have the three major nerves into the arm tested with neural tension (the median, radial and ulnar nerves).

When there is a tendonitis in the involved musculature, the pull on the bone repetitively can irritate at the insertion of the muscles. The muscle itself can actually experience discomfort if this problem is not taken care of promptly.

Imagine this group of muscles that aid us each and every day in basic activities of daily living to gripping, lifting, and pushing things. There are certain positions the wrist and fingers are in for different grips and grasps. Thus, the muscle strength is important and the endurance of these muscles is important for the activities that you use your wrist in.

Neural tension is checked all the way up into the neck at the nerve routes associated with these muscles. Postural deviations can also affect the flexibility and limitations of these muscles and nerves (and even the arteries and veins).

If there is tightness and limitations in the nerve you can imagine that you are trying to get constant nerve input to working muscles but the nerve impulses may be compromised. The muscles keep performing but with subpar input.

This, over time and the combination of repetitive uses and possible poor positioning can cause swelling and activities can be debilitating.

The key to a diagnosis like tennis elbow is to find the cause of why you are getting symptoms and try and fix the cause. It can be as simple as posturing properly, stretching and then strengthening the muscles, or fine tuning may be needed to slowly floss the nerve in the muscles so that the input to these muscles is at the top of its game.

You do not have to be reactive and wait until your have pain and limitations in your body. It is smarter to be proactive and if there is tightness and limitation you can improve the flexibilities of these tissues with the hope of never experiencing symptoms.

Prepare yourself for the activities that you participate in. Be smart, stay healthy, use good techniques; to your health!

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