On this episode of the #AskMikeReinold show we talk about treating Tennis Elbow, which is a troubling injury to deal with. But we’ll go over what you need to know to treat lateral epicondylitis. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 239: Tips for Treating Tennis Elbow
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Show Notes
Transcript
Eric:
All right. We have Paul from Switzerland. Do you have any tips on treating tennis elbow? I often see this type of injury, but it always seems to take longer to get better than other injuries.
Mike Reinold:
Awesome. Great question, Paul. Thank you, Eric. Amazing reading. Good job. We have the best students, they can read so well. This is common, right guys? I feel like there’s a few things that we deal with that people struggle with. I like what Paul said here. It’s like, I see this injury a bunch, but it seems to take longer to get better than others. Tennis elbow seems to be one of those little odd ones. Lateral epicondylitis, right? It seems to be one of those odd ones that just take awhile. Maybe it’s because of the chronicity of it. Maybe it’s a little bit more beat up, so it takes a little bit longer, but let’s talk about this. The question for me is about what are our tips, not let’s go through a huge extensive protocol. What are our tips? Dave, you want to start? What’s some of your tips for tennis elbow and maybe we’ll just keep going around the room and just go and tip by tip and try to knock this out.
Dave Tilley:
Yeah. I have a couple of these patients now that are kind of struggling and I think, unfortunately, sometimes they don’t really realize how a lot of things contribute to the issue and sometimes it’s kind of not in their awareness that a lot of different grip activities probably happen. The couple that I have now, for example, started after doing a pull-up program, trying to get a big set of pull up or something like that, but also were dead lifting very heavy. Also, were doing a lot of split squats and step-ups holding dumbbells and they were also playing golf on the weekends. He was really like, I don’t know where this came from, just one day out of the blue, but you look back at his workload program and since quarantine, he was like, yeah, I was doing pull-ups and dead lifting and split squats and then I was trying to golf when the golf course is open and realized how all of those things are very grip intensive. He was like, oh, I didn’t even realize that.
Dave Tilley:
He took time away from his pull-ups. He thought that was the only thing that caused it, but he was still golfing. He was still doing other stuff and he’s also got a young kid, so he’s holding her and all that kind of stuff. I think once he was more aware of that, he was able to modify around it. It’s hard though because these things you need your arms with to do stuff. [inaudible 00:04:22] daily life, but just educating him about the volume of gripping, I think was really important for him, but also he was really going all on the manual therapy, soft tissue care route for a while and what we needed to teach him. I was like, these things need load. The load is too high, but no loading is not going to help you. I think we know from research or trying to actually reduce some load induced changes. You actually do have to do some exercises to help that build up. He was kind of riding the roller coaster of no loading because it hurt, to full loading to try to test the waters.
Dave Tilley:
That would be my advice. Just have a really good subjective talk first before you start diving into exercises.
Mike Reinold:
Yeah. It sounds like what he did, he tried to layer some manual therapy, some feel-good stuff, which could be part of a good treatment progression, but he tried to layer that on top of not really adjusting workloads. To use a dramatic example, my finger hurts because I keep hitting it with a hammer. Well, if I keep hitting it with a hammer, but then I go see Dave to massage it, probably not going to do anything. Theoretically, right? Sometimes you have to make the analogy that obvious for people or use whatever vision that works best for you, but I think that’s a good example of that.
Mike Reinold:
I think tip number one there, is that treating without really assessing their workload, I think is going to really lead to some issues. I think a lot of people probably that happens to quite a bit is we just go right into treatments and not enough of trying to really dig in deep on what happened with their workload. In Dave’s example, that was a lot of things he was doing, for example, but it might’ve just been that one thing that threw him over the edge. You got to really kind of figure that out.
Mike Reinold:
Nice. Good tip. All right. Who’s up next? Tip number two. Who wants to take it? I’m going to blame this on the delay of Zoom and not anybody being hesitant. I like this. It’s good. Let’s see. I’m going to go Pope. I think I saw Pope raise his hand first. What’s tip number two for tennis elbow?
Dan Pope:
Yeah. Obviously there’s a lot of them, I’m going to try not to take a bunch of them, but I think the big thing is you want to make sure you have a good diagnosis. When people have pain on the side of the elbow, the obvious thing we’re thinking about is a tennis elbow, but you might be dealing with some humeral radial joint pathology. You might be dealing with say a radial nerve issue. If you’re not getting any progress whatsoever, you might just be barking up the wrong tree, had the wrong diagnosis going into it. At least for me, I didn’t know a ton about these pathologies until I took a specific course for it and now I’m just more keen to thinking about other things if something’s not proving.
Mike Reinold:
That makes sense. Good tip number two, right? Even if it were slightly off, if we’re treating the wrong thing, then we may be spinning our wheels a little bit or at least some of the things we do may not be working and we may be missing the boat on something. I like that. That’s a really good one. Get good at your differential diagnosis of lateral elbow pain. I like that. Lisa, what do you think?
Lisa Russell:
Well, piggybacking off what both Dan and Dave said, elbow pain for, I’m really in my rowing bubble at this one, but it’s actually something I’m really expecting a lot of people are going to have a wicked hard time with this spring because people have not been in boats and not having that same gripping mechanism and then especially to get a little rowing technical, but especially in a bigger boat where you’re feathering the oar or you’re shifting your wrists in timing with gripping. Typically in the spring tennis elbow and forearm tendinitis are huge anyway and then you go from missing almost an entire year in boats for some programs, I think it’s actually going to be pretty significant, but a lot of rowers who end up with that problem, it’s really more that their technique is faulty.
Lisa Russell:
I tend to, again, what Dan and Dave were talking about, I kind of tend to look back at like, okay, why is your elbow getting overloaded because it shouldn’t be. Maybe adding in some more gripping exercises outside of rowing, but at the same time it’s usually a break in the elbow that’s overloading it more and not putting the load in their back or their shoulders and different things that’ll change that loading, rather than just massaging your forearm.
Mike Reinold:
That’s great. I actually picked up on two good tips right there. Dave talked about just layering on and overloading. Lisa has a really good example of not building your workload capacity up in times. Not building enough chronic workload base before you just go crazy into whatever activities you’re doing. Maybe even putting that together with Dave’s example, right? Maybe if Dave’s patient didn’t just jump right into that pull-up program and he’s eased in a little bit more, maybe that would have been better. That’s another good one. Maybe it’s not just the overall quantity, but maybe it was the ramp up progression for that. I like that. Two, the other one is technique. I think that’s a really good one, Lisa. A lot of people just, they’re doing things awkwardly.
Mike Reinold:
I know in tennis, most tennis people, we’re not tennis experts here, but I think it’s like golf where a lot of tennis players don’t get lateral epicondylitis. It’s usually the ones that aren’t good at tennis and they’re flipping their wrists too much. They’re using the wrong mechanical force, instead of using their body to rotate through the ball. Same thing with the medial elbow. I think that’s another solid one.
Mike Reinold:
I think maybe to sum it up for this episode, I’ll add one more, maybe the fifth one for this one and I’d just say and this might be a little similar to Dan’s. I think Dan’s was more around let’s differential diagnose lateral elbow pain and what’s going on with the elbow. I would say, I really, really want you to clear the cervical spine. I actually think that that’s a large contributor in the things that I see with lateral epicondylitis, is it’s coming from the cervical spine. Sometimes you can be completely asymptomatic from cervical issues too. You can be completely asymptomatic, but the analogy I tend to use is let’s say we have a five lane highway of nerves going down your arm and for whatever reason, we have a bulge, stenosis or something, who knows, something’s going on and only four of those lanes are communicating down there, but you’re still living life at a hundred percent. Then you’re going to overload that.
Mike Reinold:
This muscle is being overloaded by 20%, just by living normal life because it’s only getting 80% of your signal. Does that make sense? That may not actually work physiologically, but it’s a good theory to explain to somebody, to go off that, but I think conceptually that is one thing that I often think people miss, is that sometimes we’re having some cervical neurogenic issues that go with this and they’re just overloading their grip in their elbow. Okay.
Mike Reinold:
Solid tips right there. I like how none of our tips involved what to do for treatment, right? None of them is like, do this exercise or do this. I think we all know mobility. I think we all know strength and eccentrics and stuff like that could be important for lateral epicondylitis. I think we all know that, but we still all seem to struggle with the chronicity and how long these take to come back. Maybe there’s something deeper we need to do with workloads or differential diagnosis or some of their techniques they’re using or maybe even some of the cervical spine put together. I think that’s a really, really good five tip process you can go through to see if we can get better at lateral epicondylitis.
Mike Reinold:
Good, great question. Thanks so much, Paul. Appreciate it. If you have a question like that, head to mikereinold.com, click on that podcast link and you can fill out the form to ask us more questions and keep us going. We’ll keep doing this as long as you guys keep answering questions. Although I haven’t cleared that with everybody. Is everybody good with that? I didn’t ask everybody. Okay, good. We’ll keep answering questions as long as you keep asking them. We’re here for you guys. Just let us know. Head to iTunes, head to Spotify. Subscribe so you can get updates every time we have a new episode and we will see you on the next episode. Thanks so much.
