We are continuing to discuss treatment strategies for common diagnoses that leave us scratching our head. In this post, we are going to give you some tools to treat that irritating elbow pain. In the process, we want to make you confident in being YOUR OWN “First Line of Defense” when dealing with aches and pains. Hundred dollar words like epicondylitis or epicondylagia leave us scratching our heads. Today you are going to get your own soft tissue treatment tool kit. If it doesn’t work, a physical therapist or other qualified medial provider can put their degree to work. If the term golfers elbow and tennis elbow are more familiar, it is all the same THANG!
Quick Overview of “Epicondylitis”
Lateral Epicondylitis= Tennis Elbow Medial Epicondylitis= Golfers Elbow
Similar to plantar fasciitis, epicondylitis (Golfer’s Elbow and Tennis Elbow) is a catch-all term for elbow pain. It is often used to describe local inflammation at the inside or outside portion of the elbow. In many cases this isn’t an inflammatory issue at all. Many times this problem is myofascial (muscle and fascia) in nature. In research we also see degeneration of the tendinous insertions to the elbow rather than inflammation.
Certain symptoms should raise more of a red flag. That doesn’t mean that you shouldn’t give these strategies a try first before running to a medical provider.
Reasons to be more suspicious…
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Numbness in the arm or hand
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Feeling of instability at the elbow, especially following trauma
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Notable strength deficits (is that vague enough? A little weakness because of some pain is no reason to call 911)
If you have all three… be extra suspicious. But still give these exercises a college try first!
Surprisingly, trigger points and myofascial issues can also cause feelings of numbness into the limbs. Often times being confused for nerve entrapments. On the other hand, increased muscle tension could apply excess stress to a nerve, making it unhappy. Treat the muscle. In return the nerve will thank you.
Top 3 Soft Tissue Treatments:
1. Trigger Point Treatment
In previous posts we have discussed the havoc that trigger points can inflict on your body. You can quickly find relief from elbow pain if trigger points above or below the elbow are the culprit. In the video above we discuss common muscles that reproduce pain in “Golfers Elbow” or “Tennis Elbow”. We also discuss two muscles that are no where near the elbow that can also be a nasty culprit.
Pectoralis Major
Supraspinatus
Supinator
Brachioradialis
triggerpoints.net
2. Instrument Assisted Soft Tissue Manipulation
Soft tissue treatment using metal tools has become popular in physical therapy practices. How does it work? That’s a good question. We are not 100% sure. Regardless, it works. The best explanation I have heard is from Robert Schleip’s paper titled “Fascial Plasticity”. To keep it short and sweet; soft tissue treatment encourages the central nervous system to decrease the tone of the muscle (Schleip, 2003). Sometimes called a “muscle release.” You aren’t actually stretching fascia or breaking down scar tissue when using these techniques. The fascia may be “lengthening” or more mobile because the muscle it is attached to has “released.”
3. Contract/Relax Softening
Yes… I replaced stretching with softening. Cue the soft R & B music!
This technique is hugely beneficial in getting the muscles to soften. I have been a culprit in the past of thinking that I am actually stretching muscle. In reality we aren’t “stretching” the muscle. In all of these techniques we’re reducing the tone (or tension) in these tissues. In turn, improving blood flow, improving nerve function and eliminating trigger points.
When “stretching” we want to feel the muscle relax. Performing relaxed breathing is helpful. This is one of the reasons people tend to benefit from yoga. There is a strong focus on breathing and active muscle stretching. Instead of just sitting there tugging on your elbow for a minute praying that something happens.
“Pain at My elbow is not getting better despite My laser like focus with these strategies?”
Now you need to decide if you are going to an orthopedic specialist (physician, nurse practioner, physicans assistant, etc.) or your local physical therapist. Here is the 411. Your physician’s first line of defense will most likely be medication or a cortisone injection. Medication is by no means a problem solver, it’s a pain masker. Cortisone has been shown to speed up recovery. However, one study found that people who received a cortisone injection actually did worse over the course of a year (Coombes, 2015). They also had an increased risk of re-occurrence of elbow symptoms.
If for some odd reason surgery seems necessary (i.e. to repair a lateral collateral ligament), most surgeons will encourage you to attempt a course of physical therapy first. Unless your LCL is completely gone…. In that case you are a champion for even being on this page right now.
RE-CAP
Fancy diagnoses annoy me to no end. Especially when they are from a medical provider that only saw you for 5 minutes. It is comparable to me saying I am sad, and someone telling me it is depression. Similar to epicondylitis, people throw terms like depression out loosely. When you want to treat that irritating elbow pain get to work on these soft tissue techniques. If they aren’t helping, by all means go see a qualified medical provider that promises to give you the thorough evaluation that you deserve.
Michael Infantino, DPT
COOMBES, B. K., BISSET, L., & VICENZINO, B. (2015). Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. Journal Of Orthopaedic & Sports Physical Therapy, 45(11), 938-949. doi:10.2519/jospt.2015.5841
Schleip, R. (2003). Fascial plasticity — a new neurobiological explanation: part 1. Journal Of Bodywork & Movement Therapies, 7(1), 11-19.
Schleip, R. (2003). Fascial plasticity — a new neurobiological explanation: part 2. Journal Of Bodywork & Movement Therapies, 7(2), 104-116.
Trudel, D., Duley, J., Zastrow, I., Kerr, E. W., Davidson, R., & MacDermid, J. C. (2004). Scientific/Clinical Articles: Rehabilitation for patients with lateral epicondylitis: a systematic review. Journal Of Hand Therapy, 17243-266. doi:10.1197/j.jht.2004.02.011