One Easy Way to Get Rid of Knee Pain Instantly!

One Easy Way to Get Rid of Knee Pain Instantly!

Knee pain is annoying, and can often impact almost everything in your daily life. Whether that be walking to and from work, squatting down to get or getting in and out of your car. Unfortunately, there isn’t a band-aid solution that can solve your particular knee pain. Knee pain is multifaceted and requires a proper diagnosis of what particular structure might be causing the discomfort or pain.

However, for a specific type of knee pain – or even for any knee pain – taping can be an effective way to get some quick pain relief and help you get through your day. The purpose of this post is an informative guide on a specific taping technique called: “Modified McConnell Taping“. This is not encouraging the use of knee taping without proper rehabilitation advice from your healthcare professional.

Before We Begin: Contact Dermatitis

Before application of tape, you must test if you are allergic or have a reaction to the tape itself. Some individuals may have a reaction to certain components of the tape which may results in symptoms such as:

  • Redness
  • Itchiness
  • Swelling
  • Tender to touch

Occasionally, specific brands of tape can cause allergic reactions, so you may have to ask your pharmacist on recommendations and to trial different types. This usually involves getting a small piece of tape placed on your hand or wrist, then seeing if there’s a reaction.

Diagnosis of knee pain 

The diagnosis of knee pain is quite difficult as there are a multitude of structures that surround the knee. The particular structure this taping works well for is something colloquially coined: “Fat pad impingement“. Unfortunately, with the huge amount of variability within the physiotherapy profession, there is a large amount of variation behind the diagnosis and treatment behind this specific pathology.

The following signs and symptoms may indicate you have “fat pad impingement”. However, many of these symptoms are all common knee pain symptoms for any pathology.

Knee pain signs and symptoms:

  • Pain directly under the knee cap
  • Generally achy but sometimes sharp depending on movements
  • Sometimes may radiate to the sides of the knee cap
  • Pain with putting weight in a bent position (e.g. up and down stairs, lunging / squatting)
  • Usually settles with rest and not moving it
  • Returns after resuming activities, especially high impact exercise such as running or jumping

I must reiterate. Each of these symptoms individually will not mean anything, but collectively when combined with physical tests from a physiotherapist may reveal evidence of “fat pad impingement.”

The Taping Technique

After taping

General guidelines after the application of tape are:

  • Check for any adverse reactions, such as those mentioned in the Before We Begin: Contact Dermatitis section.
  • Tape can be kept on for 3 – 5 days, so long as you haven’t been sweating excessively
  • Tape can get wet, and just needs to be pat dried after showering
  • If the tape begins to come off, it is recommended to reapply as opposed to trying to fix it
  • Removing the tape: Roll the tape, do not rip the tape off. This can help with reducing skin irritation after taking off tape. (Hint: Don’t just rip it like a band-aid).

Final Words

Let’s get one thing straight… Taping of the knee is not a long-lasting solution and will not be useful in the prevention of further knee pain. If the underlying reason behind the knee pain is not resolved, then recurrence of knee pain is common. However, this knee taping technique can still be useful in providing some pain relief with general knee pain. 

A recommendation would be to follow this knee pain guideline as well as trial the application of this taping technique.

To summarise the knee pain guideline, knee pain can be improved by:

  • Short-term pain relief strategies, such as massaging, myofascial release and trigger point therapy 
  • Passive stretches 
  • Education on pain management and understanding the pain cycle
  • Long-term management through a structured exercise programme

What would you do with less knee pain?

Could your neck pain be causing your headaches? Here’s why!

Could your neck pain be causing your headaches? Here’s why!

Have you ever had the weird sensation where your neck pain seemed to cause headaches, but was unable to describe why? 

It is theorised that the pathophysiology of cervicogenic headaches involves a specific structure in the neck called the “cervicotrigeminal nucleus.” Essentially, the sensory input from this region coincides with both the head and neck, and the brain can sometimes confuse this input and interpret neck pain as headaches. However, neck pain of any type has been suggested to cause headaches regardless of location, so the exact reason is still unknown.

Cervicogenic Headaches

As with many other pathologies, there are different types of headaches. The one we will focus on today is “cervicogenic headaches” and neck pain. There are unique symptoms that arise with cervicogenic headaches, including:

  • Headache originates from muscular, articular, osseous (bony), neurologic (nerve) or vascular (artery / veins) structures of the neck 
  • Neck pain should trigger or precede the headache 
  • Travels from the occipital area (see figure below) and spreads towards the front of the face 
Cervicogenic Headache Pattern
  • It is usually unilateral (one-sided) 
  • Aggravated or worsened by neck movement 
  • May have some associated restricted range of motion in the neck or shoulder 
  • Potentially associated shoulder or arm pain 
  • Headaches can also cause: 
    • Nausea 
    • Photophobia (Light sensitivity) 
    • Phonophobia (Sound sensitivity) 

 (Gallagher, 2007)

In future posts, we will touch more on the different types of headaches and how each of them can affect you! 

Treating the neck pain / headaches

Treatment of the neck can help with headaches and decrease the frequency and severity of symptoms of headache. This includes common treatment procedures such as massage, strengthening of associated muscles and stretching of involved muscles (Gallagher, 2007). 

The combination of manual therapy (e.g. massage, trigger point release etc.) and exercise has proven an effective treatment for neck pain compared to many other alternative treatment types (Miller et al., 2010). The combination of these treatments is important, as mobilisation and manipulation only provides short-term relief. Exercise appears to have the added benefit of improving pain and function over long term (Miller et al., 2010). Therefore, the combination of both treatments can combine pain reduction with long-term changes (Miller et al., 2010). The exact type of manual therapy and manipulative treatments is still speculative and varies according to individual practitioners. Similarly, exercise therapy requires further research and the exact type of strengthening is difficult to determine. 

Learning new behaviours associated with common tasks, such as sitting down and looking down to read a book or read your phone for long periods of time can also assist with treating your neck pain. As prolonged postures in a specific posture can increase neck pain frequency, and subsequently induce more headaches (Gallagher, 2007). 

So what can we do? 

Step 1: Postural Adjustments 

Posture… Is really not that important. Now before you explode with utter outrage on the blasphemous nature of this statement, hear me out! There seems to be a lack of high quality evidence on the relationship between posture and pain (Mahmoud et al., 2019; Slater et al., 2019). However, what we do seem to know is that prolonged time in one particular posture is detrimental and can lead to increased pain and discomfort (Mahmoud et al., 2019; Slater et al., 2019). 

Instead, what we should be focused on is regular postural adjustments. As discussed in my shoulder pain blog post, small postural adjustments in sitting, especially while doing desk work can provide many benefits to your pain and discomfort. 

Step 2: Regular Movement

To reiterate the previous point, prolonged postures or positioning in one specific posture can be detrimental and lead to increased pain and discomfort. Therefore, to counteract this, regular movement is encouraged of the neck and shoulders. One particularly important structure that requires movement is the shoulder blade, and ensuring adequate movement of your shoulder blade during various movements. 

A particular muscle is of interest when interpreting the link between neck pain and scapula function. This muscle is called the “Levator Scapulae.” This muscle originates from the transverse processes of C1-4 (your upper cervical spine), and attaches to the superior-medial border (top-middle) of the shoulder blade. Its role in shoulder function is the elevation and downward rotation of the shoulder blade. 

The Levator Scapulae Muscle

Without getting too in depth in this post, the reason why this muscle and shoulder blade is important is that many individuals can get neck pain and tightness within this muscle. Which can subsequently lead to headaches to the neck pain nature. Fortunately, the fix for this is generally very simple, and only requires more awareness of the shoulder and shoulder blade region. Simple exercises that can fix this issue include: 

  • Neck rolls
  • Ear to shoulder 
  • Shoulder roll
  • Overhead arms stretch 

There are not any specific repetition or set ranges for these exercises. Instead, they should just be performed when you remember or feel like you need some movement in your shoulders and neck! 

Step 3: Strengthening of upper body and neck 

General strengthening exercises of the upper body are extremely beneficial and important in treating neck and shoulder pain. However, what needs to be focused on in these situations is the positioning and the movement of the shoulder blades. This will be further explored within a gym setting in a future blog post. 

For now, the general recommendations will be to be aware of shoulder positioning and scapula position during movements. Essentially, the scapula should have freedom of movement when performing any exercise, rather than being stuck onto the ribcage wall.

Conclusions

Neck pain can be the cause of a very specific type of headache called “cervicogenic headaches.” However, despite the complex sounding name, the treatment and prevention of further headaches is quite simple and can be resolved with proper diagnosis and treatment strategies. This includes strategies such as postural adjustments, continuous movement and upper body strengthening practices.

Do you think your neck pain is causing your headache?

References 

  • Gallagher, R. M. (2007). Cervicogenic Headache. Expert Review of Neurotherapeutics, 7(10), 1279 – 1283. 
  • Mahmoud, N. F., Hassan, K. A., Abdelmajeed, S. F., Moustafa, I. M., & Silva, A. G. (2019). The relationship between forward head posture and neck pain: A systematic review and meta-analysis. Musculoskeletal Medicine, 12, 562 – 577.
  • Miller, J., Gross, A., D’Sylva, J., Burnie, S. J., Goldsmith, C. H., Graham, N., Haines, T., Brønfort, G., & Hoving, J. L. (2010). Manual therapy and exercise for neck pain: A systematic review. Manual Therapy, 15(4), 334 – 354. 
  • Slater, D., Korakakis, V., O’Sullivan, P., Nolan, D., & O’Sullivan, K. (2019). “Sit up straight”: time to re-evaluate. Journal of Orthopaedic & Sports Physical Therapy, 49(8), 562 – 564
What are red flags? A comprehensive guide for the major signs and symptoms

What are red flags? A comprehensive guide for the major signs and symptoms

Red flags should be the first point of assessment in any condition. Regardless if it is neck pain, shoulder pain, lower back pain or even foot pain. Red flags are important as they can indicate to the health professional of any serious underlying pathology or anything that would need to be sent to the emergency department for immediate investigations. Across each of the joints, there are some specific red flag signs and symptoms we need to be aware of. 

These signs and symptoms should never be interpreted as a direct causation or diagnosis of the conditions that may be associated with them. Instead, a cluster of symptoms are what is commonly used in order to diagnose and correctly identify the condition (Sizer Jr et al., 2007). Therefore, when analysing these red flags, contact with your local doctor is usually the recommended course of action. As in these situations, if an allied health practitioner (e.g. physiotherapist, occupational therapist etc.) identifies any red flags, the usual procedure is to refer onto a doctor for immediate review or referral. 

From a clinicians point of view, there are several factors that we need to be aware of (Sizer Jr et al., 2007): 

  1. Patient history
    • Physical changes (e.g. changes in bowel and bladder function, blood in sputum, bilateral or unilateral radiculopathy pain)
    • Unresponsive to conservative treatment 
  2. Report of present fluctuations in signs and symptoms. Presence of serious pathology is indicated by: 
    • Pain that is worse during rest vs activity 
    • Worsened at night or not relieved in any position 
    • Poor response to conservative care including a lack of pain relief with prescribed bed rest 
    • Poor success with comparable treatment 
  3. Physical examination and laboratory findings 
    • E.g. Abnormal reflexes, gait (movement) changes, strength disturbances / differences, changes to sensation (i.e. numbness, tingling)

The Three Category System

A three categorical classification system has been developed and proposed by Sizer Jr et al. (2007). In this paper Medical Screening for Red Flags in the Diagnosis and Management of Musculoskeletal Spine Pain, he outlines this three step categorical system for each part of the spine. Namely, the cervical, thoracic and lumbar. 

The classification system that he uses is as follows:  

  • Category 1: Factors that require immediate medical attention
  • Category 2: Factors that require subjective questioning and precautionary examination and treatment  procedures
  • Category 3: Factors that require further physical testing and differentiation analysis
Category 1Category 2Category 3
Blood in sputum
Loss of consciousness or altered mental status
Neurological deficit not explained by monoradiculopathy
Numbness or paresthesia in the perianal region
Pathological changes in bowel and bladder
Patterns of symptoms not compatible with mechanical pain (on physical examination) 
Progressive neurological deficit
Pulsatile abdominal mass
Age >50
Clonus 
Fever
Elevated sedimentation rate
Gait deficits
History of a disorder with predilection for infection or hemorrhage 
History of a metabolic bone disorder
History of cancer
Impairment precipitated by recent trauma 
Long-term corticosteroid use
Long-term worker’s compensation
Nonhealing sores or wounds
Recent history of unexplained weight loss
Writhing pain
Abnormal reflexes
Bilateral or unilateral radiculopathy or paresthesia 
Unexplained referral pain
Unexplained significant upper or lower limb weakness
Sizer Jr et al. (2007)

Cervical Region 

Category 1 Findings: 

These examinations are usually performed as a result of a trip to the emergency department as a result of motor vehicle accident or fall. Major injuries to this area include fracture or dislocation. 

  • Canadian C-Spine Rules (CCR)
  • National Emergency X-Radiography Utilisation Group (NEXUS)

These two decision-making criteria can be used as a screening device to rule out the need for radiography of the cervical spine. 

Category 2 Findings: 

Mechanical conditions of the cervical spine that require special attention in category 2 are upper cervical instability (atlantoaxial laxity) and vertebrobasilar insufficiency (VBI). 

Atlantoaxial laxity

Suspicion of ligament laxity in the upper cervical spine may be tested through two specific physiotherapy ligament tests – The Sharp Purser test and TLA laxity test. Further radiographic evaluation must be undertaken to confirm any upper cervical instability. 

Vertebrobasilar insufficiency (VBI)

VBI circulation is important as it can lead to transient ischemic attacks and cerebrovascular accidents. However, difficulties arise as the signs and symptoms of VBI overlap with more common diagnosis, especially vertigo. The red flags that are relevant to this diagnosis are: 

  • Visual disturbances (diplopia) – Blurry or double vision 
  • Auditory phenomena (sudden sensorineural hearing loss) – Hearing loss
  • Facial numbness or paresthesias – Numbness, tingling or pins and needles especially around the lips or tongue
  • Dysphagia – Difficulty swallowing
  • Dysarthria – Difficulty speaking 
  • Syncope (drop attacks) – Sudden syncope episodes 

Category 3 Findings: 

Finally, the cervical spine should be screened for radiculopathies (pinched nerves) and myelopathies (compression of the spinal cord).

Radiculopathy can be screened through inspection for muscle atrophy (wastage / loss of muscle), sensory changes (numbness, tingling, pins and needles), tendon reflex testing and a positive Spurlings test.

Cervical spine myelopathies can include symptoms such as: loss of dexterity (e.g. difficulty writing or handling small objects), nonspecific weakness (e.g. unable to grip) and abnormal sensations. Lower cervical myelopathies can also include weakness and stiffness in the legs, as well as changes to their walking. The most common cause for myelopathies is a traumatic injury or incident, usually from a stabbing / gunshot wounds, motor vehicle accident or falls. 

Thoracic Spine

Category 1 Findings: 

There are numerous category 1 red flags that can be found within the thoracic region. Primarily because the same signals that arise from the organs often coincides with a selected region of the musculoskeletal system. Essentially what this means is that the pain felt in a muscle, bone or general upper back area can be caused by pathology involving the organs. 

A common example of this relates to acute myocardial infarction (i.e. heart attack). Pain can often be felt in the left pectoral region (i.e. around the left nipple of the chest) and the upper arms or sternum. This is often associated with pallor (pale color of skin), sweating and nausea. 

Tumours, metastatic disease, metabolic diseases and fractures can also create pain signals around the area. These conditions can often be marked by severe thoracic pain, decreased range of movement of the thoracic region and potential intercostal neuralgia (i.e. stabbing, burning pain between the ribs). 

Category 2 Findings: 

Of particular concerns are osteoporotic changes to the thoracic vertebrae, which can lead to severe changes of postural deviations, vertebral fractures or spinal cord injury. A red flags can be evaluated to identify the potential likelihood, including: 

  • Age over 50 
  • Long-term corticosteroid use 
  • Presence of menopause 

Category 3 Findings:

As discussed previously, category symptoms require further physical testing and differential analysis. Within the category 3 classification for thoracic level related pathology, many of these symptoms must be clustered together to provide any meaningful reasoning. These symptoms include: 

  • Referral pain to the front and side of the rib cage
  • Parathesia or dysthesia (e.g. numbness, tingling, pins and needles, abnormal changes to touch and feeling) 
  • Sensory loss (e.g. absence of feeling) 
  • Bowel and bladder changes 
  • Hyper-reflexia (associated with reflex testing) 
  • Coordination loss

Lumbar Spine

Lower back pain is extremely common and these red flags are important, as they can indicate more serious diagnosis such as: malignancy, spinal fracture, infection or cauda equina syndrome (Downie et al., 2013). 

Category 1 Findings: 

The category 1 symptoms as mentioned in Table 1 outline many of the symptoms that are evaluated in lumbar spine pain for red flags, particularly of which include: 

  • Numbness or paresthesia in the perianal region 
  • Pathological changes in bowel and bladder
  • Patterns of symptoms not compatible with mechanical pain (on physical examination) 
  • Progressive neurological deficit

Category 2 Findings: 

Similar to the thoracic spine, lumbar vertebrae are also at risk of compression fractures. The risk factors relative to the lumbar spine remain the same as the thoracic region. Infections can also arise in the lumbosacral region, which produce symptoms such as: 

  • Fever
  • Malaise 
  • Potential bowel and bladder symptoms 
  • Severe lower back pain
  • History of drug use 
  • Prior spinal implementation or surgery 
  • Severe lower back pain radiating into both buttock and thighs  

Category 3 Findings: 

Lower back pathology can sometimes be associated with altered or changes in sensory, motor and reflexes. These can be tested through physiotherapy sensation tests, muscle tests and reflex testing. Two common tests we also use to assess nerve involvement is the straight leg raise test or slump sitting test.

Other serious pathology

Signs and symptoms unrelated to the spine can also manifest in other serious conditions. These include infections, malignancy (cancer) or a more serious pathology called ankylosing spondylitis.

Chou et al. (2007) briefly outlines some of the symptoms that are associated with a more severe diagnosis:

  • Cancer:
    • History of cancer
    • Unexplained weight loss
    • Failure to improve after 1 month
    • Age >50 years old
  • Infection:
    • Fever
    • Previous drug use
    • Recent infection
  • Ankylosing Spondylitis
    • Younger age
    • Morning stiffness
    • Improvements with exercise
    • Alternating buttock pain
    • Awakening due to back pain during the second part of the night only

Conclusions

As you can probably tell, there is a lot of overlap between symptoms for each region as well as other pathologies. Many of the findings in category 3 also present in category 1. Which is why a cluster of testing is required in order to rule in or out any certain pathologies.

The world of diagnosis through the use of signs and symptoms is still evolving, and there is certainty more ongoing research require to create established clinical guidelines for clinicians (Chou et al., 2007; Downie et al., 2013; Verhagen et al., 2016).

So if you do have any of these red flags, the important thing to remember is to take a deep breath, relax and go seek a professional opinion from a healthcare professional. Ideally in these situations, a doctor would be first point of call, as they can directly refer or treat many underlying pathologies not related to the musculoskeletal system. 

References

  • Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Jr, Shekelle, P., Owens, D. K., Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, & American Pain Society Low Back Pain Guidelines Panel (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine, 147(7), 478–491. 
  • Downie, A., Williams, C. M., Henschke, N., Hancock, M. J., Ostelo, R. W., de Vet, H. C., Macaskill, P., Irwig, L., van Tulder, M. W., Koes, B. W., & Maher, C. G. (2013). Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ (Clinical research ed.), 347, f7095. https://doi.org/10.1136/bmj.f7095
  • Sizer Jr, P. S., Brismée, J., & Cook, C. (2007). Medical screening for red flags in the diagnosis and management of musculoskeletal spine pain. Pain Practice, 7(1), 53 – 71. 
  • Verhagen, A. P., Downie, A., Maher, C., & Koes, B. W. (2016). Red flags presented in current low back pain guidelines: a review. European Spine Journal, 25, 2788 – 2802
Treating Your Tennis Elbow in 3 Easy Steps

Treating Your Tennis Elbow in 3 Easy Steps

Tennis elbow, otherwise known by its anatomical name – lateral epicondylitis (or epicondylalgia) – is a condition that affects the elbow joint. It is typically categorised as what we call an overuse injury and primarily involves the tendons that attach into the common extensor origin (Tosti et al., 2013). Namely, the muscles of the forearms that help extend the wrist. 

Extensor (E.) Carpi radialis longus
E. Carpi radialis brevis 
E. Digitorum communis
E. Digiti minimi 
E. Carpi ulnaris 

The wrist extensor muscles

Initially lateral epicondylitis was thought to be an inflammatory condition. However, the current consensus explains the process of “microtrauma” as the primary cause (Tosti et al., 2013). Despite the name “tennis elbow” denoting its sole cause from tennis, many individuals can develop tennis elbow through everyday activities and work. 

Some examples include: 

  • Jobs that require specific repetitive movements
  • Handling handheld tools for an extended period 
  • Regular heavy lifting at work

(Dingemanse et al., 2014) 

The specific signs and symptoms for tennis elbow are quite easy to spot, and many individuals will have similar presentations for their tennis elbow. However, the difference generally lies within the length of time, the intensity and the demands of their work. 

The Signs and Symptoms of Tennis Elbow

The signs of symptoms of tennis elbow can be different according to an individual’s specific circumstances. However, they do follow a general pattern (Tosti et al., 2013): 

  • Pain over the origin of the common extensor tendon
Pain on touch on the outside of the elbow joint
Pain on touch on the outside of the elbow
  • Slow and insidious onset, and may coincide with recent increases in work or sport 
  • Discomfort with hand shaking, shaving, lifting luggage or groceries or raising a coffee mug. 
  • Weakness or pain with gripping and lifting objects 

Other less common signs include jobs that require holding machinery that have a high amount of vibrations (e.g. using a jackhammer or chainsaw) or require constant opening and closing of hands (e.g. hairdresser).

Treatment: The Operative Route

Tennis elbow can be managed in various ways. The two primary categories of treatment are divided into operative and nonoperative management. Operative management options include: 

  • Percutaneous release 
  • Arthroscopic release 
  • Open release 

In most cases, operative management is not required. However, there may be some cases of chronic pain, loss of range of motion, or failed conservative management that may necessitate a release of the common extensor tendon (Nazar et al., 2012; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322435/). 

Treatment: The Non-Operative Route

In terms of nonoperative management, we must consider the efficacy and evidence of treatment modalities. There are a plethora of treatment options that exist, which can be categorised as:

  • Physical therapy and activity modification (e.g. manipulations and mobilisations, exercise training regimes or braces)
  • Non-steroidal anti-inflammatory drugs 
  • Injections (e.g. corticosteroid injection, botulinum toxin – otherwise known as botox, platelet-rich plasma) 
  • Electrotherapy modalities (e.g. Ultrasound, Extracorporeal shock wave therapy, low laser therapy) 

This list is by no means exhaustives, and many more recent methods have popped up including friction massage or using different types of elbow splints. However, these treatment methods generally have insufficient scientific evidence to back and support the claims against traditional treatments. 

So what does the evidence say? 

The evidence for lateral epicondylitis generally trends towards exercise as a primary treatment modality. There seems to be some evidence that other treatment modalities may be effective as an adjunct to exercise or as a stand-alone treatment method. As a summary, treatment options can be bulleted as such: 

  • Exercise for lateral epicondylitis is an effective treatment modality (Cullinane et al., 2013; Dingemanse et al., 2014).
  • Exercise may provide greater effect for tennis elbow when compared to electrotherapy and placebo (dummy) treatments (Dingemanse et al., 2014).
  • There may be some short term benefits with regards to ultrasound and corticosteroids, but no differences in long-term outcome (Dingemanse et al., 2014. 
  • Currently, there is a need for further research in the optimal use of biologic injectables, particularly with regards to timing, concentration and dosage (Tosti et al., 2013). 

While these treatment methods may be beneficial for your tennis elbow, they require repeat visits and consultations with your physiotherapist. Unfortunately, this costs time and money that some individuals may not have… so what can we do instead?

Finally, the 3 steps to pain-free Tennis Elbow

Like many of my posts on shoulder, knee and lower back pain, the treatment of tennis elbow can be completed in a few easy steps.

Massage and relaxation of the extensor muscles of the elbow 

Massaging your sore forearm muscles are a fantastic say of generating some short term pain relief, and there are a few guidelines we must follow when doing so: 

Do not massage directly over the tendon and sore spot. Direct massage over the sore tendon can irritate the already sore tendon, and increase the amount of time needed for recovery. 

Avoid stretching the sore muscles. Although stretching the affected sore muscles may feel good, but can cause stress and irritation of the tendon. Which, again, can increase the amount of time needed for recovery. 

Massage of the forearm muscles can be done by hand, massage ball or foam roller

Strengthening of the forearm muscles 

Isometric strengthening of the wrist extensors is extremely important. Stability of the wrist is often found to be lacking in the affected side of the person’s upper limbs. Some easy exercises include: 

  • Isometric wrist extension – different ROM 
  • General isometric grip strength work 

Wrist position during everyday life  

Excessive ulna deviation or pronation during lifting activities can irritate your extensor tendons. Being mindful of wrist positions even during working activities and lifting everyday objects is important,such as lifting a full and heavy kettle. 

Wrist position is often overlooked when treatment of tennis elbow. Particularly when performing activities in the gym, wrist position is extremely important and we must be mindful of it when performing various activities. A few particular examples include: 

  • Wrist position during horizontal pushing movements and vertical pushing movements – avoiding excessive radial or ulnar deviation of the wrist. 
  • Wrist position during heavy dumbbell holds e.g. farmer carry – We want to ensure a neutral wrist position when we are carrying the weight. As we fatigue, the wrists will naturally drop, which is normal. However, we want to try to actively maintain a neutral wrist position for as long as possible. 

Now that’s not to say that lifting heavy loads should be avoided entirely, but through strengthening and awareness of wrist positions we should be able to build tolerance of the extensor muscles and the wrist itself to be able to tolerate heavier loads. 

Conclusion

Tennis elbow is a common condition that affects many people and often has its origins outside of playing tennis. Unfortunately, the current research on how to treat tennis elbow can lead into a rabbit hole of complex equipment or requiring a in-person physiotherapy consultation. However, as this isn’t financially viable for many people, this post highlights some easy ways to resolve your tennis elbow at home!

References 

  • Cullinane, F. L., Boocock, M. G., & Trevelyan, F. C. (2013). Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil, 28(1), 3 – 19.
  • Dingemanse, R., Randsdorp, M., Koes, B. W., & Huisstede, B. M. A. (2014). Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: A systematic review. British Journal of Sports Medicine, 48(12), 957.
  • Nazar, M. A., Lipscombe, S., Morapudi, S., Tuvo, G., Kebrle, R., Marlow, W., & Waseem, M. (2012). Percutaneous Tennis Elbow Release Under Local Anaesthesia. Open Orthop J, 6, 129 – 132. 
  • Tosti, R., Jennings, J., & Sewards, M. (2013). Lateral Epicondylitis of the Elbow. The American Journal of Medicine, 126(4), 357.e1 – 357e6