Video and Transcript: Tennis Elbow Symptoms, Treatment, and Exercises/Stretches

Hi, everyone! Dr. Orit Hickman here, physical therapist and owner of Pain Science Physical Therapy.

So, it's the summertime right now, and we have a lot of patients that are doing tons and tons of gardening. And, because of that, we're seeing an uptick in patients coming in with elbow pain. If you Google this, you're probably going to come up with the diagnosis of tennis elbow, which is pain on the outside of the elbow. But, most tennis elbow is not actually caused by tennis. It's caused by repetitive gripping activities such as pruning and weeding. And, the technical diagnosis for this, or the medical diagnosis, is lateral epicondylitis. So, we are going to talk a little bit about tennis elbow, or lateral epicondylitis. And, basically, we're going to talk about treatment. And, the way we diagnose it. And also, what you can do if you find that — you know — home treatment isn't working — you know — where you go next.

So, diagnosis for this is usually pain with gripping. Patients will complain of, “I can't lift up my coffee cup, coffee mug, or my tea. And, if I go to shake someone's hand, it makes me cringe because it's so painful to do a grip.” This — these symptoms typically come on after a prolonged period of some sort of intense gripping activity. So, maybe it's — you know — screwdriving, an activity like that, or again — like I said — pruning. Somebody's gone out and done a ton of gardening and pruning, and a lot of weeding. So, anything where you’re doing a lot of repetitive gripping. And again, pain would be right along the outside of the elbow, so pretty point tender.

The other thing that can be painful is lifting the wrist up. And, one of the other tests that we might do is we might put our — put pressure on the middle finger and see if you try to hold up against that, if that's painful in this area as well. So, these are different tests that we might do in physical therapy. But, the most common is we can diagnose it based on the history and what you're telling us, what your symptoms are.

So, in terms of treatment, obviously rest from the activity in the initial stages. So, acutely, you would want to rest from whatever it is that was causing the symptoms. So, don't keep doing lots and lots of gripping activity if that's possible. Sometimes it’s really helpful to — believe it or not — to sleep with a night splint that keeps your wrist in kind of a neutral position. So, it really prevents you from kind of getting curled up at night, and that can keep things pretty irritated. So, just a night splint, the type that has a metal bar right across the front of the palm would be wonderful for helping to treat symptoms in the beginning stages. And, the other thing that sometimes helps it — helps is a splint that actually keeps your thumb a little bit out to the side. And so, this is called a splint with a thumb spica. And so, that prevents the hand from getting too curled up and maybe two twisted at night as well.

So, you want to remember something to know about the elbow is that a lot of the muscles that cross the elbow cross the wrist and the hand as well. And so, if we control movement at the wrist and the hand, we can help elbow symptoms get better.

Besides that, there are three stretches that we might give patients. The first one — if you saw my tech thumb videos, you would have seen these stretches already, but if you didn't see that video, I'm going to repeat them here. So, the first one is taking your thumb, putting it inside of a fist, and then dropping your hand down so that you get a stretch over the top of the thumb. And, I'm going to show you that again. So, thumb inside the palm, make a fist, and drop down. And, that will feel a stretch. You'll feel a stretch over the top of the wrist, and you'll want to hold that for about 30 to 60 seconds. So, that's one stretch.

The other stretch is palm down. Fingers down to the ground pulling on your wrist and (I’m sorry. Pulling on your palm, not on your fingers,) and you should feel a pull over the back side, or the top, of the forearm.

And then, the other is this motion where you're just pulling down on the wrist.

So, these are three stretches that we might give patients. It's really going to depend on how irritated the tissue is and how much a patient can tolerate.

So, in terms of strengthening and treatment, after — after there's been pain for a period of time, the muscles can get a little weak and strained. And so, there's a few different exercises that we like to use.

But, right now, I'm really loving these FlexBars, and FlexBars are created by a company called TheraBand. You can find these on Amazon. We sell them here in the clinic. And, they come in different colors, and those different colors have different strengths associated with them. So, this is a yellow FlexBar, and that means it's really the easiest FlexBar. It moves with the easiest. I think the thickest one is a blue or black FlexBar, and they are really tough to try and move. And so, we would start with something really simple like the yellow.

So, with the yellow FlexBar, one of the exercises we give patients is arms straight out in front. And, we do something called “motorcycles” where you twist one direction, and then back to neutral, and then you twist the other direction, back to neutral. And, these are really slow and controlled motions. You're not going to do this super fast. You're going to start with maybe five repetitions in each direction. And, I am already getting tired, so I think this is an exercise I probably need to add to my home program of exercises that I already do for PT. And so, you do about five of these, and that's great. And, I think I did about three or four. I'm already tired because it hurts to even — it’s even fatiguing to hold my shoulders for that. So, if that's too hard out here, you can start elbows bent, arms this way. But, you want to work up to this because you're going to work the muscles all the way up from how they cross the back of the hand to where they cross the back of the elbow.

Two other exercises I really like to give is one where you pull down this direction. And so, again, you're doing a couple of things. You're gripping, which is — can be very uncomfortable in the beginning. So, you're gripping, but you're also strengthening the muscles that rotate the forearm. So again, starting with elbows bent, and starting here is a good place to start. Right?

And then, the next one is starting with palms down, gripping, facing up. Sorry. Palms up. And, you’re going to pull up. And, you would do about five to ten repetitions.

So, the first exercise is palms down, and then you're moving this way with the forearm. And, the second exercise is palms up, and you're moving this way. So, you're actually strengthening in both of the directions that your elbows move, which is — this is supination into pronation, and then this is pronation into supination. And, these are the muscles that — these are the movements that the elbow is primarily doing besides elbow flexion and extension, which we sometimes don’t even do that for lateral epicondylitis. So, it just depends. Alright?

So, these are a few of the exercises. And, like I said, I really love these FlexBars right now. So, if you have any questions, I'd love to hear from you. Please give me a thumbs up if you feel like this helps. You know I would recommend that you do the stretches and you do the exercises for a couple of weeks. And then, if it's not helping and the pain isn't getting better, then definitely get in to see a physical therapist so they can evaluate it and check it out.

Alright. I hope you guys have a great weekend and enjoy your summer vacations. I hope you're getting some summer vacations, but enjoy the weather while you've got it. Have a good one. Bye!