Medial and/or Lateral epicondylitis

Both injuries involve the muscles and tendons of your forearm, and can cause significant pain and frustration with difficulty completing daily routine, sport and leisure.  Epicondylitis is the irritation of tendons that attach to the epicondyle – part of the bone on the inside (medial) or outside (lateral) part of the elbow. Irritation to these muscle groups can occur when the muscle bulks are overloaded, usually by repetitive motions of the wrist and arm.  Good news, majority of patients will get better with conservative care!

Tennis elbow involves the forearm muscles that extend your wrist and fingers originating from the lateral epicondyle of the humerus – most often the workhorse muscle is the extensor carpi radialis brevis (ECRB).

Muscles and bones of the lower arm

Lateral Epicondylitis commonly called Tennis Elbow

Whereas,  Golfer’s elbow involves the forearm muscles that flex your wrist and fingers originating from the medial epicondyle of the humerus. Contrary to what the names imply,  epicondylitis more commonly is related to work demands seen in individuals with high level of manual labor at work, and repetitive non-neutral wrist postures at the desk.

Muscles and bones of the medial lower arm

Medial Epicondlytitis commonly called Golfer’s Elbow

For this reason, ergonomic assessments and modifications should always be considered. In sports – related cases, training errors are the most common cause of overuse injuries.  Often the harmful combination of poor mechanics, muscle imbalances at the joint above / below, and inadequate recovery all contribute to microscopic tears and tendon degeneration. 

Common Fixes

  • Ergonomic assessment to ensure your workstation is set up to optimize posture and minimise tissue overload and failure.  Quick Tips: Top of computer monitor should be at eye level or just below, located an arm’s length away from you.  Elbows should be close to your body ideally with armrests adjusted so your elbows are bent 90° – 120 ° (obtuse angle) with forearms near parallel to the ground and minimal bend at the wrists.  
    To experience a pain free work day sit with proper work station mechanics

    Proper posture while sitting in front of a computer.

 

  • Exercise, stretching and massage:
      • Eccentric exercise effectively “lengthens” the musculotendinous complex resulting in structural remodeling of the tendon to a more normal, healthy tissue.
        • Lateral epicondylitis: prioritize eccentric strength training of wrist extensors with or without the FlexBar® 
        • Medial epicondylitis: prioritize eccentric strength training of wrist flexors with or without the FlexBar® 
      • Isometric training of wrist musculature to facilitate strength and stability without stressing the wrist or elbow. During isometric strengthening,  joint angle and muscle lengths do not change during contraction. Think of a plank for core stabilization.
  • Equipment check, and modifications:
    • Check in with a tennis – or- golf pro to see if any modifications can be made to your racquet -or – club
    • Grip modifications can be made for all weight training exercises; whether it is an extra piece of equipment to decrease demands on forearm muscles, or change in hand placement.
    • Some benefit from a brace, or counterforce elbow strap; which aims to reduce tension and irritation on the tendons at their origin by transferring force farther down the arm.
  • Contrast : Heat → to← Ice to areas of tenderness and irritation can also be helpful. My favorite way to prescribe cryotherapy is an ice cup massage.  
    • Sounds a lot more fancy than it actually is. First, fill a paper dixie cup  with water and freeze it overnight. Once frozen, peel away the first inch and make small circles around the elbow and forearm. Follow up with a hot shower to maximize relief and recovery.

Please seek out skilled, supervised physical therapy care If you have already tried the above self management strategies and are still experiencing discomfort. Manual therapy and  patient – specific exercise will improve forearm strength and stability, and manage any contributing factors and deficits. Examples of such impairments include postural control training for work – related epicondylitis; and trunk mobility with shoulder stability for overhead athletes.  Our bodies function as a machine, and when there is a break in the chain an overuse injury is never an isolated incident. Contact us for more information! Remember, we always offer a complimentary injury screen!

Stephanie Ferro – Doctor of Physical Therapy. Graduate of Northwestern University Feinberg School of Medicine. Former collegiate soccer player at Florida Atlantic University.

The FIT Institute is a physical therapy and sports performance facility in North Center. We increase the of an athlete’s career by teaching proper movement patterns that often lead to overuse injuries, we do this by bridging the gap between physical therapy and sports performance.