A Clear Home Plan For Tennis Elbow Pain Relief

Transcript

Welcome And What We Will Do

SPEAKER_00 0:03

Welcome back to the Hand to Shoulder Solution where pain meets its match. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist. I specialize in treating orthopedic conditions that affect the fingertips through the shoulder. Let's talk about tennis elbow. It's a tough condition to treat, and I see a lot of people who've been hoping that it's going to go away, but it persists over weeks, months, and months, sometimes turn into years. And as with anything else, the longer that it goes on, the more difficult it is to treat and to get rid of permanently. I want to show you some tips and tricks and some key points that we use in the clinic to really educate patients to an optimal home exercise program that they can do for themselves at home. We'll touch on briefly what we do in the clinic, but let's focus on what you can do at home. And remember, it's I the ideal thing is to be seen by your healthcare professional so you can be thoroughly examined. I do a thorough evaluation and find out really what your personal situation is with your tennis album. And by the way, they're all different. And even in the same person, if they have it on the right side, and then we get it cleared up, and then it happens on the left side, it's a total different ball of wax. So let's talk about some basics. So the muscles that extend your wrist, extend your fingers, turn your hand palm up, they're anchored in on what's called the lateral epicondyle. It's a bony knob right there. If you feel on the the thumb side of your, if you turn your hand palm up, it's the thumb side of your elbow, the outside part of your elbow. You follow the humerus down, and there's that knobby bone. That's the anchor point for those muscles that do this. And when the muscles contract and they do those motions, it pulls here on the end. And sometimes these muscles in the back of your forearm will get very, very tight. And when they get really tight, they start to pull hard on this outside part on the lateral epicondyle. It's springtime where I live, and a lot of people are raking their lungs. I know I'm going to be getting a lot of tennis elbow and golfer's elbow conditions in the office. Golfer's elbow is a different condition. We're going to talk about that in a future episode. But staying with tennis elbow, when these muscles get tight and they're pulling too hard on there, causing excessive tensile or pulling stress on the origin where they're anchored, that starts causing pain and actually causes inflammation on the bone. And it's that's called lateral epicondylitis. Itis means inflammation. It's like with arthritis, tendonitis, theitis in the word means inflammation. Now, if we can lengthen out those muscles so there's there's not as much pulling on that location, then that is a very important first step in relieving the pain at that spot. So to loosen muscles, what's really nice is just a simple electric heating pad around the forearm. And I would do that two to three times a day, not more than 15 minutes. I don't put it on the it's important to have a thermostat and to have it on the lowest or medium, low, or even medium setting, but not high. We don't want hot heat on that. So after the after the heat, um it's it's nice to stretch down like this, fingers free. That stretches the muscles that extend your wrist that are anchored up here. And I would hold this stretch for I I direct people to hold the stretch for 20 seconds and then relax one more time for 20 seconds. Now, before you use the heat, you can test yourself. So if you pull your hand down to stretch your wrist, bringing the palm toward the floor, if you feel it pulling up here, up high, then that's a stretch you should do. If it if it if it's not stretching in the back of your forearm, you don't need that stretch. Let's go to the next one. So the next one is your finger muscles. So if we wrap those finger tendons around the joints and we grasp and you grab your fist and you pull your fist down, if you feel that just stretching on the back of your hand or in the back of your wrist, you don't need that. But if you stretch, if you feel it stretching on the back of your forearm up higher, you need it. 20 seconds. Relax again for 20 seconds, very quick and easy. Doing that two or three or four times a day, where people go wrong is they might make it a habit and they think more is better, and they would do it all the time. Then it's just pulling on here too much, and it's just it's aggravating, it's just too much. The perfect analogy is you have to water your plants, but you can't water them all day long. So let's talk a little bit more mechanics. So we know that on the back of the forearm, the muscles do this, they do this, they do that. The opposite is on the other side of the forearm. So on the palmer surface, the palm surface of your forearm, those muscles close your fingers into a fist, they bend the wrist toward your palm, they turn your hand palm down. If those are really, really tight, then guess what? It makes these work harder because they're pulling against these tight ones on the opposite side. So all you have to do for this, turn it palm up, palm to palm, bring it down. Does that stretch a lot really up high up here? If it does, that one should be added to your routine as well. Now, let's talk about cold versus heat. Cold shrinks. If we put cold on the tight muscles, it's gonna shrink the muscles and make them even tighter. Okay, so we already talked about you want the heating pad around the muscles. On the bony part, you can either you can take an ice cube and just touch an ice cube just ever so slightly to that bony area where those are anchored in, and only until deeply cold, 10 to 20 seconds, which is a lot better than an ice pack for 10 minutes. And in this area, the ice pack is just too too wide, it's not going to penetrate enough. 10 to 20 seconds, direct ice, or stick the outside part of the elbow under the cold running faucet and just let it glance over that bony area right there, only until deeply cold, 10 to 20 seconds. When should you do that? You should do that midday, oh, lunchtime or so, and at the end of the day, after dinner, before bed, knock down the inflammation. When you get up in the morning, your inflammation is going to be at its lowest point because you've been resting all night. So that's the reason for using cold later in the day. Okay? Now, let's talk about some more mechanics. Right in with questions. You realize I like questions, I like to respond to them. You know, everybody's situation is different, and you and it's really important to what I do in the clinic is I do a thorough exam. So I palpate, I see what's tender, what's sore, I do some orthopedic testing, find out exactly what's the mechanics. Every situation is different. When did it start? How much time has gone by, what muscles are involved, etc. etc. etc. One tool I use a lot is the bandit B-A-N-D-I-T counterforce strap. So if we know that all these muscles, you can see them move, are anchored here, and it and the problem is pulling here, and then up also in the clinic, I determined is there also a tendon problem, too. There's usually it leads to some tendinopathy with the tendon, tendonitis first, where it's inflamed with the tendinopathy with the the tendons actually starts to shred a little bit. And and by the way, if you if you get too many steroid injections, that starts to degrade the tissues, it starts to break down the tendon. The the um best practices that have been determined by research is the this kind of therapy, not so much the injections anymore. If you put a strap around here, that holds the muscle, so now when you do the motion, more of the pulling now is coming from here, not so much outside part of the elbow. Very effective. Now, I have a lot of patients who are electricians or they do construction, and when they're using the uh squeezing the wire cutters uh or any other pliers, that squeezing hurts. But you didn't say, wait a minute, wait a minute, when I squeeze, I'm using the muscles on the other side, you said. That's true. But in order for this not to happen, when you squeeze, your wrist extensors that are anchored over here have to contract to keep your wrist straight. That's why that's one of the precautions is trying to avoid a tight grip. Or if you have to squeeze anything hard like cutting wire or using pliers for a heavy job, um, you at least use both hands or use the other hand when possible. Back to the counterforce strap. So this around the forearm should be put on firm, not chokingly tight, but just firm. And I have patients look at where's the widest part of the forearm, and that's where it should go around. It should never touch the bone, it should shouldn't touch the tendon, it should be about oh, three or three or four fingers, probably four fingers down from that bony prominence of the lateral epicondyle, and then it should be on there firmly, um snug, maybe a little extra, extra beyond snug, about like that, and then you can just push the skin underneath. Okay, now when I move, more of the pulling is coming from here, and that allows this painful area to rest, and that's called the counterforce strap. Over the last 26 years, I've used a lot of different ones. Probably for the last 10 or 15 years, I've stuck to the bandit, and this works really well for the golfer's elbow too, which occurs on the opposite side. So that bandit strap is is a great one. Now, real quick, triceps. So if you if you look at the tightness of your triceps, if you bend your your elbow and you touch your shoulder, and then you push your elbow up toward the ceiling, and boy, that's pulling a lot back here, and then you compare it to the other side, and so wow, the other side goes up real easy. This side just oh, that's really tight. That triceps tightness, that triceps inserts on the very tip of the elbow right here. And say, Well, why does that affect it? It's not the outside part of the elbow, but it changes the mechanical dynamic around all of these joints. There's three joints in the elbow. So if the triceps are tight, I have patients just stretch those triceps 20 seconds a few times a day, and that helps a lot too. So I hope this was helpful. Thank you very much for liking and subscribing, and also for sharing this video. A lot of people out there with tennis elbow, it's a big problem, and I we have it in the office all the time. Being armed with this knowledge and what to do at home is very, very helpful. So get into the clinic, get it taken care of sooner rather than later because it does get very complex. CarlPetito.com, my website, check it out. Thanks.