Tennis elbow is an absolute plague of a condition. Seen in sports people and desk workers alike, it is a seemingly never-ending barrage of pain, until you’re rendered so weak you struggle to lift a kettle of water.
But why does it take people down so badly? And why does it never seem to get better on it’s own?
To understand this, we firstly must understand the anatomy of the forearm and hand a little better.
The muscles that pull our fingers straight when they are bent are called the extensors of the forearm – they live at the elbow end of the forearm and have long sinewy tendons reaching all the way to the last bone of the fingers. The muscles contract and work as a pulley to make the fingers straighten up.
At the elbow end of the forearm, these small, tough muscles attach to the bone. This is where we have to think about levers – ever trapped your finger in the hinge side of the door? It hurts like hell, because the rest of the door is acting as a long lever – minimal pressure, maximum output.
It’s the same situation in the forearm – small attachment to the elbow end; long, long lever to maximise output at the fingers.
The upshot here is, its an anatomical pinch-point where high forces are exerted.
Next, we think of blood supply. Muscle has a good one, tendon has a poor one. Good blood supply is vital to repair soft tissues; to bring new oxygen and nutrients to rebuild damaged tissue, and to remove waste. The area that gets inflamed with tennis elbow is the lateral epicondyle of the elbow – so it is counted as a tendon pathology.
High forces, and a poor blood supply mean repeated trauma with minimal capacity to repair.
In clinic, we advise rest to reduce the forces acting on the epicondyle, and then a manual therapy to increase the blood supply in the area. Good options are soft tissue and friction techniques – or even better western medical acupuncture.
It is thought that inserting needles created micro-trauma in the tissues at the site of the inflammation, promoting hormone markers called growth factors to be released, and encouraging more efficient repair.