What is Lateral Epicondylitis?
The elbow has two epicondyles. These are the prominent bones that stick out on either side of the joint. With the arm extended and palm facing upwards, the bone on the side furthest from the body is the lateral epicondyle, and the one on the opposite side is the medial epicondyle.
What is “Epicondylitis”?
Epicondylitis is the clinical term for the inflammation of the boney projection, known as the epicondyle. This inflammation is typically due to overuse, trauma, or excessive straining.
How does Lateral Epicondylitis occur?
The lateral epicondyle is the specific point of attachment for all of the muscles of the wrist and hand that allow you to extend the wrist backwards as well as straighten fingers. These muscles are very frequently used in a minor capacity but there are particular activities that excessive strain this area. The most common way to injure the area is via repeated eccentric contractions. This means the muscles are shortening while another force is trying to lengthen them. The most common method to accomplish this is tennis.
What makes tennis so notorious for this type of injury is how the player contacts the ball. On a forward swing the wrist starts in an extended position, and ends in a flexed position. During this swing, if the timing is off by fractions of a second, the muscles that move the wrist backwards (extension) will still be engaged when the ball strikes the racquet. When this happens, the muscles that move the wrist forward (flexion) must be rapidly activated, which overly stretch the ones that extend the wrist. This causes micro tears in the muscles that attach to the lateral epicondyle. If the muscle is repeatedly subjected to this type of movement, the tendon of the muscle can also start to become damaged.
When that tendon becomes damaged and inflamed, this is known as lateral epicondylitis.
Tennis isn’t the only cause of this but it is the most frequent. Due to this, this injury is typically called “Tennis Elbow”. Any job that actively extends the wrist frequently can exhibit the symptoms of this condition. Frequently computer users get this type of pain from excessive mouse use, simply due to holding their wrist in an extended position, rather than resting their hand on the mouse passively.
How is this condition treated?
From a chiropractic standpoint, a proper diagnosis is important. Is the tendon actually inflamed? Is it simply pain in the region due to muscular damage? Is the joint restricted in its movement? Is the overuse of the forearm in compensation due to an underlying shoulder injury? Is the over activity of the muscles in the forearm due to irritation stemming from the nerves in the neck and shoulder? All of these considerations need to be addressed. However, if the case is determined to be true true epicondylitis, there are several treatment options available.
The first option is to brace the wrist and simply let the area heal. Without continued overuse, the region should heal on its own. This is the easiest method, but also the slowest.
The second option is myofascial release to the region. Once the particular movements and causes are identified, the muscles and fascia can be stimulated and stretched to alleviate the over activity and allow the muscles to heal.
The third option is therapeutic ultrasound. This is a much more focused and gentle treatment option, but it works very well at breaking and chronic scarring damage to the tissues of the area.