Tennis elbow is a common condition that can affect any of us at some point in our lives. Medically, it’s called lateral humeral epicondylitis, which for those unfamiliar with that jargon is no blind aid. Even the best-known term, tennis elbow, means very little.

You don’t have to play tennis to experience this problem, although many players of this popular sport have been disabled by it. Before power tools existed, some jobs, eg screwdriving, could cause this to happen. When using a screwdriver or tennis racket, the very act of forcefully gripping and twisting for hours amounts to what is commonly known as a repetitive stress injury (RSI).

Having established why it can happen, the $64 million question is what can be done to alleviate and ultimately cure it? To provide effective non-surgical treatment, it is important to understand which physical structures have been damaged and precisely where they are.

For most people, the medical term Lateral Humeral Epicondylitis is doubly Dutch, but it defines the location. The elbow is the visible joint between the lower and upper arms. The long bone between the shoulder and the elbow is called the humerus and on this bone there are various bumps and bumps that have names. At the lower end of the humerus are two prominent bumps called the condyle; so an epicondyle is a round point on the condyle (epi- means on). To further define the origin, the word lateral is used, which simply means the side of the bone away from the middle.

So now we know the site of the injury, but the epicondyle has had — added to it, which means inflammation, so words like tendonitis and neuritis mean those parts of your body are inflamed. Therefore, a lateral humeral epicondylitis is nothing more than an inflammation of the bony prominence on the side of the lower end of the long bone of the arm.

This is not the whole story because if it’s just a little swelling in the arm bone, what about the pain and sometimes quite disabling pain that we feel in the forearm, particularly the muscles involved in gripping? and twist?

Having had the opportunity to treat a number of top professional tennis players, it’s impossible not to notice how incredibly developed the muscles of the forearm are in comparison to the non-using opposite arm. It reminds me of the cartoon character Popeye, whose forearm muscles became enormous after swallowing a can of spinach. In some cases, the muscles can easily be twice as bulky.

Fundamentally, that is the key to the cause of inflammation. It has to do with the fact that there are five muscles that have a common tendon that anchors them to the lateral epicondyle. I often like to think of the idea of ​​five guys securing a structure, in this case the forearm, all attached to the ground by a single pin. Normally, this tendon that all the muscles have at their ends is usually quite happy. However, as you can imagine, if you continually use your forearm day after day, as tennis players do, this leads to a thickening and tightness of these five muscles.

Eventually, what can happen is that the stress placed on the actual point of attachment of the tendon to the epicondyle bone becomes more irritable and vulnerable, especially if the forces involved are sudden and violent. This leads to strain and injury at the point of attachment which, in turn, leads to loss of support of the associated muscles involved in supporting grasping and twisting actions.

An obvious way to help this injury is to simply rest it. In mild cases, the patient is often willing to wait until there is a form of spontaneous recovery, but many people do not accept this, especially if the symptoms last two years or more! When it comes to the best professional tennis players, pain and loss of function are totally unacceptable.

The only time I ever met Tennis Elbow in person was when I was a student, when a guy from the previous year challenged me to a wrestling match. Even though my arm was longer than his, he beat me quite convincingly, not so much by force but by his shorter lever. It was in the final bout of three that I felt something ping my forearm and I knew right away from the loss of grip that tennis elbow had started. My victor cheerfully told me not to worry about him and that he would fix it for me in a week. So said, so done.

It is the treatment I have used on every tennis elbow since I qualified. What it requires is a very deep penetrating soft tissue massage into the forearm muscles, which in the vast majority of cases are very tight and often quite nodular and lumpy. To tell you the truth, I’d be lying to everyone if I didn’t tell you that it can be excruciatingly painful. Many adult men succumbed to tears and asked if this treatment approach is necessary.

In my experience, this condition can take time to respond. To speed up and facilitate the body’s natural healing ability, it is important to work on injured tissue specifically to break up adhesions and nodules that can accumulate as a result of injury. In doing so, the act of massaging drains the tissue by removing cellular breakdown products, improving blood flow that provides all the necessary healing nutrients.

After treatment, the muscles may feel sore, so I encourage the patient to apply ice packs for 10-15 minutes at a time, which reduces swelling and again stimulates blood flow. Naturally, the actions that caused the condition in the first place must be modified or stopped completely until the normal status quo has returned.

Wearing a strap around the forearm placed just below the elbow can be helpful in supporting actions we take for granted, which can help reduce stress on the affected muscles.

So far I have focused on non-surgical intervention. Briefly, there is the use of hydrocortisone injections to override local inflammation. This must be delivered precisely to the sore spot. This is not easy to do and may require several injections before there is resolution. I know that many people have little appetite for these injections. Ultimately, there is an operation that can be performed. I am not an orthopedic surgeon so I will not venture down that path.

Finally, prevention is much easier than cure. Just be careful when engaging that part of your body in a forceful and stressful way, especially when gripping and twisting hard. Muscles are not machines and cannot work endlessly or tire, even if they are as well conditioned as athletes, who are just as susceptible to injury.