Lateral Elbow Pain – Heather Camenzind

Mark: Hi, it's Mark from TLR. I'm here with Heather Camenzind and of Insync Physio in Vancouver. We're going to talk about lateral elbow pain or tennis elbow. How are you doing Heather?

Heather: I'm good thank you. So yeah, I've been getting some clients in with lateral elbow pain. So there's two in particular, one's a mountain biker that he is getting elbow pain just on like the outside of the elbow, more below the elbow joint. But he's getting at when he's gripping his handlebars and just absorbing like the force is going through his arm as he's going down the mountain.

And then another one is an office worker. That's getting it just with computer work. And they're very similar in that they're two different mechanisms that are causing their pain. But the reason why they're getting a pain is actually quite similar. So it can relate to a lot of people. 

Mark: So what's the cause? 

Heather: So, the main is a breakdown, is an overuse injury of the muscle and the tendon. So there's the tendon at the elbow and the muscles come up the arm and they attach into the arm. So it can break down in three different places. So it varies from person to person. Sometimes it's a breakdown of where the muscle meets the tendon. Sometimes it can be mid tendon or sometimes it can be where the tendon meets the bone.

It's all treated the same. We figure out where it is. But as physiotherapists, we just have to know that there could be potential breakdown and disruption in any of those three places. So it's overused, those muscles or tendons are getting overused. They're overworking and they're not able to recover in time before we stress them again.

Mark: And what does it feel, what is it presenting? Where they came in and say, my elbow is sore and it goes away sometimes or comes back or how does it present? And then what's the treatment protocol? 

Heather: It presents is something that often, it's painful with use. So like for the mountain biker, when he's mountain biking in particular. With the office worker it's painful with using mainly the mouse or with typing, but it's also things that it hurts them when they lift, like if they're cooking and they're lifting the kettle and they're rotating or cooking and moving a pot, or sometimes even opening like a doorknob or something, just the twisting action can be painful on the arm.

Mark: Toothbrush?

Heather: Toothbrush, sometimes driving. So it's mainly something that you're gripping and then having to move your arm. Typically people are okay at rest and normally when they're just resting their arm, the pain goes away. So it has a very mechanical nature in that when you're using it, it hurts. When you're resting the pain goes away.

The interesting thing about this injury is that it is a breakdown of the muscles and the tendon in the area, but it can often be something contributing from the neck, actually. So, this is where it kind of gets a little bit complicated and that sometimes we treat tennis elbow or lateral elbow pain, and we're just treating the elbow and it's just not going away.

And what has to happen then is we have to look higher up in the chain. So in your neck, you have all your vertebrae and then you have your nerves that come out of each vertebrae at the holes. And the ones that innovate the elbow are mainly, we labeled them C5, C6. And so often there's something going on at that level that is compressing those nerves a little bit or irritating them and contributing to the breakdown that you're getting lower down in the limb. 

So we often have to treat the elbow itself, but also looking higher up the chain to figure out what the true source of, why are those muscles overworking on one side of the body manly versus the other side? That's often a common question I get is why is it this side? Not the other side. And it's due to something higher up in the chain. 

Mark: So, I guess with mountain biking, could it also be that you're using one hand, the rear brake, if you're going downhill a lot more.  

Heather: Absolutely. So it can just be that you're using it more. Maybe it's the position of your neck a little bit. Some people when they look up, if you're mountain biking, you're looking up, you might have a little bit loss of range in your neck. And so you're looking a wee bit tilted. You might just not realize it. And you're compressing the nerve roots there a little bit and contributing to the discomfort that you're getting down in the neck or down in the elbow, sorry. 

Mark: Okay. How do you make it better? 

 Heather: Million dollar question right? So like I said, you have to treat the elbow. So there's different things that we treat or we teach the patient to do, is some stretches. So those are simply just kind of stretching out your arm, stretching out the muscles, as long as it's pain-free to stretch, it's safe to do.

The other thing that we get people doing is some strengthening exercises specifically for those muscles. And so we want to restrengthen them and why we want to do that is we want to put some loading and some force through those muscles. So then they start to heal in a proper way. So that's what the elbow treatment, then the physiotherapist will often feel your neck and do some manual therapy to try to maybe facilitate some movement through those joints a little bit more and to open things up a little bit.

So just create a little bit more space for those nerve roots. And often that can just be some like massage in the area to help to decrease the muscle tone at those segments. So it's not like you're cracking your neck or anything like that. It's just that you're releasing the discomfort at that local level.

Mark: What about EMS or heat or any kind of the massage hammering types of guns, Theragun, that sort of stuff. Any usefulness there? 

Heather: It definitely can. Heat is often just more of a pain, if it's painful, you can put heat, you can put ice on it. It doesn't necessarily make it heal any faster, but it's more for pain. So you use it just, if it's painful and it's bothering you and you want it to go away. Then you can put some heat or some ice on no problem there, and you could put it on your elbow or put it on your neck. Either is fine. 

In terms of like the Theragun, lots of people are starting to have those. The neck is like, I've never tried one on my neck, so I don't know what it feels like. I think it might be a little bit too much, too strong for it, but if it feels good and it's not hurting, it doesn't feel like it's hurting you. Maybe you could try. But often just getting in there with like yourself massaging with your hands, or even like a tennis ball or a lacrosse ball or something like that. And you just sort of lay on it and just can gently kind of massage your neck there, would be good. 

Mark: And what about electro muscle stimulation? 

 Heather: Not as useful in this case for this injury.

Mark: And the kind of exercises that you would prescribe anything specific?

Heather: Yeah, so we're looking at trying to do what we call is eccentric contraction. So we think the breakdown is happening in a tendon in particular. eccentric contractions have been proven to be more useful in helping the tendon to heal.

And so what an eccentric contraction is, is it's actually a contraction when the muscle is lengthening? So if you can see my arm, so a concentric contraction is one where the muscle is shortening. So these muscles are getting shorter to pull my wrist up. That, and then an eccentric contraction is when you're lowering the wrist and these muscles are lengthening out.

So we get people to do, what's called an eccentric contraction. So you basically have your arms supported on a desk or something like that. And then you pull your wrist up and you're holding a little weight in your hand, and then you slowly lower it down. And then you raise it up and then you can slowly lower it down.

And you build up the amount of weight that you're holding in your hand and try it also in different positions. Not just kind of with your elbow 90, but maybe straight out, depending on where you're getting your pain. Everybody's a little bit different. 

Mark: And it's going to take what kind of timeframe to get better? I imagine first is you got to lay off a little bit of what's making it hurt, but then what's the recovery protocol.?

Heather: Yeah, So it can always vary from person to person. The longer something's been there, unfortunately the longer it takes to go away. So typical timeline would probably be about like six to 12 weeks can be a typical timeline. Sometimes it can be a little bit quicker if people kind of catch it really early and it's maybe not too, too bad. Then it can go away a little bit sooner, but you have to do a little bit of a rest period. And then rebuilding the strength, rebuilding the muscle. 

Mark: So the underlying message is don't tough it out.

Heather: No a lot of clients ask, like when should I come in? Like when do I know to come in for physiotherapy? And so if someone's injured themselves and if they've trying to do something about it, maybe they're, they're trying to rest, or they're trying to stretch and they're taking measures to help it recover. And there's still no change or it's still getting worse after about seven to 10 days. It's definitely time to come and seek some help and see a physiotherapist for some additional advice.

Cool. So don't tough it out. Go see Heather at Insync Physio, you can book your appointment online, Lots of opportunities there. So they have two locations as well. If you're in North Burnaby, they have a location there. Or you can call them. The Cambie office is (604) 566-9716. They'll book your appointment for you. Thanks, Heather.