Tennis Elbow – Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner. He's the chief physiotherapist of Insync Physio in Vancouver. Two offices, one in North Burnaby, one on Cambie Street in Vancouver. Many time winners of best physios in Vancouver and Wil himself, has been voted best physiotherapist in Vancouver, numerous times by, all of that coming from their customers. And we're going to talk about elbow problems today. How are you doing Wil? 

Wil: Yeah, I'm doing great. Thanks Mark. So probably the most common type of elbow injury or elbow dysfunction is this thing that everyone's heard of, it's tennis elbow. And so it's funny because really only 5% of people that have this type of injury or dysfunction, actually get it from playing tennis.  And I think the majority of it is from other sports, like other racket sports. 

And when you actually break it down to the three main things is like even like your job, like what you do for work. So if you have a job where you're lifting. And more than like, I think what they say, like two to five kilograms of weight  repetitively, like 10 times even just 10 times a day, you know, as your full-time job, that can actually be one of the risk factors.

 To even just a repetitive use of your hand and arm doing things like typing. To even like, if you're using tools that are basically handheld tools as your main implement for your job, then that's going to be another big risk factor. So there's a lot of things when you're looking at what causes it, but really 5% of it is really from actual tennis.

Mark: So, is it a tendon problem, a ligament problem, muscle strength problem. What's kind of the root cause of kind of things that are more common that all of us do. Lifting five to 10 kilograms isn't very much, honestly. So how come that causes elbow problems? 

Wil: Yeah. It's the tennis elbow. Yeah. So really it's the overuse and the overloading, which then causes the inability of the actual tendon that attaches. And so the tennis elbow is on the outside of the elbow. And so basically the issue arises where you start to get this overuse and wear and tear. And I'll say like, so I'll save the name, but basically, the common name when you look it up on the internet, it's lateral epicondylitis.

And so with this overuse issue, you have the degeneration that's happening in the tendon and what in effect happens is that then you start to not be able to heal as fast and you keep like doing things that basically say what's your normal load and because you have this ongoing issue, then you're actually going into overload. So you have to dial it back a little bit. And then there are things that you want to do to be able to start to actually you know, get it better and rehab it. 

But essentially what it is is it's like an injury to the tendon. It starts off as an overuse, but then it becomes a degeneration of that actual tendon. And that's basically what it is. 

Mark: So patient comes in, outside of their elbows hurting. You diagnose they've got tennis elbow. How do you treat it? What's the normal protocol? 

Wil: Well, the first thing that and I'm just thinking about a couple of clients that I'm seeing right now, and it's really important that you actually diagnose what's causing that elbow pain.

I mean, first of all when someone comes in with that kind of pain, it's usually like a gradual onset. So you can get traumatic like tennis elbow or the lateral epicondylitis. I've seen that before, too. Like working with hockey players, you get whacked with a hockey stick or lacrosse players get whacked or some kind of trauma in that area. But that's actually very uncommon. The more common thing is sort of that, Oh, you know, like it just gradually started happening. 

And so in part of that ascertainment of what's going on, you know, the history of what the individual does, is sort of complete that picture a little bit more. It gives us more of a bigger picture of what is causing this. 

And now the other thing is that when we're assessing it, we're also looking for a few different things. Like we're also making sure that, okay, so this isn't like an entrapped nerve. So that's important to also assess. And that this isn't possibly some kind of you know, degeneration of the joint, like an arthritis because when you're looking at the lateral elbow, right. 

Or if it's coming from the neck, so that's actually really important too, because is it like a disc thing that's causing a pain down in your lateral elbow or even a shoulder thing. And so those are really important things that we need to be able to clear first, before we condense and say yeah, you know, this is like a tennis elbow thing. 

And so then when we look at treating it, so if we have like a tennis elbow and quite commonly, what happens is that they may actually have a neck issue that's referring down. And so maybe like a double whammy. So they have a neck issue that probably precipitated a dysfunction in the elbow, and in this deficiency, which then led to now a breaking down of that tendon in the lateral elbow. So now they have two things going on. So in order to actually treat the tennis elbow, you also have to start treating stuff happening in the neck.

So I was telling you about this one patient that I saw who actually has just that. Where their issue in their neck you know, they just with the pandemic and everything that's going on, they're doing a lot more work on their computers, sitting and, you know, admitted his posture wasn't great. And he's also a pretty active guy, you know, he likes to hike, does mixed martial arts and his activity level took a bit of a backseat, but essentially he was doing a lot more computer work and mousing. And then the thing that also made it a little bit more complex was that he had a  previous injury in his elbow, like 15 years ago, but that kind of all cleared up. But that seemed to be something that was kind of pretty vivid in the back of his mind, so he brought that up. 

Mark: So what was the treatment? 

Wil: Basically when we looked at it, we had to treat both his neck. Basically the nerve was being affected. And he had a lot of nerve tension going along that whole segment related to the outside of his elbow. So we had to really start to mobilize that system and work on mobilizing his neck, but then the actual injury to the elbow we also had to treat too.

So we had to actually work on, there was some stiffness in the joint. But it was related to, I think, this overuse issue that he was having. And so we started doing some specific manual therapy to mobilize that. And actually the literature shows that that's actually really effective and in my clinical experience you know, combining that with specific exercises, which is really the key in terms of rehabbing this to be able to get this stronger. So there's a few key things and exercises that I can go over here with you after too.

Mark: So let's jump in. What kind of exercises? 

Wil: Well first of all I guess like one of the main things is how really acute it is. If it's really super bad, then we wouldn't be jumping into too many things to strengthen too much right away. But some of the things that we really want to work on the concept of isometric strengthening. So what isometric strengthening is, basically strengthening a muscle in constant tension without moving it. 

So basically if you break it down there's three types of movements when you look at muscles, like let's take the biceps for example. So if I'm shortening and if I'm doing this and I'm shortening, that's called concentric. And if I'm lengthening, that's called eccentric. So I can do concentric strengthening and eccentric strengthening of my biceps or isometric, where I'm just holding the weight.

Same thing applies with the elbow. So I have a three pound weight here, and if I'm working on isometric strengthening, I want to just support that on a table. And I just want to hold it. I want to just hold it for you know, depending on how acute it is, you know, 10 seconds is usually a good start and you want to work up to like 15 seconds. And just like, a couple sets of 10, once a day to start and building it up to like a couple of times per day.

So that's a really good start to just to get the strengthening in that actual tendon. So studies have shown that that's actually really beneficial. And then you can start to move into a little bit more eccentric contraction. Which is the lengthening of the muscle. 

Now, a couple of other really interesting implements that I have with me here. I want to show and go over with you guys is basically how to recover. So I'm thinking about this client of mine, who is a rock climber, but also does a lot of computer work and has been working exclusively from home. And his workstation is not that great. And he also plays a little bit of tennis as well, which is kind of funny combination tennis and rock climbing.

So a really important part of making sure you manage this is having enough rest and recovery, but also how you do that. So if you're doing a lot of activities, even if you have a job where, like I was mentioning earlier where you're handling tools all day long. Or you're lifting stuff repetitively for two hours or you're lifting things that are around two kilograms, at least 10 to 15 times a day. Then you want to do things to relax the muscles because the muscles get really shortened and tight and it actually causes more tension and fatigues the tendon a little bit more, because the tendon is always the weaker part. 

So before I actually showed the two implements there, I just want to give a full disclosure that I don't actually have any sponsorships or getting the gratuities from these companies of the products that I'm going to actually talk about.

So the first one is this device called the Rolflex and I love this thing for myself personally. Because as a rock climber myself and doing a lot of things with my hands and arms, I get really tight. And it's a really relatively inexpensive little tool and device that you can purchase for under a hundred bucks.

And I use this every time after do any kind of physical activity, like rock climbing or even gardening, I'll do like a couple of hours of gardening. And what it is is just basically a self massager for your arm. And you can use it for other parts of the body, but for the forearm it's so amazing. It's got two foam density pads here, one flat one here, like cylindrical. And then one that has like three different types of beads. And they're high density foam. And they're really super durable. I've had this thing for over two and a half years, and it's still almost looks brand new. And I use it like every day. 

And so basically how this guy works is you can adjust it depending on how big your arm is. And then what you do is you basically have a little lever here that you hold with the other hand. And then if you want to work the lateral arm muscles or the outside arm muscles, then you're just basically squeezing the top grips here. And then you're sliding your hand through and going nice and slow. And you're giving yourself a nice, good little arm massage. You can do a minimum of five to seven minutes up to 10 to 15 minutes, if you want. Hitting a few key muscles in your forearm, basically. And you can do that also for the inside of the arm as well. So this is the Rolflex. 

And then the second thing that I have here is a little bit more pricey, but it's a device that I just got recently and it's called the Theragun. And so the Theragun is like a little bit more of a luxury type of self massager. And it's got like four power settings and I can demonstrate it here for a little bit in a second. It's got like a high density foam knob and this is the basic model and it runs for around 400 bucks. But it's quite good actually. 

I'll show you the first setting here. It's actually the lowest setting and it's pretty  powerful just on the low setting. So all I have to do is just run through certain angles onto the four muscles on the front and on the back. And you can do as little as like five to six minutes. And it is a good way of self massaging the arm. 

So those are two little tools, little implements in terms of what I do for recovery. Now, obviously there's other specific type of exercises and stretches that you can do. But I wanted to just kind of show that because I think those are neat little tools and toys. 

Now the other thing that you can also do to really help support that forearm, is to get a brace. You can get a little tennis elbow brace. So it can be like a neoprene type of brace that fits over the arm like a sleeve or like basically a little cup. So you want to just find one that fits you and that you're comfortable with. And usually the best test is that when you try it on and then you try and do the thing that would aggravate it, it's actually not painful. 

And the idea behind those braces is that it actually absorbs the force. So instead of your tendons and your muscles taking on that force, which when the muscle takes on the force, it transmits it back up to the tendon. Then the brace itself actually absorbs that force and impact. So yeah, essentially those are the things that you can do to really help in addition to the exercises that I had talked about. 

Mark: If you got tennis elbow, if you have pains in your elbows, you have pains anywhere in your body. The guys to see Insync Physio, call them to book an appointment. (604) 566-9716 in Vancouver. Or in North Burnaby, (604) 298-4878. You can also book online, very convenient, very easy, You can pick and find which therapist you want to see. Massage therapists. Physiotherapists. They got them all. They'll look after you. They'll get you feeling better and happy and back doing your favourite activities as fast as possible. Thanks Wil. 

Thanks Mark.