As you may have read elsewhere, you don’t need to be a tennis fanatic or avid golfer to suffer from chronic elbow pain. There are a thousand web pages and articles out there that describe the causes and symptoms of epicondylitis – the tearing, weakening and inflammation of the tendons connecting your arm muscles to the bones of your elbow. The difference between these two conditions comes down to the side of the elbow affected and hurting. Tennis elbow (lateral epicondylitis) is due to injury and tissue damage on the outside of the elbow and golfer’s elbow (medial epicondylitis) is due to injury and tissue damage on the inside of the elbow. So far a fairly straightforward injury to recognize and diagnose.
What causes the injury?
Regularly going through the motions of tennis and golf can certainly cause tennis or golfer’s elbow respectively, but there are a number of activities that also can increase the likelihood of tendon damage and recurring pain.
Tennis elbow can result from any activity or profession which requires constant gripping, which puts a strain on the attachment of the finger tendons and muscles to the elbow bones. Other sports that require a racket (such as racquetball or squash), painting, cooking, vehicle maintenance, and even repeatedly clicking a mouse or doing lots of typing can strain the tendon’s connection to the elbow – known as repetitive motion injury.
Likewise, golfer’s elbow can be brought on by any activity where you forcefully bend your wrist toward your palm. It’s even possible to contract golfer’s elbow while playing tennis – if your racket is too short or too heavy! It’s always best to consult your doctor to get a proper examination and diagnosis.
That said, there are a few things about epicondylitis you might not read elsewhere which can improve your understanding and subsequently hasten your recovery. Let’s dive right in.
What’s the Deal with Tendons?
Tendons aren’t like other body tissues. These white, rubbery cords at the ends of all muscles are responsible for connecting muscles to bones, and bear a heavy load whenever muscles are in use. Tendons are tough, but they have a hidden weakness – they are very poorly vascularized – they have almost no blood flow. As a result they essentially heal in super slow motion.
Normally when your body gets injured it begins to heal with an inflammatory reaction, which brings blood full of nutrients (healing blood and platelet plasma proteins) that begin the work of rebuilding injured tissues. With their limited blood flow, tendons are limited in their access to vital healing proteins and must wait for critical molecules to slowly diffuse toward the injury, like air slowly leaking out of a balloon.
It’s important to understand that real healing of a tendon injury – to the point of going back to regular activity – will take a long time, and there just isn’t a shortcut.
Why Does it Keep Coming Back?
It doesn’t. It just never went away. Rest, rest, and then rest some more! You need to allow enough time for the critical plasma and platelet proteins that are essential to healing to reach the area where the tendon connects to the elbow epicondyle. While a skin injury might get healing attention from the blood and platelets within minutes, it can take weeks and even months for enough proteins to reach the ends of the tendons.
Returning to activity before enough time has passed is the number one cause of reinjury and resetting the clock on healing (even if it doesn’t feel too strenuous to you). The typical story for most people is to rest for a few days, begin to feel better, start working or exercising again, notice the pain returning, and then getting upset that it still hurts. Rinse and repeat. We’ve been there ourselves, and it just really takes a while for this injury to heal. Give yourself lots of time, and then a bit more.
Why Is It Getting Even Worse?
By returning to activity too quickly your body’s tissues are not only being aggravated but reinjured. And each time they’re torn and tugged from the epicondyle, a brand new inflammatory reaction happens as your body attempts to heal the latest injury. Multiple inflammatory reactions from repeated reinjury can set off a viscous cycle of chronic inflammation, adding another problem to the already super slow motion healing.
Again, rest. And maybe reduce inflammation to calm things down.
Avoiding reinjury by resting long enough before returning to activity is the best strategy to prevent chronic inflammation. If chronic inflammation is a component, then using non-steroidal anti-inflammatory medications (like Advil) can help, but aren’t a substitute for rest either. If your stomach can’t tolerate NSAIDs, or you would prefer a non-medication approach, consider using moderate cold compression therapy twice daily – cold is an excellent way to reduce chronic inflammation and promote your body’s natural healing. Just don’t overdo it and freeze your elbow into a block of ice, as freezing tissues can make things worse, setting off a frostbite-like injury that triggers inflammation or makes it worse! Though inflammation is good at the onset of an injury it is an impediment to healing if it doesn’t go away.
The bottom line
Rest and a slow return to activity are the best strategies to beating this. Seems simple, but in many ways it’s the greatest challenge to real, lasting healing.