Palms Up! Reducing the Pain of Tennis Elbow Through Activity Modification

Tennis elbow (lateral epicondylitis) is often caused by activities other than tennis. In fact, it is sometimes said that bad golfers get tennis elbow and bad tennis players get golfer’s elbow! To avoid passing judgement on your technique :),  let’s talk about the signs and symptoms of tennis elbow and how activity modification can make a big difference in your pain. 


Lateral epicondylitis involves the wrist extensor muscle fibers where they transition to a tendon that attaches to the bone at the top side of the elbow (the lateral epicondyle). The tendon is white in color, demonstrating that it has very limited blood supply, whereas a muscle is red in color because of a lot of capillary structure. The American Physical Therapy Association (APTA) reports that pain in this area is often related to excessive use of the arm in lifting, pushing, pulling, or gripping during an activity. The wrist may have been moving up and down in repetitive flexion and extension or the forearm may have been in forceful rotation. A few examples of activities that are prone to overuse of the wrist extensors are wrapping a hose, turning on and off a spigot, painting, carrying drywall, mountain biking, and certain weightlifting activities.  


Once an overuse injury occurs, the person may feel weakness, pain, loss of grip, aching, and sometimes warmth at the location. At times, the elbow actually contracts a bit into flexion in a self-protective measure to avoid additional strain. Because of the limited blood supply to the tendon structure, it can take a long time to heal if treatment is not started within 24-48 hours after injury. Certified Hand Therapists (CHTs) and Physical Therapists (PTs) are excellent resources for identifying the signs of lateral epicondylitis, identifying the root cause, beginning treatment, and teaching you how to modify your activities to avoid further pain.  


It might be helpful to consider the position of the forearm during a forceful activity. If the palm is facing down with the elbow straight then there is more force on the wrist extensors. If the palm is facing down with the elbow bent, there is a little less force on the wrist extensors since the elbow flexors are helping out. If the forearm is in a neutral rotation (thumb pointing up) then the force on the wrist extensors is significantly reduced. And if the palm is facing up and the elbow is bent, then you’re golden.  


So reaching into the washing machine is safer if your palms are up and your elbows are bent. Carrying plates to the table might be less painful if your palms are up and your elbows are bent. Driving a car may be easier if you hold the steering wheel on the sides and allow your palms to be in a neutral position and elbows bent. This one little trick can make a difference in your daily activity by reducing your pain and limiting additional strain to the tendon while it tries to heal. 


There are a lot of other things that CHTs and PTs can do to help. Check us out at PT& to find a location. And best wishes to you!