1. Poor connective tissue condition (myofascial restriction)
2. Palpable Trigger points as a main pain source
3. Nerve entrapment happens due to surrounding tissue tightness
4. Decreased range of motion and strength in elbow and forearm
5. Healing process is limited in the forearm tendons due to its nature of poor circulation (Tendons do not have good circulation so it needs external stimulation for healing)
Tennis elbow, Golfer’s elbow, medial or lateral epicondylitis, tendinitis, tendonitis, fibrosis
It comes with different names of diagnosis. The term often includes -itis meaning there is inflammation. However, taking anti-inflammatory medication or steroid injection is not a fundamental solution.
What’s causing the inflammation is abnormally increased tension in the tendon and muscles. We need to normalize poor muscle and tendon condition by breaking up the adhesion (Myofascial restriction) and releasing trigger points. This is the fundamental solution for elbow pain.
1. Pain and stiffness in the inside or outside of your elbow
2. Pain, tension, numbness and tingling sensation radiate into your forearm and wrist
3. Difficulty doing common tasks, such as turning a doorknob or holding a coffee cup
4. Difficulty with gripping activities
5. Weakness in the forearm, wrist, or hand
1. Normalize poor connective tissue quality in wrist flexors/ extensors/ finger muscles (it is located around your elbow and forearm)
2. Find Trigger points and release it with manual therapy technique and using therapy tools (Releasing and deactivating trigger points are key to success)
3. Once the pain level significantly reduces, begin eccentric strengthening and stretching exercise program. The tensile force applied while doing eccentric exercise is also effective to release myofascial tightness in your elbow.
1. Trigger point release (Manual Therapy)
Trigger points in the flexor and extensor tendons are the main cause of the pain. Experienced practitioner can find the Trigger points by palpation skill and release it using ischemic compression technique or a special therapy device
2. Extracorporeal shock wave machine ➡️
Shockwave can break up adhesion and promote blood circulation. This is a very effective machine for the abnormal tendon pathologies
3. Myofascial manipulation technique (Manual Therapy)
Break up the adhesion between the muscles, tendon and fascia. The practitioner needs to make friction movement using fingers, elbow or using a special therapy tool
4. Joint mobilization technique (Manual Therapy)
In chronic condition, tight and imbalanced muscles change the alignment of the elbow joint. By collecting the alignment of the joint, we can decrease pain, improve blood circulation and speed up healing process. We use Mulligan’s movement with mobilization technique or joint alignment correction tape
5. Eccentric stretching and strengthening exercise
Eccentric exercise creates tensile force in the tendons which help break up adhesion.
There are two types of the taping methods. The first one is joint alignment correction taping. It improves the alignment of the joint continuously even after the treatment session for 2-3 days. The second one is Kinesiotaping. The elastic feature of this tape reduces pain, swelling, and improve muscle activation.
The extensor carpi radialis brevis (ECRB) muscle is the most commonly affected muscle. Find the trigger points adjacent to the lateral epicondyle and muscle belly of the ECRB. Releasing the trigger points with ischemic compression technique. Once the sensitivity decreased with manual treatment and stretching, we can use stronger treatment such as extracorporeal shock wave machine.
The treatment protocol is similar with tennis elbow. For Golfer’s elbow, we need to identify trigger points and myofascial adhesion points adjacent to the medial epicondyle and muscle belly (common flexor tendons).
1. Perform enough dynamic stretching > 5 minutes before doing main exercise
2. When you perform sports such as tennis or golf swing, you need to use your core and trunk power more than your shoulder or elbow. Thus, perfecting your swing technique decreases the chance of injuries
3. If you have trunk or shoulder stiffness, it is hard to show good swing movement. You need to learn how to self-release main muscles using a form roller, a ball and through stretching techniques
4. Do conditioning exercise using a Theraband for core, shoulder, elbow and wrist muscles
5. When you feel discomfort or tightness, don’t wait until pain increases. Take action as soon as possible. Try to release your tight muscles. If it is not successful by yourself, begin physical therapy treatment.
6. Choose the practitioner who specializes in manual therapy treatment