Have you ever come off the court and thought “wow my elbow feels tight”? Or you finished your match and noticed your elbow was sore when you grabbed your bag. Or maybe you took a shot and felt a jolt on the outside of your elbow.
All of these are potential signs that you’re developing lateral epicondylalgia, often referred to as “tennis elbow.” This is a condition commonly experienced by tennis players, but also can be caused by other sports requiring grip, yard work, or even desk work. It is also a condition commonly treated by physical therapists. The diagnosis refers to an overuse injury where the wrist extensor muscles are asked to do too much, resulting in excess strain on the tendons where they insert on the outside of the elbow. This causes irritation of that insertion point that, in the early stages, results in inflammation and in later stages results in degeneration of the tendon.
There are many strategies that physical therapists use to improve flexibility of the muscles, mobility of the joints, and strength of the surrounding structures. One technique is dry needling. Dry needling is the insertion of an a thin monofilament needle into muscular trigger points to address neuromusculoskeletal pain. Although the most researched effect of this treatment is the release of trigger points, there are other positive neurologic and circulatory changes that may result in improvement as well. Positive chemicals rush into the area, causing an immediate decrease in pain and sensitivity. Blood flow to the area improves, allowing for renewed healing in an area the body may have started to ignore in more chronic cases. All of these mechanisms combine to decrease pain and improve function of that muscle group.
So how does this apply to tennis elbow?
Let’s come back to those overused muscles that extend your wrist and assist with gripping. Dry needling can be used to release tight bands in these muscles to decrease the constant pull on their attachment at the elbow. By achieving this release, we decrease the pull of the tendons on the boney attachment and decrease the irritation at that site. Oftentimes, simply by decreasing the pain we allow the body to function more normally, with greater precision, strength and endurance.
That being said, our job is not done! Releasing these tight areas is key to resetting the area and releasing that nagging pain. However, it may not address why that tension developed in the first place. Oftentimes the elbow has tightened up because the muscle group isn’t strong enough to do its job. The tension is the muscle’s way of finding strength, but this isn’t a functional way of finding that stability. Once we release the muscle, we need to strengthen it so it doesn’t need to tighten up again. Looking even more big picture, often clients with tennis elbow have weaker shoulders and shoulder blades which has resulted in more force at the elbow complex over time. Or even further away, our core needs to provide a solid foundation from which our arm can swing or move. If our core, rib cage, shoulder blades, shoulder and neck aren’t working together properly, our elbows take more stress than they can handle. It is essential that we take a look at all of these dynamics to find the root of the problem, even if we have treated the immediate issue with our dry needling. These two together will make sure we not only get you back on the court, but keep you on the court.
If you’re interested in learning more about how physical therapy can help prevent tennis injuries, join me for an educational webinar at 12:00pm EST on Wednesday, September 23rd. Your body and teammates will thank you! CLICK HERE to register.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S, et al. The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: study protocol of a controlled clinical trial. BMJ Open 2013;3:e002825. doi: 10.1136/bmjopen-2013-002825
Day JM, Bush H, Nitz AJ, Uhl TL. Scapular muscle performance in individuals with lateral epicondylalgia. J Orthop Sports Phys Ther. 2015 May;45(5):414-24. doi: 10.2519/jospt.2015.5290. Epub 2015 Jan 10.