It had to happen sooner or later....the condition we as physiotherapists have got a lot better at treating in recent years, thanks to new research, but which we all still find a challenge, the dreaded tennis elbow!
Last week I was lifting something heavy and awkward and felt a tweak just below my right elbow. Over the next few hours, I experienced pain and weakness on lifting and gripping activities involving my right hand as well as tenderness over the muscle which runs from just above the outer elbow to the back of the hand, the extensor carpi radialis longus.
So I diagnosed myself with an acute strain to the muscle, which I should mention is not the typical type of tennis elbow which usually involves an overload of the tendon which attached the extensor carpi radialis brevis muscle at the elbow. This results in tendinopathy which, although different pathology, may result in similar symptoms.
From clinical experience, I know that if I did not look after the muscle strain, it could progress to tendinopathy, which would likely take a lot longer to settle.
So what to do?
I knew I needed to rest and offload the area for a few days to let the muscle start to heal. This meant avoiding excessive gripping and lifting for the most part, especially if provoking pain. Easier said than done, and I now have even greater sympathy for my clients who find this very difficult given how much we use our hands to grip and lift.
To help offload the muscle, I asked Lorraine to apply two strips of dynamic tape, which I find very helpful when treating clients in the early stages of a muscle injury. The tape also helped me be more mindful of not aggravating the injury by doing silly things.
The next day I started doing some gentle gripping exercises, pain-free and holding the grip for 30-60 seconds repeating 2-3 times once a day. This would be in line with current research, which advocates for this type of exercise to help ease pain and start to restore the load tolerance of the muscle and tendon unit. While experimenting with this exercise, I came up with a new version (see the pic) which involves setting my scapula and activating synergist muscles which seemed to help with the pain relief effect. I'll try this with my next client as it's easy to do in sitting at work, for example.
Next up was a few sessions, over the following three days of gentle needling treatment. I was able to self needle using my left hand and targeted the taut, tender portion of the extensor carpi radialis longus muscle which gave a few 'twitches' in response, suggesting a myofascial trigger point may have developed within the muscle, this would be common following an acute muscle injury.
Given I was starting to feel much better, by day 5, I was able to progress my exercises to involve more loading of the muscle in more functional positions.
To speed up the healing and recovery, I could have asked one of our physiotherapists to perform some specific manual therapy as well. I find this very helpful, especially when the tendon is involved, and there is a reduction in grip strength and power. The mobilisation with movement approach works very well clinically.
So a week later here I am, typing up this article using the 2nd finger on my right hand over and over, an activity which stresses my injured muscle and which now causes me no pain, so I am delighted. I am also able to fully grip and carry heavy objects now which a week ago would have been impossible.
If you suffer a similar injury, please don't wait to get it properly treated, the sooner it is treated, the quicker it is likely to settle without added complications.
In good health,