Tennis Elbow

Tennis elbow ailment.

Tennis elbow, what is it and what stretches and exercises are available?

In this nuggety condition, the muscles of the outer part of the elbow have always traditionally been presumed to be the primary site of the problem.

However, it is well known that this condition can be extremely resistant to conventional treatment, the primary cause is often not just repetitive use of the arm but a chiropractic subluxation in the lower neck, or inter scalene triangle.

Strike out the inflammatory itis in lateral epicondylitis and write osis in its stead. Read more about why further down the page.

Thus it comes as no surprise that researchers report in a journal of hand surgery that cortico steroid injections did not affect the apparently self limiting course of tennis elbow.

Given the known potential dangers of corticosteroid injections on tendon strength it makes no sense to follow a course of treatment that may at best be described as non scientific, and at worst as potentially dangerous.

If a subluxation of the first rib or lower neck joints, such as the cervical facet syndrome is the cause of the pain in your arm, then no amount of cortisone injections, or physical treatment of the elbow will cure the condition.

Path of the radial nerve.

Tennis Elbow

Chiropractic tennis elbow can only be properly addressed by first treating any subluxations in the spine that may be irritating the spinal nerves that serve the elbow muscles. This is primarily in the lower neck, but often there may be referred pain to the mid back and shoulder too.

Inflammatory changes have been noted in the acute stages but are absent after a few months which is why steroid injections have no benefit once chronic, and in fact have a significant chance of causing infection and tendon rupture.

Hence this condition is no longer called lateral epicondylitis, but epicondylosis. There is no itis or inflammation.

Is this all just exaggerated chiropractic rhetoric?

Read what Dr Jennifer Chu, professor of physical medicine and rehabilitation, university of Pennsylvania has to say about neck and elbow pain and the extensor carpi radialis longus muscle.

Often lower neck discomfort is due to C5 or C6 nerve root irritation. This can produce pain and spasm in the extensor carpi radialis longus muscle which crosses the elbow and therefore arm pain is also experienced by the sufferer.

This muscle receives C5 and C6 nerve root fibers through the radial nerve. Together with the brachioradialis and the extensor carpi radialis brevis, it is one of the three muscles that is known as the wad of three.

  1. Brachioradialis
  2. Extensor carpi radialis longus
  3. Extensor carpi radialis brevis

These three muscles can give significant pain in the arm commonly known as tennis elbow.

It originates from the outer aspect of the lower one third of the upper arm bone, or humerus, and inserts into the base of the second knuckle on the back of the hand. Its action is to bring the wrist up as in making a fist. It can also deviate the hand away from the mid line of the body.

Neck pain plus elbow and extensor carpi radialis brevis pain.

Neck pain secondary to C5, C6 nerve cervical root irritation, or a first rib subluxation setting up a thoracic outlet syndrome can cause pain and spasm in the extensor carpi radialis brevis muscle causing elbow pain.

This is one of the three muscles known as the wad of three and together with the triceps, causes the common condition known as tennis elbow.

It arises from the arm bone just above the elbow joint in the region called the outer, or lateral, epicondyle and inserts into the base of the third knuckle bone. It lifts the wrist and also deviates the hand away from the trunk.

The inter scalene triangle and thoracic outlet syndrome

After leaving the spine, the nerve roots combine in a complex of nerves known as the brachial (meaning "arm") plexus. These nerves, together with the main artery that supplies the arm pass through a narrow passage known as the inter scalene triangle where they  can be irritated by scalene muscle spasm, a first rib subluxation, cervical ribs and other more serious causes. Are you a smoker and have a cough?

If the artery is irritated it will affect the pulse in the wrist. Look up Adson's test at Chiropractic Help.

Interscalene triangle.

The diagnosis is made by clinical symptoms such as pain in the elbow, and often discomfort or stiffness in the neck and shoulder. Four orthopaedic tests are frequently used.

These tests are based on

  • contraction of the muscles as in shaking hands, and lifting a heavy kettle, for example.
  • stretching of these tendons.

Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, on the outside of the elbow.

Here is a simple home test that you can do. With the elbow straight, place the nail of your middle finger against the pulp your thumb. Now, does flicking, as though firing off a paper pellet, cause pain on the side of your arm?

Without proper treatment tennis elbow is likely to become chronic and very difficult to eradicate; nip it in the bud. There are few conditions I love more to treat; mostly, it's so easy but, occasionally, a bugger to put it succinctly.

Rest, of course, as with any sprain or strain, is an important part of the regimen. Let pain be your guide as to what you should and oughtn't be doing.

These are the symptoms of tennis elbow.

  • Pain and tenderness of the muscles the outer part of elbow.
  • Possible pain and stiffness in the neck, upper back and shoulder.
  • Gripping and movements of the wrist hurt, especially extension as in lifting a heavy kettle, and twisting movements as in using a screwdriver and even simple activities such as lifting up a glass of beer or throwing a ball.
  • Extreme tenderness to the touch.

Steroids, anti inflammatories and heat treatment should be avoided. Surgery is rarely necessary. There is no conclusive evidence that ultrasound assists in the treatment of tennis elbow.

Chiropractic Help

  1. The first goal is to free up any subluxations in the neck, if any are present. This is what makes chiropractors the pre-eminent therapists of this debilitating condition. Nerve tension tests may be positive in the acute phase.
  2. A second goal of treatment is to relieve pain and swelling, if present. Treatment of choice is alternating ice and heat. An ice block directly on the painful muscles in a hot shower is an ideal way. First cold, then warmth. More cold.
  3. Cross friction of the muscles may be useful, but should be limited to a few strokes. Personally I prefer to do it along the length of the muscle. It may be extremely painful and increase the inflammation if done too enthusiastically. Dry needling also may be helpful.
  4. Regular stretching of the tendons§; TENNIS ELBOW EXERCISES ...

  5. Progressive strengthening exercises to rehabilitate the muscles are essential part of the regimen of treating chiropractic tennis elbow. If you love baking, kneading bread is excellent exercise for the forearm muscles. For more, click here. HONEY BREAD ...

  6. Rest is also necessary in the acute phase. No tennis, shaking hands with the left hand, and no lifting of beer mugs!
  7. Strapping may help.

Stones in my clog book cover.

Measuring pain

How bad is your pain? Since we all have different pain threshholds it's often difficult tell if you have a serious debilitating problem or are just whinging.

Cervical facet syndrome

In conclusion, low grade irritation of the nerve roots as  by either the cervical facets or the joints of Luschka as they emerge from the spinal foramen is often the underlying cause of tennis elbow.

If you are having difficulty with this condition, then perhaps it's time to ask a local chiropractor to examine your neck; a cervical facet syndrome is really not uncommon.

› Tennis elbow


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.

Brachial plexus

The brachial plexus of nerves that supply the arm.

Chiropractic first poster.
The inter scalene triangle through which the nerves to the arm must pass.
Diagram showing how the thoracic outlet can cause arm pain.
Thoracic outlet surgery is a very delicate business.

Arm pain

1. Shoulder

Shoulder pain.

Frozen Shoulder

A man with a frozen shoulder.

Rotator cuff

The muscles involved in a rotator cuff strain.

"My thumb, forefinger and middle finger went weak after cuff surgery."

"Hello John, I take it you've been back to the surgeon.

It's probably temporary inflammation of the median nerve, but of course could be worse... I'm afraid I don't think chiropractic has anything to offer at this stage.

Once everything has healed up, if you don't get the strength back, or your fingers remain numb and tingly, then I'd consult a local chiro to see if there is also a problem in your neck or the first rib.

Dr B"

Letter from reader looking for advice.

Rotator cuff surgery.

2. Elbow

Path of the radial nerve.

Elbow pain

The tennis elbow muscles.

3. Wrist

The median nerve entrapment sites.
Diagram showing how the pronator teres muscle can cause carpal tunnel syndrome.

How bad is your arm shoulder hand pain?