Repetitive strain injuries, or overuse injuries of tendons and muscles, are very common and are both treatable and preventable. The severity of these injuries is directly related to the number of repetitions of a particular activity and the technique utilized while performing that activity. The severity is also proportional to the strength of the muscles utilized as compared to the force of the activity. The “weekend warrior” who attempts to participate in a sport without any prior training is a good candidate for predisposition to repetitive strain injuries. His or her technique in performing the sport would probably be poor, and the muscles utilized would not be conditioned to deal with the repetitive force of the activity. This kind of overuse causes small tears in the muscles and tendons. If tissue injury occurs faster than tissue repair, pain and eventually weakness would be experienced in the region of the damaged tissues.
Tennis elbow is a repetitive strain injury to the extensor muscles and tendons of the forearm. The symptoms of tennis elbow are of pain on the outside of the elbow and back of the forearm, and weakness with grip. A one-handed backhand performed with poor technique is a common cause of tennis elbow (Fig. 1). The one-handed backhand places a lot of strain on the muscles and tendons of the forearm that have a common attachment to the outside of the elbow, called the lateral epicondyle. Initially, pain on the outside of the elbow and back of the forearm will occur when playing tennis. If the injury is not treated appropriately, the symptoms will become more severe and constant, eventually limiting the activity. Repetitive use of a hammer or screwdriver or carrying a heavy briefcase are other potential causes of “tennis elbow.”
Case Study
Birgitte came to Dr. Dubin’s office for care with complaints of pain on the outside of her right elbow that traveled down the back of her forearm. Birgitte stated that she’d recently come back from a trip to Denmark, where she drove a stick shift for approximately 1000 miles. Later, for business, she carried a heavy briefcase with her right arm fully extended by her side. She then played tennis with her daughter’s racket, during which time she noticed an extreme pain on the outside of her right elbow.
Dr. Dubin explained to Birgitte that her activities caused a repetitive strain injury to the forearm musculature, leading to the development of tennis elbow. Using muscle anatomy flashcards, Dr. Dubin showed Birgitte several muscles she may have injured: extensor carpi radialis brevis, extensor carpi radialis longus, extensor carpi ulnaris, extensor digitorum, brachioradialis, anconeus (Fig. 2), and supinator musculature (Fig.3)
Treatment of Birgitte’s tennis elbow condition consisted of specific muscle treatment techniques to free up soft tissue motion of the forearm musculature, chiropractic adjustments to free up joint motion in the wrist and elbow, and ultrasound/electric muscle stimulation combotherapy to decrease pain and restore normal muscle tone. Birgitte was also instructed to ice her elbow 20 minutes on, 1 hour off, and reapply to decrease inflammation.
During Birgitte’s second office visit, she was instructed on a home rehab routine consisting of wrist flexion (Fig. 4A), wrist extension (Fig. 4B), and alternating forearm supination (point the palm down), and pronation (point the palm up) exercises. After three treatment sessions at Dr. Dubin’s office, Birgitte’s tennis elbow condition was almost resolved. Birgitte also began wearing an air splint placed approximately one and a half inches below the elbow to support the extensor musculature of the forearm when playing tennis.
Preventative Measures
- If you’re a tennis player, take tennis lessons with a pro to address proper stroke technique: two handed backhand instead of a single handed backhand; turn the shoulder and trunk into the swing; and when the racket contacts the ball, the wrist should be slightly extended and deviated upward instead of flexed and deviated downward.
- Select the proper racket, keeping in mind grip size, racket weight, and string tension.
- Be sure to properly warm up before play begins.
- After the match is over, ice the elbow.
- Wear an air splint placed 2 finger widths below the elbow crease, with the airbag placed over the major extensor muscle bellies. The splint should fit comfortably.
- Initiate a workout routine emphasizing strength and flexibility training for the forearm, trunk, and shoulder musculature.
