How to Heal Tennis Elbow

“I know you probably don’t want to do this and we could hire somebody but we have to do something about the tree limbs. They’re on the roof now. I mean resting on it and that’s not good. If we get a heavy rain or wind storm, a lot of damage could happen,” said my wife Ellen.

Sigh. Sigh again. I hate getting on the roof. That’s probably because I’ve fallen off of it before. But I knew she was right.

“Well, let me look at it. If it’s something easy, small enough limbs, then, yeah, I can do it. But, anything that requires a chain saw, we need to get a pro,” I said.

So, up I get up on the roof with pruning shears in hand. Lots of limbs. I start pruning away. “Not so bad” I think to myself. After about 15 minutes, the limbs were now just barely touching the roof instead of lying on it. More to go.

Another 15 or 20 minutes of trimming branches that are now 1-2 inches in diameter, and several bigger than that, and voila’! It worked! No tree limbs on the roof, trees were in good shape and so was I.

Until later that evening when I noticed pain in my right elbow.

It hurt a lot. Like to pick up a glass of water.

My first thoughts were, “I’m falling apart! I mean come on! Thirty minutes of tree trimming and I end up with a Tennis Elbow! What’s the deal!”

This was closely followed by, “Great. Now I have to change my training routines again; this thing won’t heal for months. I’ll gain back the weight I’ve lost, lose the strength I’ve gained, and life will generally suck.”

These are things that fly into your head in nano seconds and if you’re not careful, take root and blossom into full time misery.

So, I shook my head and started replacing those thoughts with new ones. “Ok. Let’s just see how this shakes out over the next couple of days. Yes, you strained your elbow but remember you haven’t been able to really train much on that arm because of the rotator cuff tear so ease up here. You know what to do. You have people around who can help. This could resolve in a week or two. The world is not going to end.” And this is a hard thing to do – change your mindset. But, if you don’t, you’ll find the evidence in the world around you to support the mindset you have.

Tennis Elbow Program

Tennis Elbow is an injury to the tendon of the wrist extensors that attach right at the outside of your elbow joint. Sometimes it can also be accompanied by too much motion in the wrist, weakness of the lower trapezius muscle in the back with or without a trigger point, or all of that. In any event, the result is a reduced ability to produce and absorb force.

It’s no longer considered “tendonitis”, although practitioners will still diagnose you with that term. It’s technically considered a “tendonopathy” or “tendonosis”  – a non-inflammatory injury to the tendon.

For the first 48 hours, I used kinesiotape and left it alone and worked on my mindset. I let my body do its thing. The tape reduced some of the pain, provided some support, and made me feel like I was doing something (and that’s a key step in the process – do something).

After the 48 hours had passed, I started tendon healing exercises for the elbow.

Tendons gain strength two ways. High load with low number of repetitions (mainly eccentric contractions) or low loads and high repetitions. Since my elbow hurt still when I made a fist or grabbed something, my option was low load and high repetition.

It hurt to just lift my hand up and down but if I turned my hand sideways (thumb pointing up), I could move the hand and wrist without pain.

So, I started sets of 100 repetitions over the course of the day. While I was in the car, I would do a couple of sets or when I took a break from working on something.

I also hunted for trigger points in the extensor tendons and found three. A trigger point is a sensitive nodule in a muscle that’s been over worked. When I pressed on those, bingo – lots of pain, the same kind of pain I had when I lifted a glass. So, I treated those with a mild sustained pressure of 30 seconds, rest a minute, repeat five times. I did that a few times a day.

Three days later, I had very little pain in the elbow. It was still there if I lifted something over about 10-12 lbs ( with one hand) but I could make a strong fist, shake hands, lift lighter objects.

The trigger points returned but were much less painful. I just kept treating those and wore kinesiotape too.

Progress The Exercise

Next, I’ll shifted into something I call variable isometrics then move to eccentrics.

An isometric contraction is one where the muscle length stays the same while the tension in the muscle increases up to a constant level. A variable isometric contraction is an isometric contraction with a varying amount of force (see the video for the examples).

Eccentric contractions are ones where the muscle tightens while at the same time it lengthens. I have an example in the video.

An additional benefit of eccentrics is the obliteration of something called “neovessels”. These are small blood vessels that grow into the tendon where no vessels were before and serve as one of the causes of pain.

I measured my grip strength and it was 110 lbs on the left and about 65 lbs on the right (not painful). I’m right hand dominant so I should be up around 120 lbs or so before I will consider myself fully recovered. Prior to that time though, I will be asymptomatic.

To summarize, the things I did to heal the injury were:

1. Don’t panic. Reset your mind about how long it will take and then get going. Don’t ignore it. Don’t think “Oh, it’ll just go away.” Maybe it will. But as you age, it’s less and less likely that injuries like this just float away like a leaf in the river.
2. Avoid non-steroidal anti-inflammatories for the first 48-72 hours (Advil, Motrin, Aleve). Let your body react to the injury. And, usually these drugs are ineffective because most tendon injuries aren’t inflammatory problems. The pain is from other biochemicals – glutamate for example – that stimulate pain receptors. Pain relievers like Tylenol can help but the pain serves as a governor so if it’s really bothering you and you take a pain reliever and suddenly feel great, just remember that you’re not great. You just feel that way. I used kinesiotape which helped reduce the pain quite a bit although the first night, I still hurt enough that my elbow woke me up a few times and I was grumbling the next day about that.
3. After 48-72 hours, find some movement that doesn’t hurt and do a lot of it. In my case, it was just moving my hand side to side. After about one hundred repetitions or so, my muscles would get tired and ache a bit but I had no significant pain at all.
4. Once you notice that the muscle can produce some force with little pain, add variable isometrics then progress to eccentrics. Of course, how you do this depends on the body part or region. For the wrist/hand it’s fairly simple (see the video above for details). The dosage is usually 20-30 reps of each exercise, 3 sets every other day. Some experts suggest daily exercise with eccentrics but in my experience, that is often too much exercise and not enough recovery.
5. Find something that can serve as benchmark for recovery. In my case, I can measure my grip force and compare it right to left because I have the tool to do it. But, you could use something else like a gallon of milk or water or some level of weight you’re used to lifting.

Usually, if you can follow these steps, you’ll keep the injury from turning chronic and will hasten your recovery.