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| Ref: https://www.usta.com/ |
Tennis elbow sounds familiar and seductive to think of tennis related injury, especially professional players because of the accommodation of repetitive and forceful movements of the arms. Not only sports, but also occupations that include butchers, manual laborers, and employees in the fish processing industry are at high - risk of work related injury. In a physiotherapy clinic, I have seen tennis elbow in golfer, squash, swimmers, weight lifter, carpenter, gardener, mob & sweep, etc.
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| Ref: https://hughston.com/wellness/tennis-elbow/ |
13 various stretch for tennis elbow and lateral elbow pain
Exercise #1: Tennis elbow stretch with hand open which consists of arm hyper - pronation plus wrist flexion plus wrist bend to little finger
Exercise #2: Tennis elbow stretch with hand open which consists of arm hyper - pronation plus wrist flexion plus wrist bend to little finger
Exercise #3: Standard backhand stretch with supination and hand open
Exercise #4: Standard backhand stretch with supination and hand closed
Exercise #5: Reverse prayer stretch
Exercise #6: Standard backhand stretch with pronation and hand open
Exercise #7: Standard backhand stretch with pronation and hand closed
Exercise #8: Table backhand stretch with supination and hand open
Exercise #9: Table backhand stretch with pronation and hand open
Exercise #10: Floor backhand stretch with pronation and hand open
Exercise #11: Floor backhand stretch with supination and hand open
Exercise #12: Brachioradialis stretch
Exercise #13: De Quervain’s stretch
History of tennis elbow was first described by Runge in 1863. This condition mechanism occurs in tennis players secondary to an improper backswing. Then, Official nomenclature of this entity was declared in 1883 as “Lawn Tennis Elbow”.
The presenting symptoms of tennis elbow typically involve the insidious onset of pain in the lateral aspect of the elbow, which may radiate distally into the forearm. Pain is often exacerbated with resisted wrist extension or repetitive wrist movements, especially with the elbow full extension. Patients also may complain of weakness in grip strength occurring with attempts to grasp or carry objects with the affected upper limb. Edema or erythema at the lateral epicondyle is uncommon, and patients typically have transient symptom relief with activity modification or relative rest of the symptomatic limb. Tenderness is also typically localized to the tendinous origin of the extensor carpi radialis brevis. The pain can be aggravated by gripping, heavy lifting, or simple tasks of daily living.
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| Ref: https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/ |
According to anatomy, the lateral elbow is the proximal of wrist extensor or backhand muscles. The origin of the wrist extensor group is lateral condyle of the humerus region. The extensor carpi radialis longus originates from the supracondylar ridge below the origin of the brachioradialis. This attachment is between the brachialis medially and the extensor carpi radialis brevis inferolaterally. The extensor carpi radialis longus crosses the elbow and carpal joints to insert onto the dorsal base of the second metacarpal and is covered by the brachioradialis over most of the forearm. Its function is that of wrist extension, radial deviation, and possibly elbow flexion. Originating from the lateral inferior aspect of the lateral epicondyle, the extensor carpi radialis brevis origin is the most lateral of the extensor group. The extensor carpi radialis brevis is covered by the extensor carpi radialis longus and its fibers are almost indistinguishable from those of the extensor carpi radialis longus and extensor digitorum communis in most cases. The extensor carpi radialis brevis muscle also has additional attachments to the radial collateral ligament and the intermuscular septa between it and the common extensor muscles. The extensor carpi radialis brevis tendon inserts to the dorsal surface of the base of the third metacarpal bone. Pure wrist extension with some assistance in radial deviation are the main functions of the extensor carpi radialis brevis.
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| Ref: https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/ |
There is one muscle that has been installed in the lateral elbow area which is brachioradialis. It originates from the lateral supracondylar ridge, the lateral aspect of the diaphysis of the humerus, and the lateral intermuscular septum and inserts into the lateral aspect of the styloid process of the radius. So, it seemed to be a neighbor of backhand muscles. The primary function of the brachioradialis is as a concentric elbow flexor and secondarily assists in forearm pronation.
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| Brachioradialis muscle location (Ref: https://gvaat.com/blog/how-to-draw-forearm-anatomy-a-step-by-step-guide/) |
Khandaker and et al., suggested stretching for tennis elbow like De Quervain’s tenovaginitis stretching. De Quervain’s tenovaginitis is a disease that is more common among people who perform manual work, owing to the unique mobility of the human thumb. Patients with this condition mostly complain of soreness and tenderness on the radial side of the distal radius that is exacerbated by ulnar deviation of the thumb; by a strong grasp combined with flexion and radial deviation of the wrist or by a firm pinching together of the index finger and thumb. Physical examination reveals tenderness and swelling directly over the first dorsal compartment. Within this compartment lie the tendons of extensor pollicis brevis (EPB) and abductor pollicis longus (APL).
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| (Ref: https://orthofixar.com/hand-surgery/de-quervain-tenosynovitis/) |
All of the above are thumb side linkages that possible transmit force to each other. The force may make the musculotendinous junction of the wrist extensor muscles group degenerate and injured afterward. As above, wrist extension force can pull the muscle - tendon unit directly. Moreover, very strong force of wrist flexion and grip can pull there indirectly because wrist extensor muscles have to contract while gripping to stabilize the wrist joint.
Stretching exercise, one of physiotherapists' protocols, is used to decrease the risk factor of musculoskeletal injuries. Muscles would be soft and length enough to tolerate the force which pulls them. The way to stretch is simple: stretch to the point where “tightness without pain” or “noticeable tension without pain” will hold at the point for 30 seconds of 3 - 5 repetitions in one muscle as demonstrated in the video.
So, as my physiotherapist experience, I would like to recommend stretching both sides of the lateral arm often to prevent lateral elbow injury that you can study wrist flexor stretching on https://yimphysionearme.blogspot.com/2022/05/physiotherapy-with-11-ways-to-stretch.html
Reference:
https://www.jospt.org/doi/pdf/10.2519/jospt.1994.19.6.357
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