Address Tennis Elbow pain as soon as you can by making an appointment with a qualified / Professional therapist that knows how to eliminate Trigger Points. And, if you ever want to eliminate the possibility of strain of any muscle or tendon - You must strengthen that muscle and tendon so that it is stronger than the amount of stress or active resistance that it will be subjected to. If I can only extend and supinate my wrist and fingers against 20-lbs. of resistance, I had better not plan on doing anything that requires me to resist 50-lbs. unless of course I want to be severely injured in the process.

Trigger Points = Tennis Elbow

The symptoms associated with “Tennis Elbow” are often directed to the inflammation and damage of the finger and wrist extensor muscles - ONLY. Although these muscles can certainly be involved in cases of Tennis Elbow, the injury is more often caused by active Myofascial Trigger Points in the Supinator muscle due to the strain of this muscle while engaged in resisted pronation or forceful supination of the wrist/forearm.

Trigger Points and Pain Sequence

The muscles surrounding the elbow joint that cause lateral epicondyle pain are likely to develop Trigger Points in the following sequence.

Supinator
Brachioradialis
Extensor Carpi Radialis Longus
Extensor Digitorum
Triceps Brachii
Anconeus
Biceps and Brachialis combined

Activities that Increase Pain/Symptoms Associated with Trigger Points

The type of activities usually responsible for the activation of these Trigger Points involves incorrect use or overuse of the tennis “backhand”, “flipping” a briefcase onto the top of a desk with the arm in a straight, unflexed position, repetitive finger flexion/extension and repetitive/static gripping with the hands.

Manual Testing for “Tennis Elbow”

Testing the Supinator Muscle:
If the Supinator muscle is the source of the symptoms experienced by the patient, examination of the lateral epicondyle by “tapping” on it will exhibit tenderness and referred pain.

Performing resisted supination will also exhibit pain and tenderness, thus revealing Trigger points affecting the Supinator muscle.

Individuals with trigger points in the Supinator muscle may complain of pain in both the lateral epicondyle and the dorsal surface of the web of the thumb, or just one of these areas may exhibit symptoms. Almost every patient with pain directed over the lateral epicondyle has a Trigger Point in the Supinator muscle, and is the MOST COMON CAUSE of “Tennis Elbow” pain.

NOTE: Supinator Muscle: The Supinator muscle acts to supinate the hand and secondarily assist in flexion at the elbow. Supinator activity predominates over biceps activity during un-resisted supination of the hand, and is responsible for “holding/maintaining” the hand in a supinated position. Although the biceps is usually thought of as the main supinator muscle of the wrist and forearm, the biceps is only activated if the elbow is flexed (Even slightly), and when strength is needed to overcome resistance to the supination of the hand/forearm. When the arm is straight, with the elbow in an extended position, the biceps does nothing in regards to supination.

Associated Trigger Points are also often found in the:
Triceps Brachii
Finger Extensors
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Brachioradialis muscle.
A Trigger Point within the Anconeus may also refer pain to the lateral epicondyle)

Other muscles associated with the Supinators Myotatic Unit that may be involved, but do not refer pain to the Lateral Epicondyle:
Brachialis
Biceps Brachii
Palmaris Longus

Testing the Extensor Muscles:

If the Tennis Elbow symptoms are directly related to the Extensor muscle group , the patient will first experience pain in the lateral epicondyle, and later, experience the pain in a broader pattern as it radiates and travels downward into the forearm, wrist, hand and fingers.

HandGrip Test:
If the Extensor muscle group is the cause of lateral epicondyle pain, it will be confirmed upon examination utilizing the Handgrip Test, which requires the patient to squeeze an object with their hand cocked in radial deviation at the wrist (Normal thumb-up hand-shake position), and then un-cocked in ulnar deviation. If the HandGrip Test is positive, the patient will experience considerable pain and weak grip-strength in the “un-cocked” ulnar-deviated position much more than the “cocked” radial-deviated position. As the Therapist moves the patient’s hand further and further into ulnar deviation during the HandGrip Test, it becomes even more evident that the patient experiences a continual reduction of grip-strength and increased pain referral patterns.

Compression Test:
The origin of the pain, exhibited by the Myofascial Trigger Points in the Extensor muscle group, is confirmed with the Compression Test. The Compression Test requires the Therapist to pinch/compress the entire Extensor muscle group just below the patient’s Lateral Epicondyle, and held firm while the patient again performs the Handgrip Test. The pinching/compressing of the Extensor muscles will eliminate most of the pain that was previously experienced during the Handgrip Test. Once the muscles are no longer compressed/pinched by the Therapist, and the patient performs the Handgrip Test again, the pain that was initially experienced by the patient will again be present.

Pinpointing the Pain:
Identification of the involved muscle(s) can also be confirmed by causing / creating referred pain within the suspected muscle when it is passively stretched, and/or when it is actively loaded in the shortened position.

Pain Referral and Tennis Elbow

Supinator - Pain at lateral epicondyle with general ache in anterior forearm.
Extensor Carpi Radialis Longus - Pain and tenderness is referred from the lateral epicondyle down the arm to the posterior hand, and anatomical snuff box (Base of thumb)
Extensor Carpi Radialis Brevis - Pain is referred to the back of the hand and wrist.
Extensor Carpi Ulnaris - Pain is referred to the posterior / ulnar side of the wrist.
Extensor Digitorum - Pain is referred from the lateral epicondyle, down the forearm to the back of the hand and fingers.
Extensor Indicis - Pain is referred to the back of the hand and wrist.
Brachioradialis - Pain is referred to the lateral epicondyle and down the length of the arm to the posterior aspect of the web of the thumb.

Activities that Increase / Cause Symptoms Associated with Tennis Elbow:

Strain can occur at any time when resisting unexpected pronation / flexion or performing forceful supination / extension) of the wrist/forearm. Any type of strenuous force, repetitive motions and/or sustained supination/extension of the hand/wrist, especially when the elbow is straight, can cause injury to the Supinator and Extensor muscles, and refer pain to the lateral epicondyle.

Carrying a briefcase with the elbow straight (Fully extended) forces the Supinator to stabilize rotation of the wrist/forearm. This scenario presents even greater chance of injury if the briefcase tends to bump the individuals leg while walking and causes the briefcase to rotate, which has to be counteracted by the individual by resisting the pronation of the wrist/forearm with sudden contraction of the Supinator muscle. Also, heaving a briefcase up onto a desk with one arm, elbow fully locked in the straight position, forcing the weight of the briefcase to be directed entirely to the finger and wrist extensors, thus causing strain to the associated tendons and their origin / insertion points.

Repetitive Flexion while typing, causing the flexor muscles to become stronger and tighter, thus putting a tensile strain on the weaker extensor muscles from the constant “pulling” action of the more restrictive flexor group.

Playing tennis with a racket that has too large of a handle , which requires much more force to hold it steady, especially if the ball is hit off-center with the elbow fully extended and wrist in ulnar deviation, causing the racket to jar forward or rotate forcefully. (Full extension causes direct load to the Supinator muscle with no assistance from the biceps. If the elbow is even slightly flexed, the biceps will absorb much of the load and greatly reduce the chance of strain and injury of the Supinator muscle)

Other Contributors / Causes of Tennis Elbow:

Trying to unscrew a jar lid that is stuck, especially with fingertips.
Wringing out wet rags/washcloth
Ironing
Walking a dog that is pulling hard on the leash
Raking leaves
Falling onto outstretched hand
Digging with hand-shovel
And. many other activities causing excess, continuous or sudden strain to the underdeveloped Supinator and Extensor muscles.

Trauma, Repeated Stress and Muscle Overload = Tennis Elbow

PROBLEM: Trigger Points, Irritation, inflammation and damage of the supinator / extensor tendons at the tenoperiosteal junction, at the point of origin where the tendons attach to the Lateral Epicondyle of the humerus. (Upper Arm bone)

ANSWER: Develop adequate strength to withstand trauma and repetitive use by building up power and muscle endurance. Build up more endurance, strength to withstand stress to extensors.

EXAMPLES OF INJURY:

1. Examples of Individual that has enough finger, wrist and elbow extensor strength and endurance to perform the following three (3) activities on a daily basis without injury.
a. Repetition: 10,000 finger/wrist extension repetitions several days in a row (Typing on computers.)
b. Trauma: 60 lbs. Of instant pressure applied once (1x).
c. Resistive Power: 40 lbs. of pressure applied ten times (10x) a day.

2. Examples of same Individual performing the exact same tasks as listed above, but now in a situation that has caused injury. The following situations caused injury because the extensor muscles were not used to, or prepared for the increased stress placed upon them.
a. Repetition: Performing 20,000 (instead of 10k.) repetitions several days in a row. Endurance problem exists. (Typing on computers.)
b. Trauma: 100lbs. (Instead of 60lbs.) of sudden/instant pressure applied once (1x) to the supinator / extensor muscles, thus stressing supinator/extensor tendon insertion points on lateral epicondyle. Power/Strength Problem exists. (Catch a falling weight / dumbbell)
c. Resistive Power: 40lbs. of pressure applied twenty times (20x) per day. Power/ Endurance problem exists. (Tennis backhand trying to return very hard serve again and again)
NOTE: Any one of the situations described above can cause trauma and associated trigger points within the involved muscle(s).

Eliminate Tennis Elbow

The Supinator and Extensor muscles are easily injured due to their lack of strength and endurance, and then being subjected to overuse and/or sudden strain while in a position that causes them be at a mechanical disadvantage when utilized.

Myofascial Trigger Points consist of localized tender spots in a tense band of muscle fibers that when subjected to direct pressure, refer pain to other areas along the length of the involved muscle(s).

Strengthening the Supinator and Extensor muscles so they are prepared for tasks that require direct resistance, and learning to position the hands/arms correctly during those tasks can greatly reduce the chance of strain and serious injury to these muscles.

Prevention is the Key!

Strengthening the Supinator and Extensor muscles, and stretching the pronator and flexor muscles will prevent the injury from occurring and/or rehabilitate an existing injury. Strength, power and endurance are the keys to a healthy, pain-free elbow!
 

Jeff P. Anliker, LMT, is a therapist and inventor of products that are used by professional musicians and athletes an around the world to prevent and treat disorders like carpal tunnel syndrome and repetitive strain injuries.http://www.repetitive-strain.com  To find other free health content see e-healtharticles.com  

Consumers are used to seeing sex, fashion, love and status being used to sell food - and the food companies can and will quite naturally do everything within the law to promote themselves.

However, we are now seeing more and more attempts not just to squeeze certain foods on to the menu but also to force themselves further in as major dietary staples.

In the States, where snack food and out-and-out junk has for a number of years sought to displace traditional and balanced meals from the household menu, the trend is even more advanced than it is the UK - but this market is rapidly catching up.

The Weight Foundation identifies three specific areas which illustrate the trend. The first concerns breakfast cereals, the advertising of which has traditionally been about the choice of start-up fuel early in the morning. However, many commercials now present packaged cereal as an all-day food option.

Another example is the attempted re-branding of flavored noodles from being a snack into the status of a traditional food staple. This is a progression down the same road already well-traveled in the US, where a TV dinners mentality has become semi-legitimated by time alone.

A third area is that of convenience shopping. A typical example is that of the multi-role juggling of a modern homemaker. Her delayed and late evening food is shown as something like ice cream or chocolate, or even alcohol in place of food altogether, naturally on special offer that week in her local convenience store.

The Weight Foundation does not support suggestions that the law should be changed to clamp down on food advertising, concentrating instead on developing strategies to assist individuals to make more informed choices about their eating habits and lifestyles.

The answer must also be found in tackling something the registered charity has identified as Diet Shock, which is the distressing uncertainty of many persistent dieters whose natural instincts have become paralyzed by an overload of conflicting and frequently bad dieting advice.

Seduced away from conventional eating by advertising on the one hand and bamboozled on the other by the ceaseless tide of eating and dieting advice, many people have simply lost a clear picture of how to feed and care for themselves.

The Weight Foundation already publishes online its highly popular The Hardcore Dieting Index free self-test questionnaire, helping dieters to assess their personal behavior. Feedback from many long-term dieters in several countries has allowed the refinement of a fresh methodology to tackle unhealthy obsessions with eating, weight-loss and self-image issues.

3 Small Steps is designed to loosen the three restricting bands which usually keep dieting fixations in place despite endless failed dieting attempts.

These ties are identified as the emotional, the cultural and the commercial pressures which make Hardcore Dieting the Manchester UK-based charity’s term for persistent and obsessive dieting - so rampant in the West. Many experts now acknowledge that repeatedly failed dieting is a contributory factor to the obesity Epidemic. The growing frustration and disillusionment with dieting approaches stems from their inability to address these wide-ranging underlying concerns.

Ignoring any one of them will almost certainly condemn a problem eater to weight-control failure.

Dieters are invited to question closely what they are using food for. Is it a substitute or a comfort for other factors in their lives? Emotional over-eating is thought to be a significant contributory factor in many cases of long-term obesity.

On the cultural front, persistent dieters are asked whether they are unthinkingly buying into a cult of excessive thinness, or following the herd instinct in the stampede from one fad diet to the next.

Everyone thinks they operate as individuals but, in fact, we are all under great pressure to conform. For many women that can mean aspiring to excessive thinness, which in many cases is sure to lead to a rebound from self-deprivation into overeating and even greater misery.

Less widely appreciated than the unrealism of waif-thin icons is the need women especially feel to be involved with dieting - the need to fit in with your friends and society generally by being able to talk, live and suffer it. Hardcore Dieting has sadly become for many a rite of passage into womanhood.

The 3 Small Steps approach to the commercial pressures to eat abnormally or diet is to ask Who’s stealing my meals and to refuse to be dragged from a natural and normal eating rhythm.

All the calorie-counting and all the BMI charts in the world cannot teach what actually matters. The difference between a lighter, happier person and a heavier, unhappy one is that for the latter food is a major and dominating issue.

Mind-shifts do not happen on paper charts, or through contrived and unnatural diets. Changes of attitude occur in the mind and that is where the battle over dieting and obesity is won. Author Malcolm Evans is founder and secretary of The Weight Foundation dieting research charity.  To find other free health content see e-healtharticles.com  

Injuries can occur anywhere and at anytime, but the most prevalent place of occurrence is in the workplace. The reason for such a high rate of injury is that people spend 8-18 hours a day, 5-7 days a week performing unidirectional (one-way) movement patterns, causing an imbalance in the musculoskeletal system that results in the overuse and under use of certain muscle groups. If left unchecked, these injuries can be come chronic, resulting in pain and dysfunction that can last for years.

Muscle imbalances are the cause of most biomechanical disorders in the body. From Carpal Tunnel Syndrome to Thoracic Outlet Syndrome, an existing muscle imbalance is at the root cause of the disorder in 90% of the cases. Too many modalities focus on the “band-aid principal”, allowing the muscle imbalance go on for years with a little bit of relief here and there. Now is the time to focus on the actual “cause(s)” of these disorders and eliminate them altogether. With the appropriate exercise and stretch routine, most musculoskeletal disorders can be eliminated quickly and effectively.

Correcting muscle imbalances is achieved through a process consisting of a number of stretches and exercises. Soft-tissue treatment and hot/cold therapy may be utilized to help expedite the rate of recovery if it is so desired. Usually the nature of performing both stretches and exercises within the same program can be quite effective at eliminating the existing condition without the addition of the soft tissue treatment and hydrotherapy. Word of caution; there is a treatment sequence to addressing muscle imbalances if the best results are to be achieved. If random stretches and exercises are performed, an individual
  may cause themselves more harm than good.

A general rule when addressing a chronic muscle imbalance is to execute the
  following program:

1. Heat Therapy*: Use heating-pad 5 Min. to warm the affected joint and surrounding
  muscles, preparing them for upcoming stretches and exercises. (Be sure that
  all sides of the joint and surrounding muscles are warmed-up.)

2. Soft-Tissue Treatment*: Soft tissue treatment utilizing Effleurage and
  Trigger Point Therapy to reduce muscle spasm and relax the tight, restrictive
  overused muscles can be very effective in correcting muscle imbalances. (Utilizing
  Transverse Friction Massage (TFM) on specifically weak, injured muscles and/or
  tendons to break down adhesions on the soft tissues can also be very effective
  in reducing overall pain and dysfunction.) Performing basic massage to the
  tight muscles is the easiest way to address the issue without getting too complex.)

3. Stretching Routine: Once the muscles are warmed up, stretching the tight,
  restrictive muscle group is key to increasing their length and reducing their
  impingement of surrounding tissues as well as reducing their effect on the
  misalignment of the joint. (Stretching the weak, underdeveloped muscles is
  not recommended as they are already too long and do not need to be lengthened
  further.)

4. Exercise Routine: Once the tight restrictive muscles have been lengthened
  from the stretches, it is time to exercise the opposing muscle group, the one
  that is weak and underdeveloped, in order to shorten and strengthen the muscles
  in order to reduce the tensile stresses imposed on them from the opposing tight
  muscle group. Exercising and strengthening the weak underdeveloped muscles
  not only forces the opposing muscle group to relax and lengthen further, but
  it also helps to maintain the length created in those muscles from the previous
  stretches. (Do not perform stretches after the exercises as this misaligns
  the joints and causes muscle rebounding. Always perform stretches first when
  addressing chronic muscle imbalances and then immediately follow with exercises.)

5. Contrast Bath*: Utilizing a contrast bath at the end of the complete routine
  can be helpful in reducing muscle spasm, remove toxins from the muscles and
  increase circulation and overall nutrient flow to the injury, helping to aid
  an increase the speed of recovery. Basic procedure is 3-minutes heat to 1-minute
  of cold. Repeat 3-times, finishing with cold.

*Optional Part of Treatment

This general treatment program for chronic repetitive strain injuries resulting from muscle imbalances is very effective and often eliminates all of the symptoms previously associated with the injury, quickly and effectively. Always consult a physician before beginning any type of exercise or treatment program.

Remember, Your Health is in Your Hands!

Jeff P. Anliker, LMT, is a Therapist and Inventor of training systems that are utilized by Corporations, Consumers, Musicians, Athletes and Medical Facilities around the world for rehabilitation and performance enhancement. repetitive-strain.com   To find other free health content see e-healtharticles.com  

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