Tennis Elbow

These days the average person that has tennis elbow doesn’t even play tennis.  What used to be a term reserved for athletes can now be achieved by painting too many coats of paint on your wall, typing on your computer, and other non grand slam activities.  If you are feeling pain in your outer elbow that gets worse with pressure or use (typing, stretching, holding or gripping), then you may have tennis elbow even if you don’t know what 30 love means.

Tennis elbow or lateral epicondilytis refers to  pain on the outside of the elbow.   The syndrome is typically a tendinitis or overuse injury whereby the insertion of the the wrist extensor muscles (the muscles that bring the back of your hand towards your body) becomes inflamed. Typically the inflammation leads to the formation of fascial scar tissue which attempts to heal and strengthen the injured area, but instead often ends up forming a thick inflexible mass that glues the injured tendon to the surrounding tendons.  When these tendons become stuck together movement of the wrist becomes painful.

There are other factors related to tennis elbow.  The term tennis elbow originated from the frequency of this injury among tennis players.  As you can imagine, in tennis a backhand puts a lot of stress on the wrist extensors which can become fatigued easily.  It is the constant repetitive use of muscles that tires the muscles to the point that they become inflamed.  Tennis elbow is quite common for office workers because of the use of the computer and the the continuous strain that typing puts on the wrist extensor muscles.

Often in tennis elbow injuries, there is also the presence of a nerve impingement called thoracic outlet syndrome.  With the nerve supply for the wrist extensor muscles being decreased, the health of the muscle deteriorates to the point that it becomes more susceptible to injury from something as simple as typing.  This is why it’s important when treating tennis elbow to also look for the presence of thoracic outlet syndrome.

Research has shown that tennis elbow can be healed through regular massage, fascial release, stretching and acupuncture.

As an athlete can you benefit from massage? The average sports enthusiast might have their doubts. If you are running 30km a week, or lifting weights 3 times a week or generally pushing your body to its limits, how can a shoulder rub help?

First of all, let’s have another look at the definition of “massage”. The College of Massage Therapists of Ontario (CMTO), in their scope of practice, defines massage therapy as:

The practice of massage therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissue and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain. (Massage Therapy Act 1991)

Pretty wordy isn’t it?  Most people that want a massage for some relaxation don’t want to hear any of that.  They would prefer a nice, relaxing, soothing massage… the kind you see on tv or in the movies.  But the beauty of the definition is how open it is.  As an RMT, I treat “soft tissue and joints by manipulation”.  Soft tissue can be muscles, ligaments, tendons, or fascia.  Well, we all know what muscles are and we generally accept that RMT’s are pretty adept at “loosening” or “getting the kinks out of” muscles.  Ligaments are what are involved in ankle sprains, MCL or ACL tears of the knee.  Tendons are involved in any kind of tendonitis or tendinosis overuse conditions such as treat golfer’s elbow or tennis elbow.  And then there’s fascia which act like ropes attaching a sail from the boat to the mast.   If you imagine that the sail is the muscle that powers the boat, then the lines, ropes and pulleys are the fascia that decide how tightly the sail/muscle will be stretched and how powerful the sail/muscle can be.  An RMT is trained to work on the muscles, fascia, ligaments, tendons and joints or basically all those great little parts that work together to achieve peak athletic performance.  For the moment, let’s forget about the typical relaxing “massage” and start thinking of this as “therapy performed by a massage therapist” much the same way we think of therapy performed by a physical therapist or chiropractor.  Massage therapists are qualified to perform most of the stretches, exercises and manipulations that a physiotherapist does.

Athletes are familiar with the burn and soreness in the muscles that accompanies a good workout.  The pain is often caused by lactic acid build-up and inflammation in the muscles or spasm (shortening) of the muscles.  During a post event treatment, RMT’s can flush out the muscles helping to remove lactic acids and other metabolic waste products while flooding the muscle tissue with fresh oxygenated blood. RMT’s can use different massage & stretching techniques to lengthen the muscle back to its normal length and reduce pain from muscle spasm.  These all help to reduce pain, increase mobility and shorten healing time after an event or a tough workout.

During the training season athletes are constantly trying to find a balance between pushing the body harder while nursing old injuries and preventing new ones.  These injuries or imbalances can shorten an athletic career and decrease performance.   Scar tissue or fascial adhesions  often build up over injured areas or between  muscles almost gluing these structures together and decreasing strength and mobility.  Rolfing & MRT work to remove and re-align the scar tissue.  Acupuncture is also very effective at decreasing inflammation by giving the injury the equivalent of a cortisone injection.

Here are some examples of injuries that Sports Massage can help:

• Plantar Fasciitis
• Shin Splints
• Hip Pain
• Hip Tightness
• Knee Pain
• Tennis Elbow
• Golfer’s Elbow
• Patellar Femoral Syndrome
• Post Event Stretch & Flush
• Frozen Shoulder
• Rotator Cuff Tendonitis
• Herniated Disc
• Ankle Sprain
• Wrist Sprain
• Quadricep or Hamstring strain

What is fascia?  If you’ve ever cooked chicken, you’ve probably noticed it. The thin, transparent, filmy material that covers the chicken meat.  Our muscles are covered in fascia.  Fascia covers every muscle and keeps the muscle together.  Fascia covers and protects every single muscle bundle or fascicle that makes up the muscle.  Fascia also covers every single muscle fibre or muscle cell that makes up the bundle,  It is like the framework or scaffolding that the muscle operates within.  Fascia holds and supports the muscle together giving it shape, form and function.  It also helps the muscles slide over each other with less friction.  The body is made up of over 600 muscles that layer over each other and criss cross each other.  Each muscle needs to slide over, under or beside its surrounding muscles without interference in order to function properly.

Fascia has a few interesting properties too.

• It is pound for pound stronger than steel.  In other words, unless you know how to treat it correctly it can and will be very difficult to get it to release.
• Fascia is also the material that makes up tendons and ligaments.
• It is not contractile.  That is, it doesn’t contract or relax the way a muscle does.
• It can shrink or expand but we have little control over that.  It also seems to be emotional.  In times of emotional stress, fascia contracts and tightens around the muscle it is trying to protect.
• When a muscle is hurt, as in a car accident or athletic injury, the muscle and fascia often tears.  This tear eventually heals the same way that a skin cut can heal.  However, the same way that the skin can be left with a thick, inflexible, sensitive scar, the muscle and fascia can also scar.

The last point is why fascial work can be so important to healing sports injuries and traumatic injuries.  An inflexible scar in a muscle can do a few things:

• It can remain short, tight and inflexible causing pain whenever the muscle tries to stretch to its full strength.  You might even notice a sharp almost tearing feeling when you try to stretch.
• The scar can become adhesed or glued to the fascia of surrounding muscles.  This acts as a monkey wrench in the system.  None of the muscles that are adhesed can function pain free in their normal ranges with this.  For example, if a scar forms between your quads and your adductor/groin muscles you might notice that you don’t have the same strength or flexibility with either quad exercises or adductor exercises.  The reason is that those muscles are essentially glued together and pulling on each other each time you use them.

So now we know that fascia is everywhere; it’s stronger than steel; it can scar; it can become glued to other muscles.  And for many people, it is the key to solving chronic pain from old injuries. I’ll have posts in the future about how I can treat fascial restricitons with active fascial release, rolfing, myofascial release technique and acupuncture.