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  Wednesday 25th May, 2022

The real cause of tennis elbow, and what you can do about it

Doctor examining elbow
Why do broken bones heal in 6-8 weeks, yet inflamed elbows can take 12 months or more?
An overlooked cause means you don’t get better

If you’ve got tennis elbow you’ve probably been told that it is inflamed due to overuse, and that it can take a lot of therapy and 6-12 months to heal. When you think about that something is not quite right. Why can a substantial injury such as a broken bone heal by just immobilising it for 6-8 weeks, yet an inflamed muscle attachment is so difficult and takes so long? If you’ve guessed that something is being missed, and because of that a lot of treatments and advice are inappropriate you’d be right. In this article we’ll show you:

Dr Graeme's comments

Graeme's comments

Yes there are serious issues with how tennis elbows are often managed. This causes un-necessary prolonged suffering. I’ll start by showing you the standard medical version of what a tennis elbow is, then share with you what’s missed and the huge problems that causes. I’ll then show you how you can simply check if you have this overlooked issue and simple easy to do things that will help a lot.

What is tennis elbow (lateral epicondylitis)

Tennis elbow is the irritation or injury to the outside of the elbow where many of your forearm muscles are attached. This attachment is called the lateral epicondyle, hence the technical name of lateral epicondylitis. The condition is common in tennis players so it is called "tennis elbow", but it can be caused by any repetitive activity involving forearms and gripping. It is even a common problem in those continually using a computer.

What causes tennis elbow

We’ll first give you the simple model of how tennis elbow forms that you’ll find in medical journals and most articles or videos. We’ll then give you the complete version that includes the overlooked issue that causes so many problems.

The medical model of tennis elbow
The medical version of the cause of tennis elbow

The simple medical version of the cause of tennis elbow

According to medical sources tennis elbow is caused by repetitive activities that create stress where muscles attach at the outside of your elbow. With this in mind their treatment is to reduce activities to allow it to settle down. When it doesn’t settle down they blame a build up of scar tissue and slow healing, then use an assortment of therapies on the inflamed area.

The complete cause of tennis elbow
The cause of tennis elbow, including the abnormal tension due to trigger points that usually get ignored

What the doctors and other professionals too often miss

As well as causing stress where the muscles attach, repetitive activities cause muscles to tighten, and over time causes those tender lumps in your muscles that therapists often find to develop. These lumps are called trigger points, and they are actually parts of the muscle that have gone into spasm. Being in spasm they physically shorten the muscle, creating extra tension on the attachment. It is these trigger points that are the overlooked cause.

Summary

In summary, the medical approach just recognises the stress caused by repeated activities, but ignores the additional constant stress caused by the trigger points causing abnormal tension in the muscles. This seems like such an obvious thing that it is hard to believe that it is overlooked, but it is. Please check this typical medical journal article.

The problems created by failing to identify the correct cause

We’ll use an example of the treatments patients typically receive to show you why this omission creates such a big problem.

The problem with rest and medications

Thinking that the cause is repeated use doctors will typically advise to rest and to take some medications. They think resting will remove the abnormal stress and allow the elbow to heal. However, as we’ve seen there is still the continuing stress from the abnormal muscle tightness due to trigger points, so of course it won’t heal.

Acupuncture for tennis elbow
Stirring up the inflamed elbow when the real cause is abnormal tension due to trigger points.

The problem with laser, acupuncture, massage and other therapies

When the elbow fails to heal with rest scar tissue and slow healing is usually blamed, then a shopping list of therapies are used on the inflamed elbow. You still have the abnormal tension that has been overlooked, and now you have people rubbing and poking needles into the elbow that’s already stirred up.

The problem with stretches and exercises

Your elbow is inflamed by overuse and the extra tension due to trigger points that has been ignored. Do you then create extra stress and tension using exercises and stretches and expect it to get better? Enough said.

What you can do about it

What we will do here is show you a couple of simple tests to show if you have trigger points causing abnormal tension in your elbow. If you do we have an excellent step by step guide using mainly home care to properly get rid of your tennis elbow.

The simple step by step self test for tennis elbow

Although these tests are simple enough to easily do yourself please consider them as general information only, to be discussed with a health care professional familiar with your needs.

Step one: is it tennis elbow

Tennis elbow is fairly simple to identify. You first feel the outside of your elbow. You will find a bony bump where the muscles attached. If you have tennis elbow this bony bump and for about 1cm towards your wrist will be tender. There are two very simple medical tests with the impressive names Cozens Test and Mills Maneuver. They are both simply designed to stress the elbow. If they cause elbow pain that is positive. The examination and these tests are pictured below.

Examination of the elbow
Examine for tenderness at the bony bump and for 1cm towards your wrist
Tension test for tennis elbow
With tennis elbow this stretch will cause pain at your elbow
Stress test for tennis elbow
With tennis elbow pushing back like this will cause pain at your elbow

Step two: is abnormal tension due to trigger points a problem

There are two very simple tests you can do that show if you have trigger points causing abnormal tension.

Examining forearm muscles for trigger points
Use the flats of your fingers, then if tightness or tenderness is found use one or two fingers to examine deeper for tightness and tender lumps
Test one: examining the muscles

It is simply to examine your forearm muscles. As shown in the picture you start examining with the flats of your fingers looking for areas of tightness or tenderness. If you find any areas like that you can examine deeper using one or two fingers looking for tight bands of muscle and tender lumps. Finding these is considered a positive test. Note that you don’t examine the tenderness at the elbow, as you are looking for a cause rather than a result, and if you’re not sure any property qualified professional such as a Chiropractor, Osteopath or therapist will be able to advise you.

Test two: what happens when you (temporarily) relieve the tension

For this test you simply:

  1. examine the your elbow using the tests in step one (above),
  2. treat the trigger points to temporarily relax them,
  3. then re-check the elbow and see it has changed.

If the elbow is less tender and the stress tests don’t hurt as much after treating the trigger points this shows that the trigger points are creating abnormal tension at the elbow. For how to temporarily treat the trigger points please see our article How to treat tennis elbow at home

What to do if you have tennis elbow and trigger points are an issue

We’ve got a separate article linked below that will give you a step by step guide to a very effective plan that is mostly home care and certainly takes into account this issue that is too often overlooked.

Step by step tennis elbow management, with home advice

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Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more