Bracing Yourself…For Tennis Elbow
By: Brian Lee, MD
As I previously detailed in this blog article, tennis elbow, or lateral epicondylitis, is an injury to the extensor carpi radialis brevis (ECRB) muscle. The ECRB is a muscle that contributes to finger and wrist extension, and with overuse can develop tears at the insertion on the outside of the elbow. These tears can lead to significant tenderness and weakness in the elbow joint. While tennis elbow can occur in tennis players, particularly those who have a one-handed backhand, I frequently see the same injury in people who play golf. Golfers will usually develop lateral epicondylitis in their lead arm (left elbow in a right-handed golfer) due to the repetitive stress the muscle experiences at impact. Beyond athletics, anyone who performs repetitive upper extremity motion, such as frequent weightlifting, can develop the problem commonly known as tennis elbow.
It bears repeating that most people experiencing tennis elbow will recover and heal from the condition without surgery. Under the guidance of an experienced health care provider, many patients benefit from a prescribed mix of a variety of non-surgical approaches to treating tennis elbow – from physical therapy and avoidance of activities that aggravate the condition to anti-inflammatory medications and specific strengthening exercises. Still, lateral epicondylitis takes time to heal, up to a full year in many cases. While that healing is taking place, many patients also find relief through a tennis elbow/counterforce brace. The purpose of such a brace is to decrease the tension on the wrist extensor muscles, which can help reduce the elbow pain and other inflammatory symptoms associated with the condition.
Although they may not be the more “popular” muscles most people regularly hear of, we use the wrist extensor muscles (ECRB included) frequently in performing activities of daily living. So, when someone experiencing tennis elbow attempts to perform movements such as driving, carrying groceries, working out, and typing, it can be excruciating and further stimulate the inflammatory response that should be avoided. While the injury heals, an adequately applied counterforce (elbow) brace allows the ECRB muscle to relax during activity. The brace should be applied near the mid-forearm area, and with adequate pressure, patients will often feel immediate relief when performing wrist extension motions due to the support from the brace.
Most of the tennis elbow braces on the market today are adequate. But when determining the right type for a tennis elbow injury, I always advise my patients to look for a brace that is circular, long enough to fit around the forearm, and allows for tightening – often utilizing Velcro to customize the support the elbow receives. The brace should have a pad on its inner surface which fits over the muscle belly of the ECRB. One nice feature that some braces come with is a ski boot buckle-like feature that allows the brace to be tightened instead of having to release the entire brace and pulling the end of it to tighten. This feature makes it much more convenient and easier to get that support pad in the just-right position for supporting the injured elbow.
So the next question is, ‘can I wear a counterforce brace for as long as is needed while the injury heals?’ The answer is yes and no. Any activity that involves gripping or holding with the affected elbow can be made easier with adequate bracing. And although the brace can be worn around the clock, even during sleep, doing so is not typically recommended. The brace is most helpful when performing activities of daily living due to the support it provides the wrist extensor muscles when properly applied.
As I mentioned above, physical therapy is an extremely important part of treatment for tennis elbow. But as the inflammation calms down, strengthening exercises of the forearm and the ECRB should be performed to protect against future injury. Doing so helps patients return to the activities they were participating in which incited the tennis elbow. And once those painful symptoms are finally gone, that tennis elbow brace can be taken off and placed on the shelf.
The pain experienced by patients affected by tennis elbow can range from mild to severe. Especially in mild cases, where the pain is “nagging” and not necessarily preventing the functions associated with daily living, some patients will “live with it” for far longer than they should. Pain anywhere in the body, no matter how “mild,” is a sign that something is amiss and needs to be addressed. If you’re experiencing elbow pain, no matter the level of severity, be sure to see a trained professional to have it evaluated. With so many conservative treatment options on the market today, a return to pain-free, active living is much closer than you think.