Conventional remedy: Tennis elbow is a pain on the outer side of the elbow joint which may spread down the arm towards the wrist. There will be a particularly tender spot next to the joint.
It is caused by single or multiple tears in the sinew which attaches the muscle to the bone on the outer side of the elbow. In some cases, it can be due to inflammation in the bone itself at the point where the sinews are attached.
While tennis elbow may develop without any prior injury, it is associated, obviously, with the strenuous use of the arm involved in such activities as playing tennis or carrying heavy objects. Repeated unaccustomed movements of the elbow may also bring on the condition.
There are several treatment options, all of which are more effective once the activity which produced symptoms in the first place is stopped. Anti-inflammatory drugs may also help to alleviate milder cases.
Physiotherapy is also helpful, and sports people may find it beneficial to wear a supportive strapping over the elbow.
If these treatments fail, an injection into the tender spot, using a combination of local anaesthetic and steroid, will often produce a dramatic cure. Up to three injections can be safely given at six- to eight-week intervals.
It is possible that should you do nothing apart from rest, the symptoms will gradually settle, albeit over a longer time-frame than with active treatment.
Dr Muiris Houston
Alternative remedy: Tennis elbow is traditionally associated with a bad backhand stroke; nowadays, however, it is commonly caused by everyday office activities. At the traditional typewriter, we could rest our fingers on the keys, but the modern keyboard, which is touch sensitive, requires the fingers to be held above the keys, which involves chronic overuse of the extensor muscles of the forearm.
Tennis elbow can be separated into three different types - tendinitis, muscle belly problems, and irritations of the muscle/bone attachment - each affecting the extensor part of the forearm. Tension in the forearm can be so severe that it can pull the periosteum off the bone (the periosteum is the covering of the bone; it has a lot of nerve endings and is thus very sensitive). Many patients indicate a point of pain very near the elbow joint where the extensor muscles are attached to bone.
Osteopathic treatment will involve stretching and deep massage techniques to help reduce muscle spasm and improve blood circulation. This helps to feed the often starved, over-used muscles and tissues. Local manipulation and articulation of the elbow joint also improve general mobility and function. Improvement of the mechanics of the shoulder girdle, neck and upper back helps the arm function more efficiently and reduces the strain at the elbow. Exercises are used to restore muscles and add flexibility.
Hot and cold compresses can reduce local inflammation. The use of keyboard supports is essential; possibly, keyboard shape changes are needed. It is best when working at a keyboard to allow arms, hands and forearms to rest, preferably with palms up on the lap. If the problem is due to tennis, get your coach to check your technique.
Osteopath Alexander Gibbs
The Irish Osteopathic Association can be contacted at 10 Winton Avenue, Rathgar, Dublin 6 (tel: 01-2695281)
patientquery@irish- times.ie