MR. GOODEMOTE: I am 95 percent positive that I have tendonitis. I was told it is “tennis elbow.” I have had tenderness, aching, burning at times, and just constant pain in both elbow areas for about 18 months. I am a hairdresser. I’ve been doing this for 25 years. My question is: Can the injury be treated if I also continue to work my regular schedule? Can I resolve this at home? I’m starting to get really worried now. Do you have any recommendations???
RENEE:?Thanks for writing to me. To make sure we really are talking about the same thing, let me start by saying tendonitis by definition means “inflammation of the tendon.” Tennis elbow is also known as lateral epicondylitis, which means inflammation of the tendon on the outside of the elbow region.
In order to have inflammation, there must have been a time in your past when the condition was constant. Inflammation of the tendon typically starts from a specific injury or from repetitive stresses over time. It is important that there is some time in the past when the pain was constant – truly constant, meaning 24/7 – because the treatment would be different if your pain has been intermittent.
One of the most common elbow issues that is mistaken for a tendonitis is a subluxation of the radial head. This is a condition of the joint in which the position of the bone is off just slightly, and the solution is a simple mobilization that can easily be performed by a trained physical therapist, but it is difficult to do at home on your own. A subluxation is fairly common but not commonly diagnosed.
To determine what is the source of your pain, we need to differentiate between “movement loss and painful movements.” If you have full motion and pain, it is likely tendonitis, whereas loss of motion with or without pain is more likely to indicate a subluxation.
The classic tests for elbow tendonitis are :
- pain with resistive testing in extension (the motion when the back of your hand moves up if you are starting with your palm facing the ground) toward your forearm; and
- ?pain with stretching of the muscle when the elbow is fully extended (straightened). You can achieve this stretch by gently pulling the palm of the hand down toward the ground if you are starting with your hand down.
It very important to do these tests to be sure that we are dealing with a tendonitis. For the purpose of this article, I am going to assume we are. The most effective, conservative treatment for this condition would include you stopping the offensive activities. But assuming it is not something you are able to do at this point, then I will recommend what I have found to be most effective.
I recommend that you warm up the tissues before you start your shift at work. This can include using a moist heating pad or a five-minute warmup of simple arm circles and back slaps (i.e., cross your arms across your chest until your hands slap the back of the opposite shoulder). The point of a warmup is to increase blood flow to the muscles of the arm.
Next, at regular intervals and definitely between customers (more often if possible), stretch the muscles of the forearm. Do this by fully extending the elbow and gently bending the wrist down toward the ground to get the muscles on the top of the forearm to feel a gentle stretch.
It would also be helpful to massage the muscles of the forearm, but it may not be possible if both arms are painful. Massaging yourself may actually provoke your condition, in which case it would be helpful to have a physical therapist that specializes in manual therapy do it for you. At our clinic, we specialize in the manual work and have exceptional results because of this. When you are in acute pain, it is really helpful to have someone that has expertise to do this for you, and eventually teach you or someone at home to do it properly.
Immediately at the end of your shift, put ice on the muscles for 20 minutes. I think it is important to use ice after using the muscles, ideally, to prevent more swelling.
Finally, anti-inflammatory medication is for this type of condition, but I am not able to recommend medications, so it is important for you to talk to your physician about medications that may or may not be helpful for you.
For me, the the anti-inflammatory medication should be intended to address the inflammation, not necessarily the pain. This is because the source of the pain is the inflammation, so when you get rid of the inflammation you get rid of the pain. But like I said, the specific parameters should provided by a physician.
There are splints and braces that you can wear, and there are taping techniques we do at our office, but I always like to try to resolve the issue before trying devices of any kind.
It may not be possible to resolve this on your own, but you can email me to let me know how you are doing, and I can make further suggestions at that time.
Gloversville native Matthew Goodemote is the owner of Goodemote Physical Therapy in Saratoga Springs and Community Physical Therapy & Wellness in Gloversville.