Latest / The Driven Athlete / Ep 14: Tennis Elbow: Athlete's Guide to Conquer & Recover

Transcript

Ep 14: Tennis Elbow: Athlete's Guide to Conquer & Recover · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the driven athlete podcast.
• 0:10
  Speaker 1: What's up y'all?
• 0:12
  Speaker 1: It's man, dr Kyle.
• 0:13
  Speaker 1: This is the driven athlete podcast.
• 0:16
  Speaker 1: Welcome back today.
• 0:17
  Speaker 1: We're gonna.
• 0:18
  Speaker 1: We're gonna pinpoint talk about tennis elbow.
• 0:20
  Speaker 1: Okay, elbow pain, lateral elbow pain, lateral Epicondylitis, lateral epicondylopathy, lateral epicondylosis those are all really mean the same thing and it's tennis elbow is the old-head version diagnosis that we hear a lot.
• 0:36
  Speaker 1: But the Tennis elbow is a really common thing.
• 0:40
  Speaker 1: We see people, right, because we work with a lot of golfers, tennis players and and upper extremity arm Vast athletes, people that exercise a lot.
• 0:48
  Speaker 1: So it's actually a common thing, right?
• 0:50
  Speaker 1: So I wanted to shed some light on what exactly is tennis elbow.
• 0:53
  Speaker 1: All right, the medical term is lateral epicondylitis or lateral epicondylopathy or lateral epicondylosis.
• 1:01
  Speaker 1: All right, the lateral epicondyle is a bony structure on the outside of your humerus bone and you have a plethora, a handful of muscles that all connect to that one and Origination point on your lateral epicondyle of your humerus and it all inserts something called your common extensor tendon.
• 1:21
  Speaker 1: All right, so you have a bunch of muscles that all connect through your common extensor tendon right onto your lateral epicondyle of your humerus and when that gets lit up and involved we call it lateral epicondylitis.
• 1:31
  Speaker 1: Itis meaning inflammation, epicondylosis osis just means like a chronic problem and degenerative changes.
• 1:39
  Speaker 1: It's like a degenerative, chronic problem, opathy, like tendinopathy.
• 1:44
  Speaker 1: Lateral epicondylopathy that just means that there is a pathology of that structure, of that region.
• 1:49
  Speaker 1: So probably the most accurate term it's just semantics but would be maybe like lateral epicondylopathy.
• 1:55
  Speaker 1: There is a problem going on there, super acute.
• 1:57
  Speaker 1: We would call it epicondylitis.
• 1:59
  Speaker 1: So the common extensor tendon is the structure that a lot of muscles connect right under the lateral epicondyl of your humerus.
• 2:08
  Speaker 1: Okay, knowing that from our previous conversations, things don't hurt for no reason and things don't get lit up for no reasons and the structures that are lit up and painful are usually the victims because they're overwhelmed and they're trying to overcompensate and they're working overtime Because other structures aren't contributing enough or there's compensation patterns going on.
• 2:28
  Speaker 1: It's a combination of the two Mobility disparities and muscle strength activation disparities, followed with compensation patterns.
• 2:36
  Speaker 1: Those things lead to compensation patterns.
• 2:38
  Speaker 1: So we can fix those mobility disparities and muscle strength activation disparities and then translate that into your sport and movement to fix the compensation pattern.
• 2:47
  Speaker 1: So with lateral epicondylopathy, tennis elbow, we know that the common extensor tendon and the research the most commonly reported structure that's lit up is the extensor carpy radialis brevis tendon.
• 3:03
  Speaker 1: The extensor carpy radialis brevis tendon seems to be the one that's the most commonly researched.
• 3:09
  Speaker 1: That's lit up At right as it inserts through your common extensor tendon on your lateral epicondyle.
• 3:13
  Speaker 1: So it gets really tended to touch right on the outside of your elbow bone right there, and that's a really common thing.
• 3:19
  Speaker 1: So as sports physical therapy clinicians we're thinking why is that tendon all lit up?
• 3:27
  Speaker 1: What's the cause of that cause?
• 3:29
  Speaker 1: Cause things don't hurt for no reason and it's a victim, not the problem.
• 3:33
  Speaker 1: We can intervene there with some soft tissue, maybe dry needling, to stimulate a healing response and stimulate a pain modulation response and recruit endogenous opioids, maybe stimulate collagen fiber angiogenesis and create more fiber development with fibroblast activity.
• 3:54
  Speaker 1: That's what the research suggests with dry needling.
• 3:56
  Speaker 1: That's all we're gonna really do to intervene at that site.
• 3:59
  Speaker 1: But we have to intervene elsewhere and investigate why the heck is this extensor carpy radialis brevis tendon getting all lit up like this right Right on the insertion point on your lateral epicondyle, why there has to be something else being done, some compensation patterns.
• 4:13
  Speaker 1: So we have to investigate and what we're finding for sports upper body sports it seems like there's a link with the scapula, the shoulder blade link.
• 4:24
  Speaker 1: We have to investigate the shoulder joint and the shoulder blade as to why, maybe distally down the chain, the elbow is overcompensating for stuff like golf and tennis, especially lacrosse, racket sports and stick sports like hockey, and then exercise, pull ups, grasping, rowing, lifting activities.
• 4:43
  Speaker 1: Of course there seems to be a link in the scapula that's making the elbow have to overcompensate.
• 4:48
  Speaker 1: The elbow and wrist is overcompensating because of a lack of mobility in the scapula or stability and strength.
• 4:54
  Speaker 1: So that's what we have to investigate and intervene.
• 4:57
  Speaker 1: Other things that are related to rotational sports so we can also intervene, like thoracic spine rotation, either rotation extension or flexion rotation of the thoracic spine.
• 5:05
  Speaker 1: We have to check that out.
• 5:06
  Speaker 1: The ribs, as they relate to the thoracic spine for rotation, range of motion available, that a lack thereof is gonna make something else compensate.
• 5:14
  Speaker 1: That's where that link comes in.
• 5:16
  Speaker 1: We have to investigate that.
• 5:17
  Speaker 1: So when we're going to us as sports physical therapy clinicians and we do stuff like thoracic rotation exercises, it's like well what?
• 5:24
  Speaker 1: But my elbow hurts.
• 5:25
  Speaker 1: Why aren't you working on my elbow?
• 5:25
  Speaker 1: It's like dude for golf or tennis or lacrosse, like your rotation requirements.
• 5:30
  Speaker 1: You're limited going to that side with your and rotation.
• 5:33
  Speaker 1: Your T-spine plays a major role with that and it's limited we can intervene there.
• 5:37
  Speaker 1: Right, that's what we're doing, that stuff.
• 5:38
  Speaker 1: We're also checking out your scapula too.
• 5:40
  Speaker 1: It's like, why are you doing manual therapy and intervening on my scapula?
• 5:43
  Speaker 1: There's a link correlated with a lack of scapula stability and mobility to elbow issues and elbow pain.
• 5:50
  Speaker 1: And we wouldn't be doing our job if we didn't investigate elsewhere, approximately or distally.
• 5:55
  Speaker 1: Does that make sense?
• 5:56
  Speaker 1: So that's why we check that stuff out.
• 5:58
  Speaker 1: Okay, in the research they call it a recalcitrant tendon problem or tendonitis or tendinosis.
• 6:04
  Speaker 1: Recalcitrant, being stubborn and not following expected uh pro progress and and and uh policies.
• 6:13
  Speaker 1: Right, it's like a recalcitrant teenager in school they would call this like a recalcitrant.
• 6:17
  Speaker 1: A recalcitrant um tendinopathy problem.
• 6:20
  Speaker 1: It's like not following normal protocol.
• 6:22
  Speaker 1: What the heck?
• 6:22
  Speaker 1: Why isn't it getting better If we're not fixing the compensation patterns that led to it in the first place?
• 6:27
  Speaker 1: And they continue to do their sport or their activity.
• 6:29
  Speaker 1: It's not going to get better, it's just going to continue to compensate, right, and it's going to get continually overwhelmed.
• 6:34
  Speaker 1: And if we don't intervene appropriately with this kind of a rationale and and and clinical approach.
• 6:38
  Speaker 1: Um, what, what do you think is going to happen?
• 6:41
  Speaker 1: Like, what's that road lead to?
• 6:42
  Speaker 1: Usually, the suggestions are more meds, pain meds Um, advil will be like a lower version of that but pain meds, injection, steroid injection, which aren't really super.
• 6:54
  Speaker 1: Um, helpful that when the research is finding an effective for elbow issues?
• 6:59
  Speaker 1: Um, and then a debris surgery, right, um, if anything I'm like man, maybe that it, maybe that's just stuff that helps prevent people from like, you know, is modify appropriately.
• 7:09
  Speaker 1: Right now A little, it lets things settle down and then they get back in this doing it and it comes back.
• 7:15
  Speaker 1: So it's like this constant cycle of like three months of like resting and then three to two months of like doing their thing, and then it comes back again and then they get another injection and they rest and it feels better, and then they go back and it hurts again and then it's continually fluctuate back and forth.
• 7:29
  Speaker 1: We see that pretty often and we hear that stuff.
• 7:32
  Speaker 1: We're like no, if we can intervene and stop that cycle and fix why it's happening in the first place, because there is a solution, knowing that things don't hurt for no reason, then we can stop that cycle, all right, and that's why we're just passionate and live by care.
• 7:45
  Speaker 1: So, through our patients cause we've been there our our clinicians and our practice, we see ourselves in the patients we work with as in like yo.
• 7:51
  Speaker 1: There is a better solution, there is a way to life.
• 7:54
  Speaker 1: Dude, we're trying to help you as best we can.
• 7:56
  Speaker 1: And we can't stop that cycle.
• 7:57
  Speaker 1: We just had to intervene appropriately, first things.
• 8:00
  Speaker 1: First we got to investigate and evaluate, see what the heck is going on and why, and then we can intervene appropriately.
• 8:05
  Speaker 1: Does that make sense?
• 8:06
  Speaker 1: So we can definitely avoid that cycle of meds, injections and surgery for something like a tenonopathy problem, cause we know that things don't hurt for no reason.
• 8:15
  Speaker 1: It's just compensating, right, as long as you rule out underlying red flags and systemic problems that might limit healing progressions, or an underlying visceral systemic issue that's causing pain of some sort.
• 8:26
  Speaker 1: Um, then we know it's neuromuscular skeleton, which means we can intervene appropriately.
• 8:31
  Speaker 1: So dry needle ink.
• 8:32
  Speaker 1: So people ask this what would we do to help with lateral epicondylopathy, epicondylitis, epicondylosis, whatever?
• 8:39
  Speaker 1: Tennis elbow?
• 8:40
  Speaker 1: What can we do to help intervene?
• 8:41
  Speaker 1: Here's our typical progression that we investigate.
• 8:44
  Speaker 1: We have to look at the radial head mobility.
• 8:46
  Speaker 1: The radius is one of the arms in your uh, the bones in your forearm, your all knows.
• 8:50
  Speaker 1: The other one, the radial head, is really close to the attachment point of your lateral epicondyle.
• 8:54
  Speaker 1: It actually connects uh articulates with that surface at the capitulum um and the fovea of your radial head.
• 9:01
  Speaker 1: So the radial head mobility is really important as a close relationship to the lateral epicondyle and the tendons that go across that articulation.
• 9:08
  Speaker 1: So if the radial head is stiff and stuck and not really moving well, then we need to intervene there.
• 9:12
  Speaker 1: So mainly we can intervene at the radius, at the radial head, to improve that range of motion and mobility.
• 9:18
  Speaker 1: Okay, and joint play.
• 9:19
  Speaker 1: Then we can also do soft tissue, of course, on the extensors, carpere radials brevis tendon and the common extensor tendon.
• 9:25
  Speaker 1: We can drive with cupping, stripping grass and whatever.
• 9:28
  Speaker 1: I'm not a huge fan of grass and for stuff like this because compression and scraping something that's already lit up, I'm like man.
• 9:35
  Speaker 1: It might be a better avenue to help involve and influence the soft tissue um pliability and healing potential.
• 9:41
  Speaker 1: But anyway, um, cupping I'm a huge fan of.
• 9:44
  Speaker 1: And then uh, dry needling.
• 9:46
  Speaker 1: So dry needling has some really good evidence and research to help with uh, with problematic and chronic tendinopathy issues and some of the rationale behind it is it helps to stimulate a healing response.
• 9:59
  Speaker 1: It helps to um stimulate fibroblast activity to lay down new collagen tissue.
• 10:05
  Speaker 1: So imagine something that's like degenerative and chronic an issue.
• 10:08
  Speaker 1: It's more degenerating of the tendon.
• 10:10
  Speaker 1: If we can stimulate a better healing response and maybe laying down new collagen fibers in the tendon or the musculotenditis junction, that can help.
• 10:18
  Speaker 1: It can help lay down new angiogenesis of capillaries and then also pain modulation, all right.
• 10:24
  Speaker 1: And then we have to look at the wrist.
• 10:25
  Speaker 1: We can work on wrist extension, mobility as it relates and the scaphoid and the lunate seem to be a big influence with wrist mobility and do extension and rotation, supination or pronation.
• 10:38
  Speaker 1: And then again we have to check out the scapula.
• 10:40
  Speaker 1: We have to check out your scapula.
• 10:42
  Speaker 1: We can usually intervene with upward rotation or protraction exercises and get the stability of those muscles to activate better.
• 10:48
  Speaker 1: If there's any glenocumeral instability in the shoulder joint, we're gonna fix that.
• 10:52
  Speaker 1: And then the rotational components of your sport.
• 10:54
  Speaker 1: We can't neglect that and that's where the T-spine comes in.
• 10:56
  Speaker 1: So put yourself in the position as necessary to make other things, not have to compensate to make up for it.
• 11:01
  Speaker 1: So that's usually what we do at the intervene, all right, wrist mobility as appropriate, soft tissue, dry needling, radial head mobility, scapular mobility and strength activation, stability exercises and then the T-spine, and because we know that all those things are required for an upper body sport that has rotation lacrosse, volleyball, weightlifting exercises, golf and tennis, of course.
• 11:25
  Speaker 1: So if you have any questions of battling elbow pain, we would love to talk with you and investigate a little bit more.
• 11:30
  Speaker 1: Like I said, we're passionate about what we do because we live vicariously through our patients, that we see ourselves in them and the hampered, limited things that have just limited our pain activity from pain.
• 11:42
  Speaker 1: But we can intervene there.
• 11:44
  Speaker 1: There is a reason why things hurt.
• 11:46
  Speaker 1: There's no, they don't hurt for no reason, and that also means that there's a solution and we can work on this stuff.
• 11:50
  Speaker 1: So we would love to talk with you and chat more about maybe how we can intervene for you specifically and get you back to doing the stuff that you love in your sport, that finally we can solve this problem that's been going on forever.
• 12:02
  Speaker 1: We would love to help and help intervene as best we can.
• 12:05
  Speaker 1: So don't hesitate to reach out.
• 12:07
  Speaker 1: You can call us at 561-899-8725 or shoot us an email at team at athleterccom.
• 12:14
  Speaker 1: That's T-A-A-M at athleterccom.
• 12:18
  Speaker 1: So we're looking forward to chatting with you and, like I said, don't hesitate to reach out.
• 12:21
  Speaker 1: We'll catch y'all next time.
• 12:23
  Speaker 1: Hey, hold up.
• 12:24
  Speaker 1: As you know, we're a small local practice and we don't run any ads or something on this podcast, but it would mean the world if you could share, write a post or word of mouth recommendation for somebody just like you that's athletic and active, that wants to live their dynamic lifestyle and pay some good karma and pay it forward to somebody else just like you and who knows, you could change their world and a 10 second review could be that avenue.