Latest / The Driven Athlete / Tennis Elbow, Anatomy, Golf Affects, & Recovery Strategies | Ep 65

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Tennis Elbow, Anatomy, Golf Affects, & Recovery Strategies | Ep 65 · 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 your man, dr Kyle.
• 0:13
  Speaker 1: This is the Driven Athlete Podcast.
• 0:16
  Speaker 1: Welcome back.
• 0:18
  Speaker 1: Today we're going to 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 upper extremity arm-based 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 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 common extensor tendon.
• 1:24
  Speaker 1: 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: All right, 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: All right, so probably the most accurate term.
• 1:52
  Speaker 1: It's just semantics but would be maybe like lateral epicondylopathy.
• 1:55
  Speaker 1: There is a problem going on there, super acute, 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 epicondyle 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 right 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 right.
• 2:48
  Speaker 1: So with lateral epicondyle pain, 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 carpi radialis brevis tendon.
• 3:03
  Speaker 1: The extensor carpi radialis brevis tendon seems to be the one that's the most commonly researched.
• 3:09
  Speaker 1: That's lit up right as it inserts through your common extensor tendon on your lateral epicondyle 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: Because 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 going to 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 carpi radialis brevis tendon getting all lit up like this right Right on the insertion point on your lateral condyle, why there has to be something else being done, some compensation patterns.
• 4:14
  Speaker 1: So we have to investigate and what we're finding for sports, upper body sports.
• 4:19
  Speaker 1: 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.
• 4:49
  Speaker 1: 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 relates to rotational sports.
• 4:59
  Speaker 1: 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 going to make something else compensate.
• 5:14
  Speaker 1: That's where that link comes in.
• 5:19
  Speaker 1: We had to investigate that.
• 5:20
  Speaker 1: So we're going to us as sports physical therapy clinicians and we do stuff like thoracic rotation exercises.
• 5:23
  Speaker 1: It's like, well, but my elbow hurts.
• 5:25
  Speaker 1: Why aren't you working on my elbow?
• 5:26
  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 threat 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 scapular stability, mobility, to elbow issues and elbow pain and we wouldn't be doing our job if we didn't investigate elsewhere, proximally or distally.
• 5:55
  Speaker 1: Does that make sense?
• 5:56
  Speaker 1: So that's why we check that stuff out.
• 6:00
  Speaker 1: Okay, in the research they call it a recalcitrant tendon problem or tendinitis or tendinosis.
• 6:04
  Speaker 1: Recalcitrant, being stubborn and not following expected uh, prop progress and and and uh policies.
• 6:13
  Speaker 1: Right, it's like a recalcitrant teenager.
• 6:14
  Speaker 1: 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 clinical approach, 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 Advil would be like a lower version of that but pain meds, injection, steroid injection, which aren't really super helpful, that when the research is finding and effective for elbow issues, and then a debridement surgery right, if anything.
• 7:04
  Speaker 1: I'm like man, maybe that's just stuff that helps prevent people from like yo, this modify appropriately.
• 7:09
  Speaker 1: Right now it lets things settle down and then they get back into this doing it and it comes back.
• 7:14
  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.
• 7:30
  Speaker 1: We see that pretty often and we hear that stuff and 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.
• 7:40
  Speaker 1: Then we can stop that cycle.
• 7:43
  Speaker 1: All right, and that's why we're just passionate and live vicariously through our patients Cause we've been there, our clinicians and our practice.
• 7:49
  Speaker 1: 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 and we can't stop that cycle.
• 7:57
  Speaker 1: We just have to intervene appropriately.
• 7:59
  Speaker 1: First things 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 tendinopathy problem, because we know that things don't hurt for no reason.
• 8:15
  Speaker 1: It's just compensating, right.
• 8:17
  Speaker 1: As long as you rule out underlying red flags and systemic problems that might limit healing progressions or underlying visceral systemic issue that's causing pain of some sort, then we know it's neuromusculoskeletal, which means we can intervene appropriately.
• 8:31
  Speaker 1: So dry needling.
• 8:33
  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 bones in your forearm, your ulna is the other one.
• 8:50
  Speaker 1: The radial head is really close to the attachment point of your lateral epicondyle.
• 8:54
  Speaker 1: It actually connects articulates with that surface at the capitulum and the fovea of your radial head.
• 9:01
  Speaker 1: So the radial head mobility is really important, has a close relationship to that 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 manually 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 extensor carpi, radialis brevis tendon and the common extensor tendon we can drive with cupping, stripping, grasping, whatever.
• 9:28
  Speaker 1: I'm not a huge fan of grasping for stuff like this because compression and scraping something that's already lit up, I'm like man.
• 9:35
  Speaker 1: There 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 um 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 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 muscular tendon disjunction, that can help.
• 10:18
  Speaker 1: It can help lay down new angiogenesis of capillaries and then also pain modulation.
• 10:23
  Speaker 1: 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, uh, the lunate seem to be a big influence with wrist mobility and do extension and and and rotation, supination or pronation, um.
• 10:39
  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 glenohumeral instability in the shoulder joint, we're going to 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 that's 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 to 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, you have battling elbow pain.
• 11:27
  Speaker 1: We would love to talk with you and investigate a little bit more.
• 11:32
  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 activity from pain.
• 11:42
  Speaker 1: But we can intervene there.
• 11:44
  Speaker 1: Right, there is a reason why things hurt.
• 11:46
  Speaker 1: 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: We would love to help and help intervene as best we can, so don't hesitate to reach out.
• 12:08
  Speaker 1: You can call us at 561-899-8725 or shoot us an email at team at athlete rccom.
• 12:14
  Speaker 1: That's T-A-A-M at athlete rccom.
• 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.