Tag Archives: elbow tendinopathy

Elbow tendinopathy, whether it presents as tennis elbow (lateral elbow pain) or golfer’s elbow (medial elbow pain), is one of the most common overuse injuries in active people, desk workers, and manual labourers. At Melbourne Massage and Treatment in Fitzroy North, I frequently help patients recover from both forms of elbow tendinopathy. Elbow Tendinopathy: How Does It Manifest? “Tendinopathy” refers to irritation and degeneration within a tendon due to repeated overload. Elbow Tendinopathy, in both of its forms, tennis or golfer’s elbow, can sound like a sport-related injury, but it has little to do with the sports world. The reason why those presentations carry their name is due to the sport action, which requires that specific muscle group to work to deliver the golfer strike (medial) or tennis strike (lateral). So what can actually cause an elbow tendinopathy are: Sudden increase of tendon load – lifting heavier than usual, at the gym or at work Repetitive action – think of that constant mouse or keyboard action in the office environment Overstretching of the tendon – Poor office ergonomics can overload the elbow joint and the elbow’s tendons To be more specific, the office worker presenting with elbow tendinopathy often has repetitive mouse/keyboard use, which is often accompanied by poor ergonomic factors, such as the forearm being in a prolonged pronated position (palm facing down), which places the common extensor digitorum tendon (CEDT) under stretch. Medial and Lateral Tendinopathy of the Elbow Let’s look into the difference between the actual Tennis (lateral) and Golfer’s (medial) Elbow. Tennis Elbow (Lateral Epicondylitis) Pain in the outer elbow Irritation of the wrist extensor tendons, especially the Extensor Carpi Radialis Brevis (ECRB) Familiar with typing, lifting, racquet sports, and DIY tasks Golfer’s Elbow (Medial Epicondylitis) Pain in the inner elbow Irritation of the wrist flexor tendons Related to gripping, pulling, forearm rotation, and throwing How To Recover From a Tendinopathy? Despite different pain locations, the rehab approach is almost identical, and while rest provides temporary relief, it does not fix the underlying tendon changes. The true solution? A structured, progressive exercise rehab program that restores tendon strength and resilience. In fact, as the tendinopathy itself came to be an issue due to an overload of the elbow’s tendon, to settle the pain and discomfort, we have to: Reinforce the elbow tendon and muscle so that it can perform better. Analyse what overloaded the elbow tendons – we have to understand what can be changed in the loading process, starting from: Shoulder stability (looking up in the joint chain – Mobility and Stability) The ergonomic of your workload, that is, office or heavy repetitive work (like gardening, for example, or construction). Workout program – ensure there is a progressive load in the program that is right for your capacity. The 3-Phase Exercise Program for Elbow Tendinopathy Here at Melbourne Massage and Treatment in Fitzroy North, as a clinical myotherapist, I get to see many patients presenting with Elbow Tendinopathy, and the rehab protocol and recovery that I used is detailed below. Phase 1: Pain Reduction & Tendon Activation (Week 1–3) In this initial phase, the goal is to calm symptoms without resting the tendon completely. Tendons respond best to gentle, controlled tension, better known as isometric exercises. Isometric is ideal because: Tendons have a low blood supply compared to muscles, so in order to receive the nutrients that allow the healing process to be delivered, they need long and steady engagements. A tenodon that is inflamed presents with disorganised collagen fibres, which are not running straight, and no longer form a compact line. And there is a need for a constant load to restore new fibres that can regain the tendon’s functionality. Wrist Extension Isometric (for Tennis Elbow) You will be sitting at a desk with your forearm comfortably supported by the desk, with your hand in a prone position (palm down) Slightly extend your wrist against resistance. Pain-free movement (it could be a bend or a lightweight) Hold 20 seconds, repeat 10 reps Wrist Flexion Isometric (for Golfer’s Elbow) You will be sitting at a desk with your forearm comfortably supported by the desk, with your hand in a supine position (palm up) Deliver a slight wrist flexion against resistance. Again, it has to be a pain-free movement. Hold 20 seconds, repeat 10 reps Time of hold, repetition and pain response are subjective to each individual. That’s where we would stop and focus on each individual clinical history and presentation, and adapt the elbow tendinopathy rehab program to your needs. Gentle Mobility & Dry Needling From a point of view of massage for elbow tendinopathy, there are a few techniques that work really well, especially in the early phase of recovery: Joint Mobilisation – passive movement applied to the wrist and elbow joint, to improve the range of motion of this joint and disengage the area. Dry Needling – The usage of a needle on muscle, to create a micro-inflammation and to drive more attention from the nervous system into the targeted area. Deep Tissue Massage – When dry needling is not an option, deep tissue massage can also help in creating this targeted central nervous system response. Phase 2: Strength & Tendon Remodelling (Week 3–8) This is the most critical phase, and the one that actually restores tendon health. Eccentric Wrist Extension (Tennis Elbow Gold Standard) How to do it: Extend the wrist of the affected side with your good hand, while in the affected side, you are holding a lightweight or resistance band. Slowly lower the weight with your injured side with a tempo that last 3–5 seconds Repeat 12–15 reps, 2–3 sets – this is an endurance setup. Between each set, rest for at least 30 seconds. Eccentric Wrist Flexion (Golfer’s Elbow Gold Standard) Same method, but applied in a flexion motion. Assist the initial movement of flexion Slowly bring the wrist back to the straight position with a 3-5 second tempo. Look always at somewhere between 12-15 reps, for endurance performance. […]