Outer Elbow Pain? You may have Tennis Elbow.

Could you be suffering from tennis elbow and not realise it?

The most common kind of elbow pain is a condition known as lateral epicondylalgia – or tennis elbow. Ironically, you also don’t need to be a tennis player to get tennis elbow. Many who have suffered from tennis elbow, actually do not play tennis. It’s also important to point out that recovery from tennis elbow requires a proactive approach involving diagnosis, treatment and strengthening. Through rest alone, your recovery will be very slow.

The causes of tennis elbow

This type of problem can occur at any age, but is most common between the ages of 35 and 50. Predictably, it is more common in your dominant arm but can affect both. The biggest misconception about this type of elbow pain is you don’t have to be a tennis player to get this condition. In fact it is just as common in people who repetitively overuse their forearm muscles such as office workers or tradespeople.

Referred Pain
A huge contributing factor to this condition which can be easily forgotten is referred pain from the neck or shoulder. This can either mimic symptoms of tennis elbow, or most commonly there is a combination of elbow and neck, shoulder or thoracic spine issues. You will need to have a thorough examination by a physiotherapist to determine if you have any referred pain from your neck and shoulder or if your elbow pain is isolated. This will assist in a more direct approach to your problem and a speedier recovery.

Tennis elbow and it’s symptoms

Typically, this condition presents as pain at or just below the lateral epicondyle- that is, the pointy part on the outside of your elbow. Generally people experience pain with gripping, lifting or wringing activities which cause tension over the tendon (see above picture). Clinically, we as physiotherapists often find people suffering this condition have weak and/or tight forearm muscles and stiff elbow and wrist joints.

There is a wide variation in the severity of this condition and how long the symptoms may last for. As with any injury, it is best that we see you as soon as possible to start you on an injury management plan. On assessment, your physiotherapist will be able to give you a guide as to how long your injury may last.

6 Steps to treating tennis elbow pain

Initial management of this condition is through pain relieving techniques such as soft tissue massage, joint mobilisations, stretching tight nerves and muscles, dry needling, heat and/or cold therapy and taping. We also sell tennis elbow braces to our clients that are effective in relieving pain in some people. I’ll cover these methods in more detail;:

1. Soft Tissue Massage: A massage therapist can use a range of techniques to release soft tissue, break down tension and realign the fibres. These techniques include myofacial release and transverse friction techniques.

2. Joint mobilisation: this management may include massage around the problem area or gently mobilising the joints of your neck and elbow.

3. Stretching: As soon as your pain allows, start stretching the area. Extension exercises of the wrist will be the most important stretches you can do to improve your range of motion and to increase the amount of load on the tendon.

4. Dry Needling: Dry needling is a technique that is fast gaining appreciation within the physiotherapy world, with many practitioners throughout Australia now trained in the use of acupuncture needles to assist with their client’s pain and rehabilitation. The insertion of needles at varying lengths and points are thought to alter the way pain signals are transmitted by nerve pathways.

5. Hot/Cold therapy: Apply ice to the elbow regularly to reduce the pain and inflammation will be a good start, particularly at the early onset of pain.

6. Kinesio Taping: Kinesio taping may help decrease the pain and can reduce the likelihood of injury aggravation.

Another exercise option is the ‘The Tyler Twist”, where clients are asked to perform an exercise using a FlexBar®. The experiment consisted of a group of 22 subjects who suffered from tennis elbow. These subjects were then split into 2 groups. The first group were asked to perform the FlexBar® exercise as well as receive standard physiotherapy. The control group received physiotherapy alone. It was found after 7 weeks of therapy that the first group had significantly more improvement than the group receiving only standard physio; in particular, the eccentric exercise group improved their pain level 81% vs. 22% in the standard group.


Ongoing management and prevention of tennis elbow.

Of utmost importance in managing this condition is a progressive strengthening program. Tendons require gradual load in order to heal correctly, so it is very important to continue to strengthen your muscles even if your pain is gone. At this phase of your rehabilitation, it is also important to look at contributing factors such as workstation setup and your posture. If you have some referred pain, assessing your pillow may also be necessary to ensure that your whole body is always in optimal alignment.

Sometimes patients are recommended by their GP to consider a cortisone injection into the elbow. The most recent research regarding this shows that it actually makes you worse in the longer term. Cortisone assists in settling inflammation, which may help in the short term, but generally this condition is not an inflammatory condition.

Recovery from tennis elbow pain

Typically, tendon overload injuries such as this can take anywhere between 2 and 24 months to be back to normal. No, this doesn’t mean you will be in pain for that long or that you will necessarily need one on one treatment for that long. It means that the healing process of tendons is longer than any other tissue in the body so you may need to continue with an exercise regime in the longer term- even after you stop seeing your physiotherapist. This will ensure that your pain stays away.

Remember, tennis elbow is not the same as Golfers elbow which we’ll be covering in a later post. If you are experiencing elbow pain, even if you’re not sure if it’s tennis elbow, it is important to seek treatment as soon as possible to reduce your recovery time. 

This article originally appeared on sportandspinalphysio.com.au and was written by Craig Honeybrook

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Massage Therapy for Mental Wellness

Knead Out Stress

We know that massage therapy is of great benefit to sport injuries and muscle soreness. But it is also an effective way to improve your mental health.

Massage therapy is a popular treatment for the relief of sports injuries, strains, and muscle soreness. But its benefits are more than just physical: it is also an effective way to alleviate depression and anxiety—and improve sleep quality.

Although life stresses are unavoidable, we can counter negative feelings and insomnia with the positive benefits that massage therapy offers.

Why massage therapy?

Massage has been practised for centuries. In ancient India massage therapists kneaded patients with herbs and oils to relieve tiredness, increase energy, and improve overall health. In fifth-century Greece Hippocrates was quoted as saying, “The physician must be experienced in many things, but assuredly in rubbing.” And it’s no secret why massage is still popular today—it feels wonderful.

For overall mental wellness

According to Heidi Ezzat, a registered massage therapist (RMT) practising in Pitt Meadows, BC, “Massage therapy is an excellent tool in treating anxiety, depression, and insomnia because it helps your body to relax, which in turn helps you to de-stress.”

She explains that massage therapy is effective in treating these disorders because “the state of calm [achieved] allows one to have a better chance of using coping skills that have been acquired in other therapies such as counselling.”

According to Health Canada, 11 percent of men and 16 percent of women will experience severe depression over the course of their lives. Studies show, however, that massage therapy can be an effective tool for dealing with depression.

In a study published in Support Care Cancer (2010), breast cancer patients who received two 30-minute massages weekly for five weeks reported significant reductions in depression and anxious depression compared to those who received no massage therapy.

In addition, a meta-analysis of 17 studies conducted by Taiwanese researchers found massage therapy was strongly associated with relieving depressive symptoms.

Health Canada reports that of all mental disorders, anxiety conditions top the list. They estimate that 10 percent of Canadians suffer anxiety in some form. But anxiety can be reduced by the positive effects of massage.

Turkish researchers measured burn patients’ anxiety levels before and after massage therapy sessions. Over the course of a five-week period participants showed a significant reduction of symptoms, including itching, pain, and anxiety from the first treatment to the last.

Poor quality sleep
Statistics Canada reports that 3.3 million Canadians (13.4 percent of Canadians over the age of 15) suffer from insomnia. Fortunately, massage has also been shown to improve sleep quality.

Researchers reported the positive effects therapeutic massage had on breast cancer patients’ sleep quality (Journal of Alternative and Complementary Medicine, 2009). Participants reported better sleep quality post-massage in addition to reduced anxiety and chemotherapy side effects, and increased quality of life.

Mental wellness versus muscle soreness

Massage therapy can effectively treat a variety of conditions and disorders; however, the therapist will tailor your treatment course of action based on your particular symptoms and concerns.

According to Ezzat, most massage therapy appointments begin the same way: the client fills out a case history form and an assessment is conducted by the therapist. Based on the information collected, the therapist and patient work out a plan to address the patient’s treatment goals.

However, when treating a patient with a mental health issue, Ezzat says “the environment in the treatment room is especially important, such as temperature, music, and lighting.” She also encourages patients to be still and quiet for part of the treatment so that patients can “tune in to their bodies, breathe deeply, and begin to let go and relax.”

Treatment team

Although massage therapy has been shown to help effectively treat depression and other mental health issues, Ezzat suggests that those with severe problems “should be managed and treated primarily [in conjunction with] the patient’s family doctor and/or naturopathic doctor’s recommendations.”

She explains that there are many tools that a patient suffering from a mental health problem can make use of, and massage therapy is one of those tools. However, sometimes several tools are needed. Ezzat says, “I treat many patients who report benefits from receiving counselling and massage therapy at the same time.”

How often should you go?

The frequency depends on the patient’s specific treatment goals. However, Ezzat recommends, “When someone is starting massage therapy, it is best if they come for several sessions, and according to their condition and schedules that could be once a week or twice a week.”

She reports that most people experience improvements within the first three massage therapy sessions, but long-standing, chronic conditions may take longer. Once patients feel a significant improvement, Ezzat recommends they continue treatment once a month, or more frequently, if they desire.”

Finding a massage therapist

Although RMTs receive similar training across the country, therapists have their own styles and preferred areas of practice. Below are some tips to help you find the right massage therapist for you.

Word of mouth
Speak with someone who’s had appointments with a specific therapist to find out how difficult it is to get in, what approach they favour (light pressure versus deep tissue massage), and much more.

Massage therapy associations
Most provinces have their own massage therapy associations, which can often be found online. Check the websites for RMT listings in your province.

Try a few out
The first therapist you go to may not be the right fit—that’s okay. You may have to try out a few before you find someone who suits your needs. Alternatively, you may prefer to make appointments according to who is available.

This article originally appeared on alive.com and was written by Amy Wood

Video: Understanding Different Types of Back Pain

Are you having trouble treating your back pain? This video explains why back pain can be so difficult to diagnose and treat.


When you learn about your body, you are in control of how to support it well & correctly.

Click the photo to watch a short educational video!

Getting the Right Massage for Low Back Pain

Massage therapy can provide substantial healing and pain relief for people suffering from low back pain caused by muscle tension and strain, if the correct muscles are targeted.

I asked certified massage therapist Kate Fish, who works at in a chiropractor's office, to explain how she helps heal her clients' pain with massage.

See Chiropractic Treatments for Lower Back Pain

She explained that isolating and rejuvenating the main back muscles that can have the biggest effect on low back pain caused by stressed muscles.

See Pulled Back Muscle and Lower Back Strain

Kate stresses that two important muscles, the quadratus lumborum (QL) and the gluteus medius, may play a bigger role in causing pain than most people realize, saying, "If you strain either of these muscles, the pain can be severe and debilitating.

Dysfunction in these muscles (the QL and the gluteus medius) can lead to severe and debilitating low back pain." Tweet this to share on Twitter.

Kate recommends that you specifically ask your massage therapist to spend 60 minutes on these two muscles.

Article continues below

1. Quadratus lumborum (QL) muscle massage

Ask your therapist to massage the QL muscle while you lie on your side for 20 minutes on each side (40 minutes total).

The QL muscle, which connects the last rib to the pelvis, is responsible for pelvic stability and structural alignment. It is a common source of low back pain.

See Back Muscles and Low Back Pain

The muscle can become irritated when the lower body is engaged while the upper body is still. For example, activities that could irritate the QL muscle are:

See Office Chair, Posture, and Driving Ergonomics

See Running and Lower Back Pain

  • Lifting that requires leaning over something (such as getting groceries out of a trunk)
  • Leaning over a sink while doing dishes
  • Sitting slumped in a chair
  • Running on uneven pavement

Sharp, stabbing pain, urgent pain in the low back is a symptom of a hypertonic (tight) QL.

This muscle must be stretched and massaged simultaneously by your therapist in order to reduce lower back pain. Typically, clients can get relief by combining treatment of the QL muscle with 20 minutes of massage on the gluteus medias.

Back Strains and Sprains Video

2. Gluteus medius massage

After working on the QL muscle, ask your therapist to focus on the gluteus medius for 20 minutes.

The gluteus medius is a posterior hip (or buttocks) muscle that frequently causes pain when the QL muscle is irritated. The gluteus medius becomes inflamed as it tries to compensate for the QL’s dysfunction. Your massage therapist should focus on simultaneously stretching and massaging the gluteus medius as you lie on your stomach.

Kate has been able to provide significant pain relief to numerous clients by using these massage techniques in only one session. She recalls,

"One of my clients had experienced severe low back pain for 3 months. After his doctor ordered an MRI, he was worried he would have to have surgery. He visited the chiropractor where I worked as a massage therapist, and I assessed that his QL was ischemic (so tight that the blood supply got cut off). Working on these specific muscles, I loosened them and increased their blood flow, and the client was pain-free after one session."

See Pulled Back Muscle Treatment

Most likely, your massage therapist is well-versed in the muscles that cause back pain, but don’t hesitate to speak up and specifically request this type of massage if you suspect your pain is due to muscle dysfunction.

This article originally appeared on Spine-Health.com and was written by Allison Walsh.