What Causes Tennis Elbow and Golfers Elbow

Tennis Elbow / Golfers Elbow & Repetitive Strain

Straightforward overuse is the most obvious cause of tennis elbow & golfers elbow. The list of life’s tasks that don’t involve using our hands and forearms is short after all. Overuse only really makes sense when you understand the body’s need for constant repair.

Your body can do far more repetitive work than any machine without the need for new parts,  because it is engaged in constant repair.  Classic repetitive stress injuries occur when the body cannot keep up with the repair needed to sustain high levels of activity. Our elbows and forearms are extremely vulnerable to this for obvious reasons.

Obviously, occupational overuse is a very common cause of tennis elbow & golfers elbow. Work tasks that require a certain amount of strength, tasks performed in huge numbers of repetitions or are performed at an awkward angle can all lead to tennis elbow & golfer’s elbow

Overtraining is the most easily understood cause of repetitive strain type tennis elbow & golfers elbow. You might be incredibly strong and have perfect lifting technique but if you do the same intense lifting every day for 3 years; the damage you do will exceed your limbs ability to carry out repair processes. 

Tennis Elbow / Golfers Elbow & Inflexibility

Our body’s muscles and soft tissues were designed for a very different life from the one most of us lead; a far more wild and active life. Imagine the amount of work your hands and forearms do if you need to find your own food and water, and build your own shelter.

The modern world requires us to perform very different tasks to those our body’s were designed for. Typing all day for example limits our tendons and muscles to a very limited range of motion, it requires a great deal of repetition: but does not strengthen or mobilise the tissues in any meaningful way.

A life of typing, swiping and shopping has a profoundly weakening effect on our muscles, tendons and fascia. Our soft tissues just don’t get the varied work that they need in order to stay strong and elastic. These facts of modern life predispose us to tennis elbow & golfers elbow in a big way.

Tennis Elbow / Golfers Elbow & Postural Tension

A wise woman once said ‘It ain’t what you do it’s the way that you do it’ and she was right, at least when it comes to preventing tennis elbow & golfers elbow.

Tasks performed in a smooth, relaxed and efficient way put a  fraction of the strain on the body’s tissues than tasks performed inefficiently or in a tense and awkward fashion.

Many sufferers of tennis elbow & golfers elbow are people who have developed inefficient or tightly wound ways of doing things. Our habits of posture and movement have a way of sneaking up on us and it is all too easy to develop habits of working/living that cause strain without us realising. In the same way that we are able to slowly lose 20/20 vision without realising.

For many sufferers of stubborn tennis elbow & golfers elbow, improved ergonomics and biomechanics are major factors in the elimination of their pain. Happily, any pain clinician who knows their stuff should be able to help you take the guesswork out of making the necessary changes. 

Tennis Elbow / Golfers Elbow & Scar Tissue

Scar tissue is a major cause of tennis elbow & golfers elbow

There are 2 types of scar tissue in life. Scar tissue that comes from major injury events – and scar tissue that develops slowly due to repetitive strain mechanisms. Both types of scar tissue can contribute in a big way to stubborn tennis elbow & golfer’s elbow.

When repetitive strain in the soft tissues plays out over long periods of time (years/decades); a type of scar tissue forms within the areas of maximum tissue stress. This type of scar tissue is the mess left by all the body’s failed attempts at repairing the situation. The outcome is a degenerative mixture of scar tissue and incomplete wound healing. If you have tennis elbow & golfer’s elbow there is a high probability that you have some of this going on.

When we injure ourselves in the traditional sense, deep tracts of scar tissue are often left behind. These tracts of scar tissue that injuries leave behind are a very common ‘cause’ of tennis elbow & golfers elbow. More accurately, old tracts of scar tissue aren’t so much a cause, as a major contributing factor in tennis elbow & golfers elbow. 

There can be great value in acknowledging the role that old injuries play in tennis elbow & golfers elbow, and it can be complex. Old shoulder injuries for example can easily contribute to pain in the forearm and hand..

Happily most scar tissue is easy to break down as long as you have the right tools and the right professionals at your disposal. At Featherston St. Pain Clinic for example, relieving stubborn pains by breaking down scar tissue is our bread and butter!

Tennis Elbow / Golfers Elbow & Surgery

Surgery is great, but there can be complications and chronic pain is one of them.

We are truly blessed to live in an age of modern surgical procedures and technologies. The right surgery at the right time can be nothing short of life saving after all. Then there are all those non-life & death procedures that can relieve nerve compression and all sorts of other nasty’s. Surgery is great!

As wonderful as it is, surgery remains the most risky and invasive of all healthcare paradigms. For your body’s soft tissues getting cut open by a surgeon is an injury like any other. And like all injuries, surgery can leave longer term issues that may predispose us to pain.

Sadly very few of us are given sufficient rehab after surgery due to the pressure on our healthcare systems and the need to discharge patients in a timely fashion. A history of surgery anywhere in an arm that is showing up with persistent tennis elbow or golfer’s elbow can be a sign that there is some residual scar tissue or muscle wasting.

The happy news is that many cases of  tennis elbow & golfer’s elbow related to poor surgical recovery are an absolute piece of cake to treat as long as you are willing to put in the necessary work.

Tennis Elbow / Golfers Elbow & Muscle Wasting

If you have chronic pain (of almost any type) it’s vital to know muscle weakness is almost certainly part of the issue. Strong body parts seldom hurt, no matter what other complex factors are involved. 

Most modern humans engage in less than 10% of the activity their hunter gathering ancestors did. As a result our bodies are extremely prone to muscle wasting. In fact, compared to our ancestors, specific patterns of muscle wasting are the norm for us; due to our profoundly sedentary lifestyle patterns.

The most obvious role of muscle is movement, muscles pull on our bones and enable important life preserving activities like tennis afterall. The role muscles play in injury prevention is however just as important as their role in maintaining movement.

In moments where there is a threat of injury muscles intervene and assume their role as a highly effective suit of armour. Patterns of protective muscle contraction prevent our joints reaching extreme ranges of motion, reinforce our bones, and protect soft tissues. 

Strong healthy muscles play a major role in preventing tennis elbow & golfer’s elbow, in much the same way as they prevent traumatic injuries. The likelihood of developing pain is influenced by the amount of work you do – it is also however influenced by how strong your hands and arms are.

The good news hidden here is that by strengthening our muscles and tendons we can greatly impact the likelihood of resolving tennis elbow & golfer’s elbow in the longer term.

Tennis Elbow / Golfers Elbow & Tendinopathy

Tendinopathy is an integral part of almost all persistent tennis elbow & golfers elbow pains, and is pretty much an inseparable part of the underlying problem. It is valuable to understand what tendinopathy is and what we can do about it.

Up until recently we used a different term for tendinopathy.. Tendinitis! Until it turned out that tendonitis is a completely unscientific term for what really happens in painful tendons.

The term tendinopathy reflects what we now know scientifically about tendon pain. When you look down the microscope at chronically painful tendons you see degenerative changes. This means that tendinopathy is just as degenerative in nature as conditions like osteoarthritis. Happily though tendon degeneration can be reversed due to its rich blood supply.

Many tennis elbow & golfers elbow pains are tendinopathy by another name. Using treatments like extracorporeal shockwave therapy combined with tailored strength programs for the tendons is an excellent way to manage these types of problems both in the long and short term. 

Tennis Elbow / Golfers Elbow & Fascial Adhesions

Fascial adhesions are like a microscopic spider web of scar-like tissue that traps the soft tissues in the forearm of many tennis elbow & golfers elbow sufferers.

Fascia is the whitish/ silvery connective tissue that neatly wraps up all your body’s internal structures. We now understand that the skin is a very large and very important organ system; and we are also beginning to understand fascia is an organ. Previously it was thought of as nothing more than the boring stuff that you cut through during surgerys and autopsies. 

Fascia is really important stuff. It binds interdependent sets of muscles, bones, nerves and vessels together in a way that enables them to work together effectively. Fascia assists movement between tissues too, structures like tendons need to move smoothly against bone, and even against the overlying skin.

‘’Fascial adhesions’ are sticky thickened sections of connective tissue that cause pain by preventing normal movement between neighbouring tissue structures. If you are not a lifelong vegan you have probably seen what fascia looks like on a lamb shoulder. The fascia is the silvery connective tissue between the muscles. If you can picture what it would be like if that silvery membrane thickened and ‘sticky’ you understand fascial adhesions.

Fascia adhesions are a very common part of the body’s response to physical strain, and they are a major part of ‘the mess’ in most cases of tennis elbow & golfer’s elbow. If you have had limited success with exercise and braces it’s quite likely that you have fascial adhesions that need to be broken up. Treatments like extracorporeal shockwave and Graston Technique can do this quite easily in most cases.

Tennis Elbow / Golfers Elbow & Psychological Stress 

Increasingly science is unpacking profound links between our psychological well being, our emotions and the stubborn health issues we suffer from. These days is more or less common knowledge that stress can influence pain in a big way.

An up to date scientific view of pain hinges on one relatively simple concept. Pain does not just happen in your body’s tissues, it also happens deep in your central nervous system. When we experience stubborn pain it is happening both in the tissues but also within the ‘pain pathway’’. The pain pathway is the set of nerves and nerve clusters that manage the pain signals.

Pain can be amplified by physical stress in the body’s tissues, we all know that one. But pain can also be amplified by the effects of psychological stress on the central nervous system.

An excellent piece of research carried out on behalf of Boeing highlighted the effects work related stress can have on pain. Boeing spent a huge amount of money trying to unpack what causes so many of their staff to suffer debilitating back pain. Cutting a long story short it turned out that it wasn’t heavy lifting or repetitive work that predicted back pain in workers; the workers who experienced the worst back pain were the ones who felt chronically under-appreciated!!!

In practical terms: a mild issue in the arm of a person suffering heaps of psychological stress can lead to more ‘physical pain’ than a major arm issue in someone who is enjoying their life situation.

Happily there are effective ways of managing stress that increase our resilience and lead to reductions in tennis elbow & golfers elbow pain. Also, regardless of stress, healing the soft tissues reduces most pains meaningfully, which leaves us free to manage stress in our own time.