Have you ever experienced pain in your forearm when typing? Lifting a bag? Or twisting a door handle?
You may actually be experiencing a variation of “golfers or tennis” elbow. Yes, contrary to popular belief, you can suffer from these types of injuries without playing these two sports. It is quite common to obtain such tendon injuries just from day to day activities. Let’s first define what golfers and tennis elbow are:
Golfers elbow: Classically described as pain or aggravation on the inside of the elbow
Tennis elbow: Classically described as pain or aggravation on the outside of the elbow
We can also see golfers elbow in tennis players and vice versa so these are not synonymous to their respective sport names. All in all, both are what we call a tendinopathy which is damage and inflammation of the tendon. We have large tendons on the inside and outside of our elbow which provide common attachments for the associated forearm muscles.
The tendon can be damaged in a couple of ways. The mechanism of injury is typically through one large damaging force or a small repetitive movement over a longer period of time. The areas of the tendon which we tend to see damages are in parts of the tendon where it is attaching to another type of tissue, such as muscle or bone, or areas with less blood supply.
So, if we do have a tendon injury, what’s the right way to heal it? First, we need to know the timeline of a healing tendon after injury. It is broken into three phases:
Lasting 3-7 days post injury.
- brings blood filled with healing cells and repairing tissues
Starts 1-2 days post injury and can last up to 2 months.
- Here healing cells start laying down collagen and repairing the damages tissues
- Collagen is laid down in direction of forces
Starts 6 weeks to 2 months post injury and can last up to 12 months.
- Here we have reduced healing cells, collagen production and blood supply
- The tissue becomes more fibrous or “scar like”
Now that we understand the tendon injury process, we can apply this to how we manage the healing tendon.
During phase one we want some rest post injury we also want to control but not eliminate the inflammation. The inflammation is what is healing the tissue but can also cause pain. So, managing this by alternating with ice and heat with some compression would be ideal.
- Ice for 1 hr (15-20mins on and off)
- Heat for 10-20mins to loosen surrounding tissue
- Continue as needed
We also want to still try and keep the area moving with gentle movements, so we don’t seize up such as passive and active range of motion exercises. This is dependant on level of injury though.
During this phase we want to start loading the injured tendon so that we can promote strengthening and healing in the direction the area will be exposed to forces. The best type of loading is a combination of exercises.
Typically, we would start light or non-weighted and see how the patient responds. Then we progress to a heavy load of 70-85% I rep max. Again, this can be quite patient and injury dependant. The exercises don’t want to be high volume, but we do want to focus on slow movement and quality of movement.
- Slow eccentric
- Heavy Resistance Training
- Stay within 8 repetitions
During this stage we continue with our strength training progressions but if we are returning to sport, we now want to progress the training to sport specific functional rehab. For most patients, this stage is safe to return to normal daily activities. This can include:
- Full body kinetic movements
- Strength and conditioning
A vague timeline for return to sport would be 8-12 weeks which would allow for a few blocks of trainings. But again, the time frame of return to sport or activities can vary depending on the patient and severity of their injury. In conclusion, these timelines and exercise progressions are a general guideline and are dependent on the patient and severity of the injury. This is why treatment and management through all three phases by your allied health practitioner can seriously enhance your progress by improving healing times. This can be done through various methods but personally I find a combination of acupuncture, muscle release techniques, mobilisations and chiropractic adjustments can get the ball rolling!
By Braeden Melmer – Chiropractor Neurohealth Chiropractic
- Fenwick et al. 2002. The vasculature and it’s role in the damaged healing tendon. Arthritis Res Vol (4) 252-260
- Maddulli, N et al. 2002. Tendon healing: Can it be optimised. British Journal of Sports Medicine. Vol 36(5)
- Docheva et al. 2015. Biologics for tendon repair. Advanced Drug Delivery Reviews. Vol. 84(222-239)
- Page name: Tendinopathy Rehabilitation. Author: Physiopedia contributors. Publisher: Physiopedia, . Date of last revision: 31 August 2018 16:28 UTC. Date retrieved: 12 July 2019 01:25 UTC. Permanent URL: https://www.physio-pedia.com/index.php?title=Tendinopathy_Rehabilitation&oldid=197453. Page Version ID: 197453