How to get tennis elbow without playing tennis

What is tennis elbow? And how do you get it without playing tennis? It is a common overuse complaint that causes pain on the lateral side of the elbow.  Interestingly enough, I would say that it is more common for people that do not play tennis!  Common terms for tennis elbow are lateral epicondylitis or tendonitis (however, a more proper term for it would be a tendinopathy.)

Tennis elbow causes pain at the proximal insertion of the extensor muscle group of the forearm (for the anatomy nerds, from lateral to medial: extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris.)  These muscles have a common tendon that can become stressed if overused.  This seems to occur with people who use hammers, screw drivers, drills as well as those who keyboard too much.  Of course it can happen to those who play tennis.  Ironically, I find golfers elbow more common among tennis players than tennis elbow (figure that one out...maybe this would be good for another topic!) 

With overuse, there are a couple of types of stresses at the common extensor tendon that can cause issues.  Rapid repetitive movements (for many months, it doesn't happen overnight) such as keyboarding can cause irritation at the tendon.  Also, repetitive eccentric strain of the tendon such as hammering nails can create microtrauma causing irritation of the tendon.  These types of strain are most common where the muscle meets the tendon.  Prognosis for this is generally good.  With soft tissue treatment, modalities such as laser, shockwave and rehabilitation using eccentric strength will significantly increase recovery time.

More excessive eccentric strain such as playing tennis can cause problems where the muscle attaches to the bone (lateral epicondyle).  This is called an enthesopathy.  Prognosis for this type of injury is much worse.  Treatment usually involves resting from sport or activity for a lengthy period followed by treatment and rehabilitation. 

Though similar in presentation, it is important to distinguish between a problem where the muscle meets the tendon, or where the tendon meets the bone so you can determine the correct course of treatment. 

Ankle pain - Walking the Walk

A hockey player with ankle pain limped in to the clinic after taking a slap shot off the outside of the ankle (lateral malleolus).  He said he was able to play the rest of the game and it did not really hurt until the next morning.  When he woke up, there was moderate swelling and a bit of bruising, but he found it actually hurt more on the medial side and on the bottom of his foot. 

SIGNS
-bruising and swelling
-decreased range of motion

SYMPTOMS
-pain (weight bearing and non weight bearing)

The most likely reason for the pain on the medial and plantar (bottom) aspects of the foot are from intra-articular swelling (swelling inside the joints).  It could also be from joint dysfunction or joints being jammed.  In terms of treatment, the best bet would be to bring the swelling down ASAP.  Rest, Ice, Compression and Elevation can help.  I find that a bucket of ice cold water works more effectively than gel packs.  Compression from a tensor or tape is effective.  I have also found laser therapy to be a benefit and seems to decrease recovery time.  If joints are restricted or jammed up, mobilizations and/or adjustments can be done.  The trick is to avoid the mobs or adjustments from being painful.

The question is can they continue to walk and perform daily activities (or even play another game?)  The answer depends on how bad the ankle pain actually is.  A good way of testing this is the use of the Ottawa Ankle Rules.  This can help determine whether the person needs to go for Xrays.  If they do not need Xrays, then you should find out how comfortable it is to walk.  If they want to play a sport, you could test them with some of the movements of that sport to see if they can move without hindrance or pain.  I would test them with a one leg squat, jumping on one and two feet, and running.  If there is pain with those movements, I would recommend resting until the pain and swelling go down, but depending on the athlete and the level of sport (and importance of the game), they may ignore the recommendations

Each ankle injury will present differently.  It is important to determine the nature and severity of the injury, the type and amount of treatment that it may require, and the functional capabilities of the injured person. 

The Difference between mobility and flexibility

With a bit of understanding of the terms; flexibility, mobility and stability, we can go into the biomechanics of flexibility.

From a biomechanical perspective, flexibility of a joint is defined by the shape of the joint and how tight the joint capsule and ligaments are around the joint.  This is part of the reason why some people can touch their toes when they bend forward, and others cannot.  When you bend forward to touch your toes, the joints in your back are stretched.  This includes the joint capsules and the ligaments that surround the joint.  Knowing that when ligaments (and joint capsules) are stretched, they undergo permanent deformation and will never go back to the same length.  This does increase the flexibility of a joint, but the question is; would you want that permanent increase in flexibility?

Mobility is defined by the amount of muscular control you have over the entire range of a joint.  Talented athletes (gymnasts and dancers) have a tremendous amount of flexibility, but also have great mobility or control over the range that they do have.  Thus, many of them are able to avoid injury by controlling the amount of motion over a great range.

An injury will occur when we cannot control motion (such as through the spine) through its entire range.  Therefore, people who are too flexible will be more susceptible to injury near end ranges unless they are able to maintain control (mobility through range of motion/flexibility).  Not having the flexibility can also cause injury by not allowing one to move into a desired position (even if their mobility is good). This can lead to excess strain on joints and muscles.

The bottom line is that you want to be just flexible enough for your occupation or sport, and you want to have the control over that flexibility (mobility).