Let’s talk about elbow pain! 

Many people experience lateral elbow pain and immediately think of tennis elbow. Tennis elbow, also known as lateral epicondylagia, is a common overuse injury where the common tendon origin of the wrist extensors becomes irritated and inflamed due to repetitive motions such as gripping, lifting and extension of the wrist.

Similar presentations also occur when something called “double crush syndrome” occurs and can lead to symptoms consistent with tennis elbow. Double crush syndrome is a term used to describe the sub maximal threshold compression of the nerve causing a decrease in the flow or conduction in the nerve. If the compression is great enough it can cause disruption in the nerve signal resulting in symptoms of pain, numbness or altered sensation. What can cause compression along the nerve? Compression of a nerve can occur along mechanical interfaces which can be intervertebal foramen where the nerve exits the spine in the neck, passing through or around fascia and muscles and bony canals that can occur anywhere along the nerve pathway.

A way to visualize this is to think of a garden hose. If you step on the garden hose causing compression, there is a disruption and decrease to the water flow, but once you remove your foot (the compression) the water flow returns to normal. This is similar to what happens to the nerve when it passes through these mechanical interfaces that can create compression and altered sensation, pain etc.

When a client is experiencing double crush syndrome of the a peripheral nerve, the symptoms can mimic those of tennis elbow as the nerve and mechanical interfaces can be localised at the elbow and can be injured by similar repetitive movements. As physiotherapists, our job is to determine whether you are experiencing a “true” tennis elbow or double crush syndrome and create a treatment plan from there to address not only the symptoms, but ultimately the cause.  Examples of treatments that might be used to treat both of the scenarios are soft tissue massage or myofascial work, joint mobilizations and nerve mobilizations.

Soft tissue work can address the tight muscles along the pathway of the nerve that can act as mechanical interfaces. Other treatment techniques include joint mobilizations which allow us to mimic the physiological and accessory movements of the joints such as in the neck, shoulder and elbow which the nerve passes through. Many times with this presentation there are joint restrictions in the neck which can impact the nerve and cause compression therefore resulting in referral pain down the nerve pathway. Mobilization of the nerve using nerve sliders or glides are also often useful to reduce the nerve related pain occurring as a result of potential mechanical compression or irritation.

If you are experiencing symptoms consistent with tennis elbow, or double crush syndrome, give our office a call and one of our highly skilled physiotherapists will conduct and thorough assessment and devise an appropriate treatment plan.

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