We all know of someone who has suffered from tennis elbow. Quite often this person will have had steroid injections into the elbow but the symptoms persist or return after a few weeks. It is well known that this condition can take a long time to heal, and conventional medical treatments can be quite ineffective.
I have been asked to share some insights into Tennis Elbow from the perspective of my skills as an Osteopath and BodyTalk practitioner.
ANATOMY AND PHYSIOLOGY
Tennis Elbow conventionally describes a nagging and persistent pain at the elbow, on the lateral side only that may radiate down the forearm into the dorsum of the hand. The onset may be gradual or sudden.
There are thought t be several types of lesion for this condition – including:
1) soft tissue degeneration at the origin of the common extensor tendons at the epicondyle, usually microscopic tears at the teno-periosteal interface at the epicondyle, and especially at Extensor Carpi Radialis Brevis, which is a weak muscle and vulnerable to strain. Calcification may subsequently occur and be a further cause of chronic pain.
2) joint pathology of the radio-humeral joint. Surgery has revealed that often there is degeneration of the cartilage at this site.
The mechanical picture is that of forceful overstraining of the wrist from flexion into extension, as in doing a backhand with a tennis racket. (Remember that the Extensor Carpi Radialis Longus and Brevis insert past the wrist, into the carpal bones). Also excessive repetitive pronation and supination can set it off.
3) The site can be exquisitely tender, with inflammation, crepitous, worse for activity, but when severe, can awaken the person.
The Osteopathic take on Tennis Elbow
Commonly, osteopaths will look at issues in the neck facet joints and muscles, and can get very good results from freeing up the nerve supply to the elbow via the segmental nerve roots and brachial plexus. This in turn encourages energy flow down the arm. Psychologically, the neck, if tense, indicates rigidity in attitude. By mobilising this rigidity, the patient is more able to let go generally, and this in turn will promote the eventual correction of the elbow symptom.
Soft tissue treatment to the relevant muscle origins and to the musculo-tendinous junctions can be useful. Also techniques like Strain-Counter Strain can be used to re-calibrate the muscle spindles. However Muscle Energy Technique would be contra-indicated since that approach tensions the already inflamed muscle. The radio-humeral, radio-ulnar, humeral-ulnar joints and the interrosseous membrane between the radius and ulna must all be balanced (this is best done with the cranial approach).
Lymphatic drainage of the arm and at the thoracic or lymphatic ducts is crucial to the healing at the elbow. This will enable a good drainage of the inflamed area, a reduction of inflammation, and encourage the immune system to heal the area. Lymphatic drainage can be effective without one actually needing to work at the pain site. Again, a tense neck and thoracic inlet will constrict the lymphatic drainage from the upper extremity.
The BodyTalk Take on Tennis Elbow
In BodyTalk we are able look at the consciousness of the elbow, and here it helps to note where the meridians pass through, and look at what the meridians signify. For example The three Yang meridians that pass laterally are the large intestine, triple heater and small intestine meridians. These relate to the psychological concepts of being intellectually over-challenged, difficulties in deciding what is good and bad or right and wrong in one’s life, and difficulties in letting go and of forgiveness.
So with Tennis Elbow, psychologically, we may be having difficulty (via the colon meridian) in eliminating the wasted parts of our life, and problems in forgiving ourself or others because of some negative (or “wasted”) event. Also, via the small intestine meridian we may be struggling with discerning what is useful for our life or struggling with the ability to judge life in a positive way. Here we tend to develop negative beliefs and attitudes and our clarity of thought becomes muddled.
One of the causes of T.E. can be repetitive movements, eg racket sports, or work-related. This constant repetitive movement will eventually be interpreted by the mind as a chronic tendency to be inflexible in life, ie “life is in a rut”.
A physical implication of large intestine meridian involvement in T.E is chronic constipation. If this is the case, then colonic irrigation, and dietary changes, and abdominal massages can produce excellent results for the T.E.
John Veltheim (founder of BodyTalk) says that “The key word for the elbow is flexibility. Our elbows reflect our flexibility to life; an ability to adapt and be spontaneous without getting bogged down and constipated by life. The more flexible we are, the more we are able to flow with life, forgive, differentiate right from wrong, intellectually process life, and adapt to our surroundings. If our elbows are losing their flexibility through pain, swelling, arthritis or injury, then we are being told to look at those aspects of our life relating to flexibility.”
In BodyTalk we can address reciprocals in the body. These are parts of the body that have an intrinsic relationship with another part and are mutually supportive energetically. So for the elbow the reciprocal is the knee unless otherwise specified by Innate. Tapping out this reciprocal can be very useful in helping reduce the elbow pain. In fact the BodyTalker may be instructed to tap out the reciprocals for the whole upper extremity, for increased effectiveness.
I hope that I have been able to provide some insights into the physical, emotional and psychological implications of Tennis Elbow, and approaches to treatment. I am happy to talk with you individually about any issues arising from this.