Tendon disorders (tendinopathies) of the elbow (epicondylitis) and of the wrist (styloiditis)

What does this mean?
The major symptom of tennis elbow is a pronounced pressure pain on the outer side of the elbow which, in acute cases, is so pronounced that even a light touch is unpleasant. The same painful phenomenon can also occur on the inner side of the joint which in this case is known as throwers arm or golfers elbow. This irritation on the outside or inside of the bony prominences in the elbow area is also called epicondylitis, and is actually the result of increased muscle tension (tone) of the extensor or flexor surfaces of the forearm. The wrists can be affected in the same way (styloiditis). Whilst this hardening or tension can affect the entire muscle mass, frequently only a few fibers are involved. The therapist feels these hardened muscle strands as tense filaments on the outside and inside of the forearm. A hardened muscle is also always shortened, and thus it’s sinews, which connect it to the bone, are under constant tension, day and night. In most cases the pain decreases during usage but then resumes afterwards during rest.  If the tendons in the elbow area are under such constant tension, their blood flow is disturbed and they begin to become inflamed. Tendons are poorly perfused with blood and need alternating cycles of tension and relaxation. Chronic tension due to involuntary muscular contraction or stress such as the clenching of a tennis racket, the carrying of a suitcase, working with a computer mouse or a workout with a range of fitness devices, springs and rubber bands, etc. disrupt normal tendon metabolism, especially in the elbow, but sometimes also at the other ends of the same muscles in the wrist area. Alongside muscle hardening triggered by chronic stress, an acute sprain, resulting in a muscle shortening, can also be the cause of tennis elbow, throwers arm or a so-called wrist inflammation.

How the spine and tennis elbow connected
Man, as a vertebrate, is divided into segments, each associated with specific nerves, joints, muscles and skin areas  etc. Any disturbance to the spine can therefore simultaneously affect multiple parts of the musculoskeletal system. Restricted spinal movement or the dysfunction of discrete spinal segments can cause transmitted symptoms and involuntary muscle tension, for instance in the forearm. For this reason, the cervical spine can trigger the symptoms of tennis or golf elbow. Every examination and treatment of tennis arm should therefore also comprise functional testing and treatment of the cervical spine.

Where are the underlying faulty movements, or what triggers tennis elbow ?
To prevent the overloading of a given section of the musculoskeletal system, the load must be distributed to other parts. The hallmark of an optimal motion technique in sport or in everyday life is therefore the distribution of motion throughout the body via the spine, the command centre of the musculoskeletal system. To illustrate this, it is estimated that, when optimal technique is used, 70% of the power of a tennis forehand stroke is provided by the leg muscles. A local overloading of the arm muscle is therefore, in most cases, a reflection of a disordered/disturbed pattern of movement. Arm movements are normally coordinated with rotary movements of the torso in the thoracic spine. External factors such as seat backs, clothing or internal ones such as concentration, stress, and disturbed coordination cause us to decouple arm movements  from the rest of the body. This is apparent from the lifting of the shoulders and the control of the hands by the sensory organs in the head, especially the eyes. The arms and hands are no longer coordinated with the rotational movements of the body, but instead via the cervical spine with the control of the head, eyes, ears, etc. The shoulders are mostly pulled up in this way whilst a new movement is learnt or during stress which leads to neck muscle spasms. The arm muscles are in addition tensed and the lifting of the arm is no longer a natural, relaxed rotation of the upper extremity, which instead remains twisted with the palm facing down, whilst the shoulders and elbows are raised. The upper body looks stiff, because lateral bending rather than turning movements are made and a hollow back also remains during flexing movements.

Correct: rotation of the scapula is achieved by the posterior fixators Incorrect: rotation of the shoulder blade by the upper fixators Touch the back of your head as if you are combing your hair. When the arm is lifted a simultaneous rotation of the scapula occurs to enable the articular surfaces of the shoulder joint to be optimally positioned with respect to one another. If, when an arm is lifted, the shoulder is raised, a disorder of pectoral girdle movement is indicated. Mobility test for the pectoral girdle muscles The arms and the shoulders are only articularly connected to the torso via the collar bone (clavicle), otherwise exclusively via the muscles of the pectoral girdle. The shoulders are anchored between 3 muscle groups, specifically the posterior, anterior and upper pectoral girdle fixators.  It is therefore totally clear that the DKB system, i.e. a balanced combination of stretching, strengthening and movement, also has a special meaning in this case. Disturbances manifest as shoulder pain and spinal complaints (cervical and thoracic) and sometimes also as headaches.

Treatment The most important goal is to treat the hardening of the arm and neck musculature. For further information please click here...