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LAURA 0:00
And it’s not just the elbow like if you go up to hit a forehand, it’s not just the elbow doing the work, you have to think about what your shoulders are doing, what your upper back is doing, what your hips are doing, what your feet are doing. So I like to look at it not just as the overuse of the elbow, but what has been underused elsewhere.
INTRODUCTION 0:19
Welcome to the fit and healthy Denver podcast where we discuss all things revolving around health, fitness and wellness in the amazing state of Colorado. So you can get behind the scenes information from industry insiders, special events, and more. Coming up is our host, physical therapist and strength coach, Dr. Jamie Beauvais. And here we go.
JAMIE 0:45
Welcome, everybody to this episode of the fit and healthy Denver podcast, I am super excited to have on Dr. Laura Lund, who is a doctor of physical therapy, as well as a fellow of applied functional science. And this episode is all about tennis elbow, what you can do to recover from it, what you need to be aware of. And if you missed Episode 23, we also covered tennis injuries with Damon Jillette at the Denver tennis club. If you’re done, if you’re a good tennis fan, check that one out as well. But onto this episode, this is a very, very common injury in tennis. And most people don’t have the right information. So we wanted to have Loron, who’s an expert in treating tennis elbow, and Lori, your doctor of physical therapy, I know what that is. Tell me more about this fellow of applied functional science, not quite as clear on that. Okay, very much
LAURA 1:39
for having me on. Yeah, so the applied functional science is I created a fellowship through the Gray Institute. And pretty much we kind of look at it as a movement specialist in that we were trained from the head to the toe, on how to look at the body and how we move in three planes of motion and how to make it very specific to what that person wants to do. So we really want it to be authentic. So if you’re a tennis player, a golfer a runner, but looking at each of those joints, and each of the muscles to move in three planes and get you back to your sport or activity or whatever you want to do, and
JAMIE 2:12
in the correct way. And this is very, very significant for tennis, because we all know tennis is played in all three motions, or all three planes of motions. There’s lots of rotation, there’s forward and back, there’s up and down. Lots of different motions. And so we’ll get into that in just a little bit. But let’s just start with the basics, Laura, because a lot of people hear the term tennis elbow thrown around, but they don’t necessarily know exactly what it is. So what is tennis elbow?
LAURA 2:34
Yes, I do get that one a lot. So the technical term is lateral epicondylitis. So pretty much that means that the lateral side of your elbow, so if you’re sitting with your palms up, looking at the outside part of that elbow, where what we’d call your extensor muscles are the muscles that help to extend your wrist attach, get overused or inflamed, and they can lead to pain, irritation, difficulty with gripping things doing kind of your daily activities. And so that’s the medical way of looking at it on the outside of the elbow. Okay,
JAMIE 3:08
So how does somebody know if they have tennis elbow or not?
LAURA 3:12
I would say sometimes we have to catch all terms, if you have pain on the outside of the elbow, I feel like someone’s going to diagnose you with tennis elbow, even if you don’t play tennis. But typically, if you have a pain like, when you’re gripping or moving that wrist, you’ll feel it kind of isolated on that side of the bone and it might radiate a little down into the arm. That would be kind of a general way to kind of get the idea of possibly having that tennis elbow.
JAMIE 3:38
Yeah, I think you touched on an important point there with tennis elbow, it is a lot of gripping things. And it’s not just with tennis, because as any tennis player will tell you. Not playing tennis sucks. But then when they go home, and they you know, they’re putting up their dishes and it’s hurting or they’re a businessman, and they have to shake hands and they can’t shake a hand because it hurts so bad. It really affects the daily aspects of your life as
LAURA 4:00
well. 100% I agree completely.
JAMIE 4:03
Okay. What are some of the causes of tennis elbow can’t be just playing tennis, because then everybody that plays tennis would get it. So why do some people get it and other people, other people don’t.
LAURA 4:14
So usually we look at it as an overuse injury. So meaning that that area is getting used too much for whatever reason that could be from playing tennis, if it might be from gripping the racket too hard or just doing that kind of repetitive movements. The big thing I like to look at especially with my tennis players, but really any athlete is what else plays into that. And it’s not just the elbow, like if you go up to hit a forehand. It’s not just the elbow doing the work, you have to think about what your shoulder is doing, what your upper back is doing, what your hips are doing, what you’re eating, your feet are doing. So I like to look at it not just as the overuse of the elbow, but what is being underused elsewhere. Okay,
JAMIEr 4:50
so you mentioned the shoulders. What else did you mention there?
LAURA 4:53
So like your upper back or your mid back or what we call your thoracic spine. Your hips also play a role either In your feet, like if you have a really stiff ankle, maybe that changes the way you move. And so you don’t get there as fast to the ball. So you start reaching with your arm a little more, and then all of a sudden, your elbow and your wrist are trying to take over power, when, ideally, we should use it more from like our center muscles, like our core and our hips.
JAMIE 5:18
Okay, so in the case of the hips, or the thoracic spine, you’re saying, maybe there’s under like, under using them or under rotating through them, and because that they’re hitting extra hard with like those four muscles?
LAURA 5:32
Yes, yep. So pretty much, if we can’t get the motion from somewhere else to help us out, maybe we’re using that elbow too much to take up a bit. And that’s where I’ve seen a lot of people who’ve gone through treatment before at either other clinics or other types of healthcare providers had the injections, things like that, and they just don’t seem to get back to where they want to everyone’s focus just solely on that elbow. And they maybe didn’t take that larger view to where we look at how everything comes to play. And I think that’s, unfortunately, that has been missed a lot.
JAMIE 6:06
So it almost sounds from that explanation almost sounds like a technique issue.
LAURA 6:11
Yeah, a technique issue. You know, that can be technical, like in your tennis, you know, in your actual tennis motions. But it also could just be that you have some stiffness here or there that needs to be worked out or at least be addressed, to help them perform better and then take that to their tennis pro that can help them fine tune that into their game.
JAMIE 6:32
Yeah. And I have to imagine not only technique, but there’s certain habits that need to be broken in order to get to the ideal technique to where this isn’t stressing them as much anymore. Yes. Okay, how much? How much would you say is habit versus how much is technique?
LAURA 6:51
That’s a hard question. Everyone’s a little different than that. I think habits definitely develop over time. And, you know, we’d all love to say we have perfect technique. But if we kind of started off just kind of picking it up as for fun and not having a specific direction on technique those habits have developed. And so it can be like a 5050, but it just kind of depends on the person. Okay.
JAMIE 7:15
All right. And what is somebody? So let’s say they’re working on their technique, what else do they need to do to get rid of the pain and be able to play?
LAURA 7:27
Well, first thing is to get the pain in the area down, I mean, so that might be anywhere from having soft tissue work, or having some physical therapy done on it to help to relieve the tension on that elbow to, like, bring the pain down. But then focusing also on creating that mobility, like freeing up the other areas. So when you are holding the racket, or you’re going out for a serve or a forehand or backhand, you feel like it’s not all coming from the elbow. So it keeps you playing without having to like to take as much rest because you’re, you’re giving it a buffer. So you’re giving it some assistance from somewhere else in your body.
JAMIE 8:05
Kind of like you’re redistributing all the power and everything from hit.
LAURA 8:10
Yeah, like so if you. Yeah, you redistributed or you just I think you space it out a little bit. So that’s not just the elbow. You can use some of those bigger muscles, like your butts a lot bigger than your wrist muscles.
JAMIE 8:23
Yeah. I hope so. Yeah. Okay. All right, that makes sense. Um, what are some of the roadblocks to recovering because this is a pretty common injury. A lot of people really struggle with this for months, and you and years.
LAURA 8:39
Yeah, I think a lot of robux somewhat come from just kind of like what we’re doing right now. Like, maybe you don’t know where to go to seek for treatment or not getting it treated quick enough. They think, oh, it’s gonna go away, I went out and hit it hurt, but then it recovered by the time I played next weekend, and they just kind of ignored it. And then it becomes into that, that longer process of becoming less of like the tendinitis, as we talked about to like, kind of get tendinosis meaning like, it’s no longer in that inflammatory state, it’s actually into a degenerative state where it just can’t react the way we want to. So why don’t we have time and then two, I think, is getting, really getting the proper treatment for it and having someone who can look at it from that whole picture of, you know, it’s not just sitting there and resting. It’s how do we keep them in their activity, but in a safer manner?
JAMIE 9:35
Well, that brings up a good point, because I know one thing that I frequently hear is like, you know, I knew there was something wrong, but I, I didn’t want to see somebody because I didn’t want to take time off at tennis. So how would you approach that for somebody who wanted to continue playing here, they’re a little nervous to actually have somebody help them treat it because they didn’t want to miss out on the things they love to do.
LAURA 9:57
I hear that all the time. I Think that’s, you know that the reassure them that you know, just because you have the pain doesn’t mean you have to stop, it just might be, like we talked about like in your previous question was, if we can bring other areas of your body into assist, that’s less stress in that elbow. So it’s just kind of helping your body perform better to where the elbows are not taking all that stress, there’s lots of soft tissue work. And if they ever had issues with therapy, there’s some dry needling techniques, different things that can help relieve pain, but having that other kind of avenue of where we can really assist the body in moving more effectively. It keeps them in their sports, they might have to decrease the intensity just a little bit. But you know, that’s they’re probably already doing that because they hurt too. So they’re, you know, kind of a give or take there. It’s like, if you’re playing not to your full ability, because you’re in pain. Let’s just adjust that just a little bit, but where we can get you where you don’t have the pain, but keep you in your sport. Right?
JAMIE 11:00
Yeah. I mean, could it also be kind of looking at that long term, right? Like you’re not playing as well as you can right now? What do you think is gonna happen if you don’t do anything about it? And if I’m reading kind of between the lines of what you’re saying, you’re working on performance, and improving their technique in order to get rid of this. So ideally, it would put them in a better position to either play better, or be more resilient and prevent this in the future. Yes, 100%. Okay. And what would you suggest, then, for people to start working on this ahead of time, let’s say they don’t have any issues, but all their friends have had tennis elbow and are starting to worry about it, what can they start doing now, so that they can try to get ahead of this and make sure they don’t get tennis
LAURA 11:42
elbow? Well, I think about, you know, having, you know, good mobility, yes, the pain of the elbow. So you can do wrist stretches, shoulder stretches, but also beat up your spine, your hips, so the cabin, a very three dimensional movement, workout or kind of routine, but then also throwing in the stability. So you have that kind of resilience to where the elbow won’t take that stress. You know, if you have that good motion, you’ve been working on that, that also might be a great time, then go see your tennis pro, and be like, hey, I really like to hone in on some of my techniques, you know, when I’m doing that backhand, I really feel that, you know, when I bring that right arm across, it’s getting that elbow, and then you kind of take the TT or the movement side, and then have the tennis pro or that professional, kind of fine tune that and bring the techniques eye to it as well.
JAMIE 12:36
Okay. And so a question I have then is, let’s say somebody’s been playing for five years, and then all of a sudden, they kind of developed tennis elbow, their technique, probably didn’t change that much over, you know, a period of a month or so. So why May after they may develop tennis elbow, after several years of playing tennis,
LAURA 12:59
that can be, you know, there’s different things that fit into that, you know, it could be as simple as they change rackets or they change their strings or something in that realm. But it could be maybe they’ve increased the intensity, or they have increased the volume. So you have to look for the variables and see what has changed. Other things, you know, it’s not always connected to that, you know, there are, you know, occasionally there’s side effects for certain antibiotics, even they talk about that can lead, you know, people are prone for kind of tendinitis and irritations in the tendons with that, that’s a whole nother podcast. So it just kind of depends on what they changed. And if it just came on randomly, then there’s probably something that is different, like what I’ve seen more recently, with just the whole COVID thing is someone started working from home, they weren’t used to working from home, their setup is not ideal. While they didn’t change their tennis routine, they did change the way they did their daily activities. And that was just enough to tweak it just a little bit and it got sore, they kept playing through it, and unfortunately, it kind of snowballs.
JAMIE 14:08
They’ve changed the workload on their body somehow.
LAURA 14:11
So it’s not always you kind of got to be the, you know, the we have to be the, you know, kind of be the detective and figure out really where it came from. And it takes a little bit of digging through the stuff but we usually figure it out.
JAMIE 14:29
Okay, all right. And so I know one of the most common things that people are going to turn to right away when they get tennis elbow are those little straps and like braces that they wear on their elbows or their forearms. What are your thoughts on this?
LAURA 14:47
They’re fine. Third Band Aid, you know if it gives them some temporary relief, or it gives them some comfort when they’re playing. I’m not opposed to it. It’s not going to fix them though. So I’m You know, I’m not I probably wouldn’t prescribe it to one of my clients, you know, they’ve already used it. And they, they, you know, they like it. That’s their choice. I think going at it from how we address the actual muscles, and then everything around it will get you more bang for your buck.
JAMIE 15:19
Okay, and how long does this whole process take?
LAURA 15:26
It varies, you know, going by like the internet, you know, they probably say six to eight weeks, you rest and do some stretches, and it’ll go away, you know, but like you said, some people have it for years, some people have it, you know, very temporarily. So it’s very, very, based on the person kind of what’s been going on for how long and are like how they kind of irritated in the beginning. So it’s hard for me to give a set number. I do think the quicker you can get into physical therapy, or to get it addressed and start working on those tissue limitations, the quicker you recover will be. But again, it’s looking at the whole body, you can’t just focus on the elbow, or else I think it’s going to be more of a yo-yo effect.
JAMIE 16:06
Yeah, that makes sense. And what would a, what would a typical session look like with you? Let’s say somebody’s come in, and they’ve had tennis, pain in their elbow for five weeks. And it’s getting to the point where they can admit, hey, my tennis game isn’t the same, not playing the way I deserve to? What would that actually look like? Because I think a lot of people love to see kind of a little window into what the process might look like for them. Yeah.
LAURA 16:33
So first, we’d come in and we do an assessment, we’d look at kind of the wrist and the elbow, kind of check the mobility, kind of feel those tissues feel, then check your shoulder, your upper back, and kind of work our way, like I said, kind of hit the whole body to kind of see how everything is moving. In the beginning, I would say we do address the pain, I mean, that is why you’re coming in. So we want to get the pain down. So I would probably do some soft tissue work to improve the tissues mobility, if they’re up for it, I would do what’s called dry needling. So pretty much using a very small needle too, for a trigger point release to help to improve the blood flow and getting those muscles moving better. And then it just kind of depends on kind of what I find, but kind of work on those elbow muscles, but then work on the other muscles around it and then build in some kind of light stability to start strengthening it. And bringing in like I said, the other muscles, like in the hip in the back to kind of help take that stress off the elbow.
JAMIE 17:36
Okay, what about cross training? Let’s say somebody wants to train, they want to play their tennis, but they want to stay active? Let’s say it’s so bad, they can’t play tennis, what else could they do to stay active, that might actually help the process.
LAURA 17:51
I mean, they can still do, you know, obviously, if they like to walk or run, things like that, I still go with them doing some kind of cardio if they have not been a runner, I mean, if you’re playing tennis, hopefully you have some form of cardio. But that can still continue. And I still think you can do forms of strength training, you know, maybe you’re not using really heavy dumbbells or things like that. But you could use a cable machine or Thera bands to where you’re adding a little resistance, but you’re not overloading the wrist. And I would look at that from how like, you know, if you’re doing like lateral movements similar to you would on the core, you know, you can still mimic that, but without taking the elbow, you know, putting the elbow in an area that would cause
JAMIE 18:38
pain. Yeah, that makes sense. So this all sounds fairly challenging. We’re basically looking at the whole body and trying to get somebody to play that maybe they don’t want to stop playing even though that can cause them pain. What’s, what about it with this population? Do you like working? Why do you like working with tennis players and tennis elbow so much?
LAURA 19:00
I like it, because it is a puzzle. I think that’s fascinating. I think that’s really any injury typically, like you kind of really kind of dig through the weeds and figure out, you know, finding that root cause and helping them stay active and what they want to do. So I think that the gratifying part of it is when they do feel a little better, and they go on to have that game. They’re like, man, you know, it was still a little sore. But I felt like I had more power on that forehand than I’ve had in a while like that’s, that’s gratifying to me. But I got to be my own detective and I had to really look through the mechanics. And that’s kind of what I learned in my fellowship. And that’s what I like about it. Like, it’s not just picking one body part and sticking to it, but it is challenging. That’s why it’s good if you do have the symptoms, and even if it’s pretty acute and you think maybe it’ll go away to have someone look at it, to get that full kind of that picture and help you pick through some of this stuff that maybe you would waste a little of your time doing and get to the root cause versus pentylene. Macare,
JAMIE 20:01
What are some of the biggest mistakes that you see people make when trying to recover?
LAURA 20:07
Like the biggest things like doing nothing. Like they’re like, Okay, I just stopped playing, I’m not going to move anything. And then they get stiffer, and then they notches in the elbow, they get tighter in their hips and their back and everything else. And then they just feel like they’re out of shape. And, I mean, they give out tennis like, you have to be quick on your feet. If you’re not getting to that ball, you probably are reaching with your arms in a way, that’s not my way to get there. So I think that the biggest mistake is just doing nothing or going straight, straight to like injections and not even like trying anything else before going. Of course, objection.
JAMIE 20:41
What are your general thoughts on cortisone injections?
Unknown Speaker 20:46
I think there’s a time in place for them. I would use them if needed. I am not the biggest fan. I think because cortisone is a steroid. So it does have some degenerative properties. And if you already have an area that has some damage, putting more cortisone into it, I think, can lead to more damage. And so I would rather take it from a standpoint of, let’s treat it manually, let’s get everything else helping it out, build up our strength, and then see where we’re at. If we can’t make improvement, you know, we can cross that bridge, and we’ll refer you out to a physician that can perform that for you.
JAMIE 21:29
Right, try to try the less invasive things first. Why? Why do you think so many people, because that is probably the most common or at least one of the most common treatments for tennis elbow? Why do you think so many people jump to that so quickly?
LAURA 21:40
I think it’s partly a lack of knowledge. I think in our medical system, unfortunately, it’s a quick fix, but it might not be a real thing. And so it’s something easy, and the doctors offer it. And so they take it I, but I think it’s more they understood more of the process and what’s really going on. And you know, we could get you better without having put medication into the body and do it in a way that really will help your game overall,
JAMIE 22:15
right there because injections really wouldn’t address any of the things that we’ve talked about in this episode, they wouldn’t address the technique, the overuse, the overload, any of that.
LAURA 22:24
No, probably give you some temporary pain relief, or unfortunately, people who’ve had no relief with it. So I think having that coming at it from a little bit, like an almost more holistic II way. And then kind of crossing off some of those things before you go down.
JAMIE 22:46
Yeah, using that as the kind of ace in the hole if you have to use it while working on other things. Yeah, that makes sense. Well, what, what else do you think? Tennis players out there or anybody else that’s suffering with tennis elbow, because it’s very common and weightlifting and other things as well? What do you think? Anything that we haven’t talked about that you think people out there should know?
LAURA 23:11
I think the big thing is to listen to your body. And you know, it’s starting to feel a little sore, think about kind of try to get ahead of it before it gets to the point where it becomes that kind of chronic thing, or it gets really starting to limit you and think you know, if you’re doing something like okay, that feels a little sore, whether you weightlifter, you play tennis that day, you know, did you change any of your technique? Or did you whatever variables that came into our use airplane, and then it ran out to the court and you know, things felt a little stiff. And don’t put it off till it gets to the point where it’s harder to fix, the quicker we can fix it. Even if it seems like you’re jumping on it too soon. You’re not I mean, we listen to our body and be proactive. And then think, you know, how do we make our warmups better? How do we make our activities more authentic to the sport we want to play? You’re trying to talk about cross-train. I love cross training. I think that’s good for whether the runner, the golfer, the tennis player, we should cross train, you shouldn’t just be the sport you want to perform. That’s how we keep our body feeling good. And all the different places are supposed to move. Yeah, fantastic.
JAMIE 24:22
Well, Laura, I know you got to run. And I know you are going to be at the upcoming Colorado open which I read is the largest tennis tournament in the US. And now you’re gonna be there working on some of the tennis athletes. But if people have any questions, where can they reach you?
LAURA 24:40
Yeah, so we’ll get you open. But also they can reach me at kinetic chain Denver. My email is also Laura at kinetic chain denver.com And yeah, you find us on the internet or give us a call at the clinic. Okay, what is that number That number is 720-651-0674
JAMIE 25:09
Laura obviously doesn’t answer the phones. Everybody didn’t even know her number, but that’s okay. Well forgive her because you have a lot of good knowledge here. So, Laura, thanks for coming on. We really appreciate it. If you have tennis elbow or if you know somebody that could benefit from this episode, please share it with them and have them or have them contact Laura and see how she can help. Alright everybody, thanks for listening. Bye. Thank you.
OUTRO 25:40
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