Also known as “lateral epicondylitis”, tennis elbow doesn’t just develop in tennis players. You don’t even have to be an athlete or play sports at all. I’ve personally treated nurses and those who work in the construction industry who have had it.
What is it?
Lateral epicondylitis is basically inflammation at the site where the muscles and tissues of the top of the forearm, wrist and hand attach to the outside bony structure of the elbow. It’s painful and can make everyday tasks a challenge. It may be painful to turn a doorknob, a screwdriver, wring out a washcloth, etc. Even holding a cup might be painful. Many things that require the use of the muscles on the top side of your forearm can cause this pain. The pain can also be located in the forearm or wrist, although this seems to be less common in my own professional experience. Muscles knots (a.k.a. trigger points) may also be a factor contributing to pain in the forearm.
Causes and risk factors
Basically, overuse and straining of the muscles are the cause. Anything that causes repeated contraction of the forearm muscles that are involved in straightening your hand and raising your wrist can lead to tennis elbow. These repetitive and straining activities put extra stress on the muscles and connective tissues, such as tendons, and their attachment site. Think about using a computer mouse and pulling your fingers up away from the mouse after clicking or using the scroll wheel. Maybe you’re a writer, editor, graphic designer, secretary at a school or a nurse who documents on your patients repeatedly throughout an eight or 12 hour shift. There is repetitive stress placed on the structures mentioned previously that contribute to the development of lateral epicondylitis.
Maybe you’re fiercely competitive when it comes to ping pong, tennis, racket ball, badminton or another sport that uses a racket.
The backswing specifically is what may contribute to the development of tennis elbow. Also age. If you happen to be between the ages of 30 and 50 you may be at a higher risk. I’m smack dab in the middle here.
Treatment
Rest, ice and over-the-counter pain relievers according to the Mayo Clinic. Massage can help to alleviate tension in the muscles, on the tendons and in other connective tissues. This can speed the recovery from tennis elbow. One thing that I incorporate is ice massage at the beginning of the treatment session. I may use a dixie cup with ice and massage the attachment site at the elbow. This helps calm the irritated and inflamed tissues before I work with them. I then apply Swedish techniques, deep tissue, pin and stretch, a few other techniques depending on the situation and then back to Swedish to make nice with the tissues to finish.
You may also try using a tennis elbow brace to decrease tension on the attachment site. If the pain persists past what seems to be a reasonable period of time then you may want to consider making an appointment with your family doctor.
About the author: Ethan Pariseau is a registered nurse with a bachelor of science in nursing and is licensed by the state medical board of Ohio to practice massage therapy.
You may have heard of it. It’s painful. Imagine trying to get out of bed in the morning to get yourself ready for the day and you can barely stand or walk around your bedroom because it’s too painful. Or when you get up after sitting for a while like after sitting at a computer for work or after a car ride. Even more pain following certain exercises like running. The good news is that it’s treatable. There are several things that can be done that are natural and without medications, injections or minor surgical procedures.
Who Does It Affect?
Plantar Fasciitis is one of the most common causes of heel pain. Approximately 2 million adults are treated for this condition each year. The number of those affected is certainly higher than those reported as having been treated for it. I’ve known people personally who have been affected by it but they just toughed it out until it went away, which took a while and I would not recommend doing. It can affect those who aren’t very active in their daily lives but also those who are very active and athletic. Some of the causes are overpronation of the foot (your feet roll inward toward the arch of your foot as you walk), excessive running and standing for extended periods of time. It usually affects both feet at the same time.
What Is It Exactly?
Sometimes referred to as “plantar heel pain syndrome”, plantar fasciitis can be related to the degeneration, or breakdown, of the collogen in the tough band of connective tissue that runs along the bottom of the foot and connects the heel bone (the calcaneus) to the first set of bones of the toes (the proximal phalanges). It can also be related to bone spurs and/or inflammation as the “-itis” at the end of the term suggests.
What Causes It?
Excessive Running
Even more so if the runner wears worn down shoes. I’m a long distance runner myself so this is a concern anytime I start to feel similar symptoms. I’m also always conscious of the mileage and wear and tear on my running shoes.
Being Overweight
Also guilty. In September of 2017 I began gaining weight. I gained 70 pounds of unwanted weight and I’m still working on getting rid of it. Genetics, life situations that are out of our control, poor dietary choices…the list goes on. But our connective tissue doesn’t care what the reason is for the added stress.
Sudden Changes in Activity
Even running 5-6 days a week and long distances hasn’t worked on it’s own. I’m changing my eating habits, exercising more with bodyweight and strength training. Fortunately I haven’t had to deal with PF. I am very conscious about gradually increasing the amount of activity I do and paying attention to lingering tightness, soreness and anything else that might lead to an injury of some kind.
Uneven Leg Length
This creates an imbalance of pressure, movement and stress on the lower extremities.
Flat or Pronated Feet
Also creates an imbalance of pressure, movement and stress on the lower extremities.
Arches of the Feet that are higher than average
Ditto as the two previous potential causes.
This tough band of connective tissue acts as a shock absorber and spring in the foot. But these functions are hindered when the fibers of the connective tissue fray from overuse and stress and isn’t repaired properly. PF may also occur because of other disorders like gout, rheumatoid arthritis or diabetes.
How Do You Know If You Have PF?
The signs and symptoms of PF are pretty consistent which make it easier to identify.
Acute pain in the first few steps after having been off your feet for a while
The pain is located just in front of the heel on the bottom of the foot or deep in the arch of the foot
Pain eases or goes away after a few steps
Pain comes back (possibly more intensely after prolonged standing, walking or running
There is a simple test that I do on my patients who believe they may have plantar fasciitis. This test is called the Windlass Test and it is done with the patient sitting on the table and I brace the heel of the foot with one hand and apply upward pressure on the toes to tighten the tissues on the bottom of the foot. The test is positive if this produces pain between the arch and where the connective tissue attaches to the heel.
How Is It Treated?
Here we go…onto the stuff you’ve been waiting for. Most people don’t want to jump right into steroid or Botox injections. Steroid injections can cause damage to the fat pads on the heels of the foot and can also cause the collagen fibers to become weak and the tissue to possibly rupture. There is also a focused ultrasound therapy (extracorporeal shockwave therapy) that has shown some effectiveness in treating PF.
Let’s talk about what can be done without needles, medications and ultrasound machines. The first thing to focus on is decreasing the amount of tension in the muscles and tissues that cause PF and the pain. First thing in the morning, before you even get out of bed, massage your calf muscles and feet. Get the blood flowing. Warm the tissues. Do some stretches on the calf muscles and get the tissues in your feet moving. This doesn’t have to be an extensive process. Just a couple of minutes.
You can get orthotics or heel cups to put in your shoes that help decrease the amount of movement in your feet that causes the pain. Some people even use night splints that keep the feet in a position slightly pulled back like when you pull your toes up toward you.
Ice
Using ice at the site of pain can help to lessen the pain. Try using a frozen water bottle and rolling your foot on the bottle against the floor. Even though you won’t be keeping the bottle in a single place on your foot, make sure to keep a cloth barrier (like a sock or washcloth) between your foot and the frozen bottle to prevent injury to the tissues.
Stretching
Stretch your foot and calf muscles, as I mentioned above. Why the calf muscles? There are two of them (the soleus, and gastrocnemius) that come together and form the Achilles tendon which connects to the same heel bone of the foot (the calcaneus) and continues on to form the tough connective tissue that runs along the bottom of the foot. If the calf muscles are overly tense they pull on the connective tissue and that tension translates down the lower leg and into the bottom of the foot.
Deep Tissue Massage
Deep tissue work of the calf muscles and bottom of the foot can help to release that tension I mentioned in the previous section. A licensed massage therapist who is knowledgeable about plantar fasciitis will know where to work and why. Only working at the site of pain won’t treat the cause of the pain. It’s like if you take Tylenol or Motrin for a fever…it won’t treat what’s causing the fever, just the fever that your body is producing to try and fight the cause. So, in plantar fasciitis, we have to treat not only the site of pain but also the other structures that are contributing to the issue.
These three are the least invasive and first line of treatment. After these have been done and if they have been unsuccessful then the injections and ultrasound may be an option. If those don’t get the job done then surgery may be the last option. This procedure usually involves dividing some of the connective tissue in the bottom of the foot that is causing the issue.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) might be used to help with the pain and Cortisone injections may also be used to help with anti-inflammatory and collagen-dissolving effects.
How Long Does PF Last?
Plantar Fasciitis can last anywhere from 6 months to 18 months before it’s all said and done.
I hope that this article has helped you get a basic understanding of Plantar Fasciitis. It’s not an exhaustive explanation but it should get you started. I didn’t want it to be too long and overwhelming to read. Remember to treat your calf muscles as well as your foot! The cause of pain is not always at the site where the pain actually is.
With all of that being said, find a massage therapist who is comfortable assessing and treating plantar fasciitis. Do some more research, talk to your massage therapist, physical therapist and/or primary care physician.
Also see the following references for more information:
About the author: Ethan Pariseau is a registered nurse with a bachelor of science in nursing and is licensed by the state medical board of Ohio to practice massage therapy.
