Of the PT Persuasion: For Writers - Tennis Elbow
Have you ever wished for a resource that helped writers cut back on hours and hours of researching how to accurately portray injuries and medical conditions? Look no further. In this blog series, I’ll be discussing just that. What makes me qualified to do so? Well, I’m a Physical Therapist! Or, rather, I’m a writer…Of the PT Persuasion.
Here and there throughout our writing community, I've heard several writers mention they're dealing with forearm and elbow pain known as Tennis Elbow. I've even had a few writers approach me for advice on managing it. This can be a pesky one, but if you're diligent with caring for it, you can get better!
In the medical community, "Tennis Elbow" is referred to as Lateral Epicondylitis, which means "inflammation of the lateral epicondyle"...which means "irritation of the tendons that attach on the outside of your elbow." Kind of just easier to say "Tennis Elbow," isn't it? Let's refer to it as such from here on out. Even if you don't play tennis , people who do a lot of activity with their wrists, hands, and fingers can develop Tennis Elbow (as some of you already know if you're dealing with this condition). I've seen it in chefs, rock climbers, knitters, people who work in packaging, and—of course—typists!
So how do tennis players, chefs, and writers all end up with the same diagnosis? Tennis Elbow is a condition caused by overuse. It doesn't have to be intense, rapid, or ballistic movements; it's usually repetitive, low-level activities involving the wrist and hand. Most of the muscles that move the wrist, hand, and fingers actually come from the forearm. Lots of them attach around the elbow, stretch across your forearm, and end in the hand, creating movement across the wrist and/or fingers. So when we ask a lot of repeated movement from our hands, it's asking a lot of our forearm. And which muscles are the culprits who attach of the outside of the elbow (the lateral epicondyle) and create pain? Well, that would be the muscles that extend your wrist and fingers. (Extension: if your hands are facing palm-down in front of you, extension is raising your hand so your palms face forward.) If you're a chef or a knitter or a typist, you're constantly extending and releasing your wrist and fingers. Most typists also rest their hands at the keyboard in slight extension. Thus, the extensor muscles are constantly pulling at a low level.
To make it more complicated, there are a few muscles that join into one tendon at the lateral epicondyle, so when things get inflamed, they get inflamed. But that's kind of a vague term, isn't it? What do I mean by inflammation? In this case, repeated, low-level load creates micro-tears where the muscle turns into tendon. Basically, the tendon isn't strong enough to withstand the repeated loads the muscles are asking of it; this is the definition of tendonitis, and lateral epicondylitis is a specific type of tendonitis. Think of it as a tow hitch where the hitch (i.e. the tendon) is plastic and the trailer (i.e. the bone) is a ton of bricks being hauled around by a truck (i.e. the muscle). Even if you're hauling that load at 5mph, over the course of a mile—or probably sooner, really—the plastic hitch will crack and eventually fail. The cracking is tendonitis, or lateral epicondylitis in this scenario. If the hitch breaks completely, that’s akin to a ruptured tendon.
That really doesn't sound too fun, does it? Here's what we do about it...
The root of the problem is that the tendon isn't strong enough to bear the load the muscles ask of it. The tendon, therefore, needs to be strengthened so that it can tolerate those loads. How do you even strengthen a tendon, though? Tendons are kind of a weird situation; they need load in order to heal. The body adapts to the amount of stress it's exposed to. That means it will only adapt to the highest amount of stress it's exposed to. If you're used to typing 2500 words per work day, for example, then a few days of typing 3500 words is over-stressing the system. So the muscle and tendon need to be trained at a higher level than what they're exposed to in order to be safe. That means: prepare it for 5000 words per day so 2500-3500 words is no problem.
I'm not saying that literally, though. Don't go start typing 5000 words just to make your Tennis Elbow go away. That won't work if it's already inflamed. No, the stress we have to expose to an injured muscle and tendon needs to be more controlled and more precise. Isometric contractions are the gentlest form of strengthening. In this type of contraction, the muscle is working but not moving. For example, if you're holding a tray, your muscles are working to keep the tray up, but they're not moving the tray—it's a stationary, or isometric, contraction.
Let's take a quick moment to discuss the three types of muscle contractions and how they affect strengthening:
isometric contraction: the muscle fibers are firing to maintain a position, and the joint they're affecting doesn't move. This is the easiest and safest type of contraction.
concentric contraction: the muscle fibers are shortening as the muscle is working. For example, if you're lifting a bag from the ground, your biceps muscle shortens so the elbow bends and lifts the bag. This is the most common type of contraction used in strengthening.
eccentric contraction: the muscle fibers are lengthening as the muscle is working. For example, if you're putting that same bag back down, your biceps muscle is lengthening to allow your elbow to extend. This requires the most work, puts the most load on a muscle, and puts the muscle in the most compromised position (it's working while it's stretching).
For tendinopathies, isometric (the gentlest form of strengthening) comes first, but research also shows that, once isometric is tolerated, eccentrics produce the most load on the tendon, and therefore, the greatest healing. For Tennis Elbow, that means "eccentric wrist extensor exercises." No, we don't have an accessible name for them but your search engine will be able to populate some visuals. Stay tuned on my Instagram (@bychelseaelizabeth) for exercise reels!
Of course, manual treatments like massage and deep tissue work also help tendinopathies greatly, so try massaging out those tight and sore muscles. You can also roll your forearm around on a tennis ball!
AS ALWAYS: if you have chronic Tennis Elbow, you should seek in-person, medical treatment from a physical therapist or an occupational therapist. This post is not designed to be diagnostic and prescriptive and should not be used as such.
One of the best parting tips I can give you is: prevention is better than rehabilitation. Take breaks, stretch, set up your workspace properly so you don't get Tennis Elbow or other writing-related conditions.
If you found this helpful, or if you have a writing-related ache of your own, stay tuned for more Of the PT Persuasion just-for-writers content.
Thank you for reading! I hope you enjoyed this installment to Of the PT Persuasion.
Disclaimer:
If you’re seeking medical advice for yourself or someone you know, you should speak to a medical professional. This blog is not intended for diagnosing or treating real-life medical conditions, only fictional ones.
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