The Proper Application of a Tennis Elbow Strap

Tennis Elbow Straps, or Counterforce Straps, can be very helpful in reducing the pain of lateral epicondylitis (tennis elbow) or medial epicondylitis (golfer’s elbow).
However, very rarely are people instructed in the proper technique to apply these straps.

The purpose of the counterforce strap is to reduce the tension on the tendinous origin of the muscles that start at the outside of the elbow for tennis elbow or the inside of the elbow for golfer’s elbow. These are the muscles that bend and straighten the wrist and the fingers. The strap helps distribute the tension that the tendon normally receives over a wider area. This allows the tendon to rest and become less inflamed.

To apply the strap for tennis elbow:

  • Rest your hand and forearm flat on the table, palm down.
  • Gently close the fingers.
  • Pull the wrist and fingers back off the table.
  • Do you see the muscle bulge out a bit in the forearm close to the elbow? (You may need to place your other palm over the muscles so you can feel the muscle contract.)
  • This muscle bulge is where the strap should be placed (normally about 2 finger widths from the elbow crease).
  • If the strap has a cushion or pillow, that cushion should be placed right over the muscle bulge.
  • Tighten the strap with just enough tension to feel the strap while the muscle is contracted.
  • When the muscle is not contracted, you should not feel any tension from the strap.

To apply the strap for golfer’s elbow:

  • Rest your hand and forearm flat on the table, palm up.
  • Gently close the fingers.
  • Pull the wrist forward off the table
  • Do you see the muscle bulge out a bit in the forearm close to the elbow? (You may need to place your other palm over the muscles so you can feel the muscle contract.)
  • This muscle bulge is where the strap should be placed (normally about 2 finger widths from the elbow crease).
  • If the strap has a cushion or pillow, that cushion should be placed right over the muscle bulge.
  • Tighten the strap with just enough tension to feel the strap while the muscle is contracted.
  • When the muscle is not contracted, you should not feel any tension from the strap.

Dos & Don’ts:

  • Do wear the strap only during activity.
  • Don’t wear the strap at night while sleeping.
  • Wearing the strap all the time places undue stress on tissues that are not used to the stress and can create new problems.
  • Do not wear the strap if you have numbness or tingling.
  • Do not wear the strap if you have nerve compressions such as carpal tunnel, cubital tunnel, or radial tunnel syndrome.  The tension can make these conditions worse.
  • If the strap seems to increase your pain level, do not wear it.
Advertisements

The Elbow & Repetitive Strain Injuries

Unlike the shoulder, the elbow joint has a tremendous amount of bony stability. The lower end of the long bone of the upper arm (the humerus) meets the two long forearm bones (the radius and the ulna) at the elbow. The majority of the muscles that bend the wrist and the fingers attach to the inner portion of the elbow. The majority of the muscles that straighten the wrist and the fingers attach to the outer portion of the elbow.

The neutral position of the elbow, with the arm relaxed at the side of the body, is with the thumb facing forward and the palm facing toward the body. With the elbow bent, this neutral position is the “handshake” position.
Factors that Contribute to Elbow Pain

  • Repetitive wrist movement, especially with the forearm fully rotated palm-up or palm-down, repetitive rotation of the forearm, and repetitive elbow bending and straightening can all contribute to inflammation of the tendons as they insert into the elbow.
  • Bony and ligamentous grooves and tunnels near the elbow through which the three main nerves that provide power and sensation to the hand pass. The shearing motion or compression of the tendon and nerves as they pass through these tight areas can contribute to repetitive strain injuries.
  • The degree of the elbow carrying angle (the angle of deviation of the forearm bones in relationship to the upper arm bone when the arm is held at the side with the palm facing forward).
  • Maneuvering the arms around a larger upper body when placing the hands on the keyboard is also a factor.

Cubital Tunnel Syndrome

When you hit your “funny bone” you are actually hitting the ulnar nerve as it passes through a bony groove at the inside of the elbow. The nerve is particularly vulnerable as it passes through this superficial groove. Bending the elbow stretches the nerve through this groove tautly. Holding the elbow bent for prolonged periods, such as when holding a phone to the ear or sleeping with the elbows bent, can cause this nerve to become irritated. If you experience aching along the small finger (ulnar) aspect of the forearm and hand, or if you have tingling or numbness in the ring and small finger, it is especially important to avoid positioning the elbow in a bent position, either with activity or at night. Avoid repetitive elbow bending and straightening. Contact a medical professional for treatment.
Tennis Elbow (Lateral Epicondylitis)

Tennis elbow initially begins as an inflammation where the muscles attach to the outside edge of the elbow. Activities that contribute to this inflammation include repetitively pulling back (extending) the wrist and the fingers; repetitively rotating the forearm palm-up and palm-down, especially when holding an object in the hand; and lifting objects with the forearm rotated in the palm-down (pronated) position. Carrying a suitcase, briefcase or laptop backpack are activities that can cause tennis elbow.
Golfer’s Elbow (Medial Epicondylitis)

Golfer’s elbow is similar to tennis elbow, except that it begins as an inflammation where the muscles attach to the inside edge of the elbow. Activities that contribute to this inflammation include repetitively bending the wrist and closing the fingers; performing fine motor activities with the wrist bent, and repetitively rotating the forearm.

The farther away from the body that you perform activity, the more tension that is placed on the tendons where they insert into the elbow.

RSI and Prevention

Positioning

      • Avoid sleeping with the elbow bent more than 90 degrees to reduce the amount of stress on the nerve.
      • Don’t sleep with the hands placed behind the head.
      • Avoid sleeping on your stomach.
      • Use soft pillows under the arms.
      • Wear a sleeve with a pad that protects the elbow or wrap an ace bandage around a small, soft pad.

Computer Use

    • Position the keyboard so that the elbows are open more than 90 degrees.
    • Pad any sharply angled surfaces that the arms rest upon. Or place a folded towel under the arms as a cushion.
    • Don’t lean on the elbows.
    • Avoid repetitive elbow bending and straightening, excessive wrist movement or repetitive forearm rotation.
    • Use a split keyboard, especially if you find that you need to deviate the wrists out of the
      neutral position (middle finger in line with the forearm bones) when placing the fingers on the keyboard. This is particularly important if you have a large elbow carrying angle or a larger upper body.
    • Move the mouse from the shoulder, not the wrist.
    • Take frequent micro-breaks.
    • Stretch often.

A Quick Comparison of Carpal, Cubital and Radial Tunnel Nerve Compressions

Three peripheral nerves provide power and sensation to the hand and arm.  The following is a quick comparison of the most common sources of pain caused by compression syndromes of these nerves.

nerve paths

Carpal Tunnel Syndrome

  • Nerve Affected:  Median
  • Location of Compression:   Wrist
  • Numbness and/or Tingling:  Usually in the Thumb, Index, Middle & Half of Ring Fingers
  • Pain:
    • Usually in the Thumb, Index & Middle Fingers
    • A band of pain around the wrist
    • Pain in the muscles at the base of the thumb
    • Pain radiates up the forearm
  • Likely Cause (activity related):
    • Frequent gripping/squeezing/holding of tools
    • Gripping or pinching tools or objects for a period of time
    • Finger movement with the wrist held at an awkward angle
  • Prevention:
    • Avoid sustained or repetitive grip and pinch
    • Maintain the wrist in a neutral (straight) position with activity
    • Avoid leaning on or putting pressure against the front of the wrist of the base of the hand
  • Splinting:   A wrist brace that  holds the wrist in the neutral (straight) position at night

Cubital Tunnel Syndrome

  • Nerve Affected:  Ulnar
  • Location of Compression:   Elbow
  • Numbness and/or Tingling:  Usually in the Ring & Small Fingers
  • Pain:
    • Usually in the Ring & Small Fingers
    • Pain in the hand muscles on the small finger side of the hand
    • Pain radiates up the forearm and into the elbow along the small finger side
  • Likely Cause:
    • Leaning on the elbow or pressure against the forearm along the small finger border
    • Frequently bending and straightening the elbow, such as when pulling a lever
    • Holding the elbow bent for long periods of time, such as when sleeping or holding a phone to the ear
    • Forceful elbow extension (straightening) activities, such as rowing, gym activity, push-ups
  • Prevention:
    • Avoid leaning on the elbow or putting pressure on the forearm muscles
    • Avoid holding the elbow bent more than 90 degrees for any length of time
    • Avoid repetitively bending and straightening the elbow
    • Avoid repetitive or forceful elbow extension activities
  • Splinting:   A soft pad or elbow support that holds the elbow in a mostly straight position at night

Radial Tunnel Syndrome

  • Nerve Affected:  Radial
  • Location of Compression:   Muscles on the back of the forearm near the elbow
  • Numbness and/or Tingling:  Uncommon
  • Pain:
    • Usually in the elbow and forearm muscles
    • Pain may radiate down the arm into the wrist and the back of the hand
    • Pain may radiate up the arm towards the shoulder
  • Likely Cause:
    • Computer mouse activity, swiveling the wrist and forceful mouse “clicking”
    • Holding the fingers tensely extended over the computer keyboard
    • Forcefully bending the wrist forward and back
    • Repetitive twisting movements, such as when using a screwdriver
    • Carrying or lifting heavy objects, particularly with the forearm pronated (palm rotated down)
  • Prevention:
    • Maintain the wrist in a neutral position while using the computer mouse
    • Don’t hit the keys or click the mouse forcefully and keep the fingers relaxed over the keys and mouse
    • Avoid repetitive and forceful wrist movements or twisting movements
    • Avoid heavy lifting, especially with the palm facing down, such as carrying a suitcase or heavy briefcase
  • Splinting:   A wrist splint that holds the wrist neutral may be helpful when performing stressful activities