Tennis elbow (lateral epicondylitis) results from the overuse of forearm muscles. This injury involves the tendons connecting the forearm muscles to the bony prominence on the outside of the elbow joint. Repetitive strain, often from gripping or lifting, causes microscopic tears in the tendon fibers, particularly the extensor carpi radialis brevis (ECRB) tendon. This damage leads to the characteristic pain and tenderness felt on the outer elbow. The timing of heat or cold application is paramount to effective relief.
Cold Therapy for Initial Pain and Swelling
Cold therapy (cryotherapy) is the preferred treatment when tennis elbow pain is new, sharp, or accompanied by visible swelling. It should be applied immediately following an injury or a severe flare-up, typically within the first 48 to 72 hours. Cold works by causing vasoconstriction, the narrowing of local blood vessels. This restricts blood flow to the injured site, helping to minimize swelling and inflammation.
The temperature reduction also provides an analgesic, or numbing, effect by slowing down pain signals transmitted to the brain. Cooling the tissue helps to decrease local metabolic activity. This reduction in cellular activity helps control the inflammatory response, preventing it from becoming excessive. Cold application reduces initial symptoms of inflammation, creating a better environment for natural healing.
Applying Heat for Chronic Stiffness
Heat therapy is beneficial for managing pain once the initial acute phase of inflammation and swelling has subsided. The primary mechanism of heat is vasodilation, the widening of blood vessels. This action increases blood flow and circulation to the affected tendons and muscles.
The improved blood flow delivers oxygen and nutrients that aid in tissue repair and recovery. Applying heat causes muscles to relax and increases the elasticity of connective tissues, which helps to alleviate stiffness. Heat is a favored choice for chronic, dull aches and for increasing flexibility before physical activity. Using a heat pack before stretching or light exercise can help loosen the area and improve range of motion. Heat should never be used on an area that is visibly hot, red, or swollen, as it can intensify the inflammatory response.
Safe Techniques for Temperature Treatment
Both heat and cold therapies should be applied for a maximum duration of 15 to 20 minutes per session. Overexposure can cause tissue damage, such as frostbite or burns. Treatments can be repeated several times daily, ensuring a break of at least one to two hours between applications.
A physical barrier, such as a thin towel or cloth, must be used between the skin and the hot or cold source. This protects the skin from direct contact with extreme temperatures. Avoid placing heat packs over areas where topical pain-relief creams have been applied, as this combination can lead to severe skin irritation or burns. Patients with poor circulation or numbness should consult a physician before using temperature therapies.