Lateral epicondylitis, commonly known as tennis elbow, is a frequent cause of arm pain that often interferes with daily activities like lifting or gripping. A counterforce strap or brace is a common non-operative treatment recommended to manage this discomfort. This strap works by employing biomechanical principles to alter the forces acting on the injured tissues, providing immediate relief for many users. Understanding the mechanics of the strap is key to using it effectively.
Understanding Tennis Elbow
Tennis elbow affects the tendons connecting the forearm muscles to the outside of the elbow. The pain originates from the common extensor tendon, primarily involving the extensor carpi radialis brevis (ECRB) muscle, which attaches to the bony prominence called the lateral epicondyle. This condition is classified as a tendinosis, representing a degenerative process rather than a purely inflammatory one.
Repeated stress and overuse of the wrist extensor muscles cause microscopic tears and disorganization of the collagen fibers within the tendon. This degeneration occurs because the tendon is subjected to continuous load, often from repetitive gripping or wrist extension movements. The result is chronic pain and tenderness focused on a small area below the lateral epicondyle.
The Counterforce Mechanism
The counterforce strap works by introducing a new point of mechanical stress absorption within the forearm. When secured correctly, the strap applies focused, compressive pressure across the largest part of the extensor muscle belly. This strategic compression acts like a temporary, artificial origin point for the muscle, effectively shortening the functional length of the extensor muscle-tendon unit.
By artificially shortening the muscle, the strap redirects the tension generated when the muscle contracts. A significant portion of that tension is absorbed at the strap’s compression site, rather than being transmitted to the damaged attachment point on the lateral epicondyle. The strap creates a new fulcrum, reducing the strain placed directly on the injured tendon fibers during activities like lifting or grasping objects.
Studies estimate that this counterforce mechanism can reduce the tensile strain on the common extensor origin by approximately 13 to 15 percent. This measurable reduction in load explains why the strap often provides immediate pain relief during activities that normally cause discomfort. By lessening the stress on the damaged tendon, the strap can also improve pain-free grip strength. The goal is to offload the degenerative tissue, allowing it to recover.
Correct Placement for Effectiveness
The functional success of a counterforce strap depends entirely on its precise positioning on the forearm. Placing the strap directly over the area of maximal pain on the elbow’s outer bone is a common mistake and negates the intended counterforce effect. The strap must be positioned to compress the muscle belly, not the bone or the joint itself.
For proper application, the strap should be fastened on the forearm approximately one to two inches below the crease of the elbow. A good rule of thumb is to place it about two finger widths down from the bony prominence of the lateral epicondyle. The compressive pad should be centered over the extensor muscle mass on the back and outer side of the forearm.
The strap must be secured snugly enough to provide compression, but not so tight that it causes numbness, tingling, or restricts circulation. The correct tension provides firm pressure that is noticeable but still comfortable, allowing a full range of motion in the hand and wrist. If the pain is not significantly reduced during a gripping motion, the placement or tension should be adjusted until the desired relief is achieved.