Tennis elbow, formally known as lateral epicondylitis, is a common overuse injury affecting the tendons that join the forearm muscles on the outside of the elbow. Because the injury is caused by repetitive strain, effective rest is the most important step in allowing the damaged fibers to heal and repair themselves. Understanding how to properly rest requires identifying and eliminating the specific actions that perpetuate the cycle of injury.
Identifying and Halting Aggravating Activities
Rest for tennis elbow means more than simply stopping sports or high-intensity exercise; it requires a practical cessation of nearly all movements that put tension on the injured tendon. The forearm muscles responsible for extending the wrist and fingers are constantly engaged in everyday activities, and it is these seemingly minor actions that often prevent healing. Repetitive gripping, twisting, and lifting motions are the primary culprits in maintaining the strain on the lateral epicondyle.
Activities like firmly shaking hands, repeatedly carrying grocery bags by the handles, or using heavy tools such as hammers or wrenches can continuously re-injure the tendon. Even light office tasks, such as improper mouse and keyboard use or prolonged typing with the wrist extended, contribute to chronic strain. Furthermore, twisting actions, like wringing out a wet towel or opening a jar, must be avoided completely during the acute recovery phase.
Tendons require complete relief from tension to transition from an inflammatory state to a reparative one. The goal during this initial phase is to protect the injured arm from any action that causes pain, requiring modification of nearly all daily routines. Protecting the tendon involves avoiding actions that load the wrist extensor muscles, often requiring a conscious effort to change how objects are held or lifted.
Utilizing Immediate Supportive Devices
To aid the cessation of strain and support the tendon during the rest phase, several supportive devices can be employed to manage pain and stabilize the area. One of the most common tools is the counterforce brace, also known as a tennis elbow strap, which is designed to redirect muscle forces. This strap is typically placed two to three centimeters below the painful bony prominence on the outside of the elbow.
The mechanism of the counterforce brace involves compressing the forearm muscles, which changes the angle of pull and absorbs some of the tension before it reaches the painful insertion point at the elbow. By applying this focused pressure, the strap lessens the strain on the damaged tendon during necessary movements, facilitating a less painful period of rest. Proper placement is important; if it is too close to the elbow joint, it may not effectively redirect the forces.
In cases where excessive wrist extension is a significant contributor to the pain, a simple wrist splint may be recommended for temporary use. This device holds the wrist in a neutral or slightly flexed position, mechanically limiting the amount of strain placed on the common extensor tendon origin. Limiting wrist movement ensures the tendon remains shortened, which reduces the mechanical load placed upon the injured tissue.
Cold therapy, or the application of ice packs, is another helpful technique used during the acute resting period to manage inflammation and pain. Applying cold for 10 to 15 minutes at a time, several times a day, can help decrease localized pain signaling and reduce swelling. The cold application should be focused directly on the area of tenderness on the outside of the elbow. Utilizing these devices helps create an optimal environment for the initial stages of tendon repair.
Transitioning Back: Modifying Movement and Preventing Recurrence
Once the acute pain has significantly subsided following the dedicated rest period, the focus shifts toward a gradual reintroduction of activity and long-term prevention. Attempting to return to full activity too quickly often leads to immediate recurrence because the repaired tendon tissue is not yet strong enough to handle previous loads. A phased return allows the healing tendon to adapt progressively to increasing mechanical stresses.
Ergonomic adjustments are an important step in preventing the re-injury of the newly healed tendon fibers. For those who work at a desk, adjusting chair height so the elbows are bent at a 90-degree angle and the wrists remain straight prevents undue strain on the forearm extensors. Using specialized tools, such as a vertical mouse or keyboard wrist supports, can significantly reduce the awkward postures that contributed to the initial injury.
Technique modification is also particularly important for activities involving lifting or grasping objects. When lifting heavier items, patients should consciously try to keep the palm facing upward (supination) rather than facing down (pronation). This simple change engages the biceps and other muscles, reducing the reliance on the overworked wrist extensor muscles.
Finally, the long-term prevention phase includes the gradual introduction of strengthening exercises, but only after the pain is completely resolved. This strengthening should focus on progressive resistance and eccentric loading, which involves lengthening the muscle while it is under tension. Eccentric exercises, such as slowly lowering a weight after a wrist extension, promote the structural remodeling and strengthening of the tendon matrix, preparing it for a full return to activity.