Lateral Epicondylitis, commonly known as Tennis Elbow, is a painful condition resulting from the overuse of the forearm muscles and their tendons. This involves degeneration of the tendons connecting the forearm extensor muscles to the bony prominence on the outside of the elbow. While daytime bracing is a common strategy to reduce strain during activity, the question of continuing support throughout the night remains a frequent concern. The appropriateness of nighttime bracing depends on the specific type of support used and whether the pain interferes with rest. The goal is to facilitate healing by preventing unconscious movements that can aggravate the injured tissue.
Why Stabilize the Elbow During Sleep?
The primary reason to consider stabilization during rest is to counteract unconscious movements that can aggravate the injured tendons. While sleeping, people often place their arm in positions that put tension on the damaged extensor tendons. Positions like extreme elbow flexion or sleeping with the arm tucked overhead can stretch or compress the tendons attached to the lateral epicondyle. This nocturnal strain often manifests as significant elbow stiffness or sharp pain upon waking. Stabilizing the elbow at night maintains a neutral, relaxed position for the forearm and wrist. This passive rest allows the tendon to remain slack, reducing the mechanical load and promoting tissue repair.
Differentiating Brace Types for Night Use
The term “tennis elbow brace” refers to different devices, and only specific types are suitable for use during sleep. The most common daytime support is the counterforce strap, a band worn around the forearm just below the elbow. This strap applies focused pressure to the muscle belly, dispersing force away from the tendon’s attachment point. Since it redirects force during muscle contraction, the counterforce strap offers little benefit when muscles are inactive at night. Furthermore, wearing a tight, compressive strap while lying still can restrict circulation, which is counterproductive to healing.
Supports recommended for nighttime use are usually night splints or wrist braces, sometimes called cock-up splints. These devices restrict the range of motion of the wrist and sometimes the elbow joint itself. The wrist splint prevents excessive extension or flexion, limiting the pull on the extensor tendons. Some specialized night braces keep the elbow joint in a fixed, slightly bent position, preventing the arm from curling into an aggressive flexed posture.
Potential Risks of Overnight Bracing
Wearing any restrictive device for many hours presents specific physiological risks that must be considered. The most immediate concern is the compromise of circulation if the brace is applied too tightly. Reduced blood flow can slow the healing process and may cause the extremities to feel cold or tingly.
Another significant risk is the potential for nerve compression, particularly of the ulnar or radial nerves. Excessive pressure on the forearm can irritate the radial nerve, potentially causing numbness and weakness in the hand. Incorrect placement over the back of the elbow could compress the ulnar nerve, leading to tingling in the ring and little fingers. Prolonged use can also cause localized skin irritation or pressure sores.
Making the Decision: When Is It Recommended?
The decision to wear a brace overnight should be based on the severity of symptoms and the extent to which they disrupt sleep. Night bracing is generally recommended only if elbow pain consistently wakes a person up or if there is significant pain and stiffness immediately upon waking. If daytime treatments, such as activity modification, have not provided sufficient relief, a stabilization splint may be considered as an adjunct treatment.
It is important to consult a physical therapist or physician before initiating night bracing. A medical professional can accurately assess the condition and ensure the correct type of stabilizing splint is selected. Non-brace alternatives can also be effective, such as changing sleeping posture. Using pillows to prop the arm or avoiding positions where the arm is bent tightly helps maintain a restful, neutral position for the healing tendon.