Lateral epicondylitis, commonly known as tennis elbow, is a painful condition affecting the outside of the elbow. This injury involves the common extensor tendon, where forearm muscles attach to the bony prominence on the outer elbow, called the lateral epicondyle. The primary muscle affected is the extensor carpi radialis brevis (ECRB), which stabilizes and extends the wrist. Pain arises from repeated, forceful motions like gripping and wrist extension, causing microtears and degeneration of the tendon tissue. Despite its name, this overuse injury affects many people who do not play racquet sports, including painters, plumbers, and those who frequently use hand tools.
Understanding the Difference Between Braces
A wrist brace restricts movement at the wrist joint, mechanically resting the forearm muscles attached to the elbow. While immobilizing the wrist reduces overall strain on the extensor muscles, it does not apply targeted compression to the muscle bulk. This targeted compression is the mechanism needed to address the pain at the elbow.
The device generally recommended is the elbow counterforce strap, often called a tennis elbow strap. This strap is worn around the forearm, not the wrist, and applies localized pressure to the muscle belly just below the elbow joint. The purpose of this counterforce is to change the angle of pull and absorb the tension created by contracting forearm muscles.
By compressing the muscle bulk, the strap effectively reduces the mechanical load transmitted to the tendon insertion point, which is the source of the pain. This redistribution of force provides immediate relief during activity and allows the irritated tendon to rest. The counterforce strap addresses the problem closer to the injury site, unlike a wrist brace which only limits motion.
How to Properly Use an Elbow Counterforce Strap
For the counterforce strap to be effective, correct placement and tightness are crucial. The strap should be positioned around the thickest part of the forearm extensor muscles, typically two finger-widths below the bend of the elbow. Crucially, the pressure pad must rest on the muscle tissue and not directly on the bony lateral epicondyle.
The strap should feel secure and snug, but never so tight that it restricts blood flow or causes numbness or tingling in the fingers. Excessive tightness risks compressing the radial nerve. Some therapists recommend tightening the strap while the wrist is actively extended to achieve optimal compression when the hand is relaxed.
The counterforce strap is intended for use primarily during activities that aggravate symptoms, such as lifting, gripping, or sports participation. It should not be worn continuously throughout the day or while sleeping. Using the strap only during specific tasks reduces strain when needed, allowing the arm to move freely during periods of rest.
Complementary Treatments for Healing
While bracing manages pain effectively, it is a temporary measure and not a cure for underlying tendon changes. Long-term recovery relies on activity modification and a structured rehabilitation program. The initial step involves relative rest, meaning reducing or altering the specific repetitive movements that caused the irritation.
Applying ice to the affected area for 15 to 20 minutes helps reduce localized pain and tenderness. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may provide short-term pain relief. However, NSAIDs do not alter the long-term course of the condition, which is often degenerative (tendinosis) rather than purely inflammatory.
The most effective strategy for lasting recovery involves specific exercises targeting the wrist extensor muscles. Gentle stretching and eccentric strengthening are commonly prescribed. Eccentric strengthening involves lengthening the muscle while it is contracting, which helps rebuild the strength and tolerance of the damaged tendon structure. If symptoms persist or worsen despite conservative management, seek a professional evaluation to confirm the diagnosis and establish a comprehensive recovery plan.