Tennis elbow is a common condition characterized by pain where the forearm muscles attach to the outside of the elbow. This injury involves the tendons responsible for extending the wrist and fingers, which become strained from repetitive use. Applying targeted pressure is a common strategy to manage discomfort and promote recovery. Understanding precisely where and how to apply this pressure is essential for effective pain management.
Identifying the Source of Pain
The pain of tennis elbow originates at the lateral epicondyle, the bony bump located on the outside of your elbow. The primary structure affected is the tendon of the wrist extensor muscles, which attaches here. This tendon is prone to micro-tears and degeneration from overuse, such as repetitive gripping or wrist extension.
While the bony attachment is the site of tendon injury, the muscle belly in the forearm often becomes tight, holding excessive tension on the injured tendon. Effective pressure application must focus on releasing this tension in the forearm muscles, often called the extensor wad, rather than pressing directly on the inflamed bone. Pain radiating down the forearm is a sign that the muscle belly contains tight spots or knots that require relief.
Manual Pressure and Trigger Point Relief
Manual pressure targets specific, hypersensitive spots known as trigger points within the extensor muscles of the forearm. To locate these points, gently palpate the muscles starting a few inches below the elbow, moving toward the wrist. A trigger point will feel like a taut band or a small, tender lump that is noticeably painful when pressed.
Once a tender spot is identified, sustained deep pressure, a technique often called ischemic compression, can be applied using a thumb, finger, or a small ball. Apply gradual pressure until a discomfort level is reached that is tolerable but not sharp or unbearable. Maintain this sustained pressure for 30 to 60 seconds, or until the tenderness begins to lessen or “melt” away.
Another effective technique is cross-fiber friction massage, which involves rubbing firmly across the muscle fibers rather than along them. This technique is typically applied closer to the elbow, over the common extensor tendon, and is intended to break down scar tissue and promote healing. Perform this friction with moderate pressure for up to five minutes, being mindful to stop if the area becomes acutely painful.
Pressure Application Through Braces and Straps
External support devices, specifically counterforce braces or straps, apply sustained, compressive pressure to the forearm muscles to redistribute the load. The primary function of this strap is to create a new, artificial anchor point for the forearm extensor muscles. This effectively shortens the functional length of the muscle-tendon unit, which lessens the pulling force exerted on the injured tendon attachment at the lateral epicondyle.
Proper placement is crucial for the strap’s effectiveness and safety. The device should be positioned over the largest part of the forearm muscle belly, typically about one to two inches below the elbow joint. Crucially, the strap should never be placed directly on the bony prominence of the elbow, as this will only increase irritation. When fastening, the strap should be snug enough to provide firm compression during activity but must not be so tight that it restricts circulation or causes numbness.
Duration, Frequency, and Safety Guidelines
The duration and frequency of pressure application depend on the method used. Manual trigger point pressure should be held for the time it takes for the spot to yield, typically 30 to 60 seconds per point, and the entire self-massage session can be repeated once or twice a day. Counterforce braces are generally worn only during activities that typically aggravate the elbow, such as during work or sports. As symptoms improve, brace usage can be reduced, but it should not be worn constantly unless advised by a healthcare professional.
It is important to heed specific safety warnings when applying any form of pressure. If manual pressure causes a sharp, shooting pain, or if the area feels worse immediately following a massage, the technique or pressure is likely too aggressive. Signs such as tingling, numbness in the hand, or discoloration indicate that a brace is too tight and may be compressing the radial nerve, requiring immediate loosening. If pain persists or worsens after a few weeks of conservative management, or if you experience severe weakness, consulting a physical therapist or physician is necessary for a comprehensive treatment plan.