Do you need an elbow brace or strap to help you get through your regular pickleball games? What if I told you there’s a BETTER way to manage your elbow pain AND prevent it from coming back? If you’re willing to devote ten minutes per day to a few exercises and some self-massage techniques, there’s a good chance you can ditch that elbow strap and get back to the court WITHOUT pain and with improved motion in your arm to have you playing at the top of your game?
If you’re having pain on the outside of your elbow, there’s a good chance you could have lateral epicondylitis, or more commonly known as “tennis elbow.” This condition can also occupational, such as with people who turn a wrench for a living or perform any task involving repetitive twisting of the forearm. I even have seen a pastor with this condition, which he attributed to doing some renovations around his church (talk about hands on!) He was actually a pretty decent golfer too (though not playing frequently at the time) which may have irritated the area previously.
Here are four simple do-it-yourself interventions plus one simple treatment that work quite reliably when done consistently. If these approaches don’t resolve your pain AND help you return to the pickleball court, the next step would be to seek help from a rehab professional who has other techniques available and can also look for potential causes such as in shoulder function.
Mobilization with movement – Whether performed on yourself or delivered by a professional, this is the “go-to” technique for persistent tennis elbow. Both options are shown below. Note that you can vary the angle of arm bend to provide different stimuli to the area, as patients can vary in which angle works best for them. Typically the treatment is performed by applying lateral pressure and then having the patient grip and release, though you’ll find different variations on the same theme commonly practiced. The key point here is that PAIN SHOULD REDUCE with this treatment. If pain is getting worse, this likely isn’t the right treatment for you. Which is fine, because there are other options….
One of my all-time favorite movie scenes is from Karate Kid, when after spending countless hours doing “chores” for Mr. Miyagi, Daniel complains one night that he’s been Mr. Miyagi’s “slave” and hasn’t done any karate training to prepare for the All-Valley Karate Tournament. What follows is a profound reminder that EVERYTHING he’s been doing is karate training. (and gotta love Mr. Miyagi’s on-the-spot shoulder joint manipulation haha!)
So what’s the point of sharing this clip, besides an excuse for me to watch some Karate Kid? Everything we do in training has a reason. Quite often that reason connects to important aspects of our life. In athletics, each exercise helps condition the body in some way to improve sport performance. But for daily life, exercise selection can also have far reaching benefits.
Hinge patterns are important for many reasons, but the ability to pick up objects from the ground is a practical one. Many students and patients have regained and even improved their abilities in this area simply by learning proper mechanics. We can take the hinge and turn it into a powerful conditioning exercise with kettlebell swings, or we can simply use the hinge as a teaching and rehabilitation tool. Remember, it’s not just about the exercise, it’s about what the exercise EMPOWERS you to do.
The psychological side of injury is something rarely discussed, and when it is, the discussion occurs in hushed tones or exists on a very superficial level. But it remains, equally if not more important than the physical side. The mind is what gets us to show up every day and put in the work to make the rehab process successful. The mind is what processes the information presented to us and makes a decision on how to respond. Even before we start, we also know that EXPECTATIONS are one of the key predictors of rehab success (if you think you’ll get better, then chances are better that you will!)
First, it is important to understand this topic has immense breadth and depth. This isn’t our time to play amateur psychologist (stay in your lane!) but it is essential to appreciate that a rehab approach is incomplete without considering the mind. In the field we often find ourselves uncomfortable with metaphysical concepts we perceive as being pseudoscience “woo-hoo,” sometimes for good reason, but understanding the mind-body connection is also very pragmatic.
A knee injury is not just about “ouch my knee hurts.” It might keep you out of work, and potentially without any immediate source of income. It also could mean you have to stop running or walking, which may detach you from your social group. An injury could present a loss of identity if you’re an athlete who then feels invisible when relegated to the sidelines. I remember when Tom Brady suffered a serious injury during a game several years ago, that one of the most jarring moments for him was seeing the team run a play as the game continued on without him while he was driven off.
I too experienced this jarring effect as a 12 year old baseball player who was crestfallen upon hearing the news that a knee injury would keep me out of the entire regular season (my way of managing the void was to serve as first base coach on crutches haha). Thanks in part to the resilience of youth, I was able to return for a successful playoff run, albeit while wearing a brace that weighed about as much as me!
You may also experience changes in brain chemistry, as your body has grown accustomed to the “high” of the endorphin release associated with exercise. If an injury takes that away, your entire mental state can feel disoriented. Within elite runners, for example, some unpublished research from the USOC has shown that they NEEDED about 10 miles per day to reach the same mood baseline as non-exercisers. As most active people can attest, the very same thing can be true for amateurs. It reminds me of the old adage, when you’re a runner it usually seems like you’re the only person running, but when you’re injured it seems like the rest of the world is running.
One recent study of regular exercisers (defined as engaging in moderate exercise at least once per week) found that injured exercisers reported more than twice the level of depression than the non-injured control group (Lichtenstein 2018). The injured exercisers also reported high stress levels, impaired daily functioning and were more likely to have over 10 days injury-related work absence (the latter of which we may speculate could connect with social interaction, finances and/or a sense of purpose, among other things).
Fortunately, there are ways to improve these effects. One study of collegiate athletes (Yang 2014) found that injured athletes who were satisfied with the social support received from their athletic training staff were less likely to report symptoms of depression before returning to play compared to those who were dissatisfied with the social support received from the AT staff. Mindfulness training has also been shown to improve mood in patients. There is also evidence from physical therapy research showing that about 40% of patients experiencing depressive symptoms during PT treatment will experience resolution upon successful completion of their PT program.
Another strategy is to focus on what you CAN do rather than what you can’t. I often tell patients that if one leg is injured, you still have three uninjured limbs and a torso that are perfectly healthy for high quality training. In fact, the evidence has shown quite clearly that a “spillover” effect exists, in that if you only train one side of the body, some strength gains may carry over to the untrained side. Additionally, use the injury as an opportunity to address areas where you weren’t as strong as you’d like and that you may not have otherwise emphasized. An injury is nothing more than unplanned down time, as legendary running coach Dr. Jack Daniels used to say. Use it as an opportunity to become a more well-rounded with your movement. I’ve had many patients after surgery, return to their surgeon for a follow up and the surgeon is unable to distinguished the repaired limb from the uninjured one! In sum, rather than dwell on what you’ve missed due to injury, embrace the OPPORTUNITY that the situation presents!
Everyone’s experience will be different. But we understand that your injury is not just about your injury...The IMPACT on your life can reach much further and deeper, and awareness of this fact by both the patient and the clinician can be a vital element of the rehab process.
Allan Phillips, PT, DPT is owner of Ventana Physiotherapy