Will a Tennis Elbow Brace Fix my Elbow Pain?

Tennis Elbow, also known as Lateral Epicondylitis, Lateral Epicondalgia, Lateral Epicondylosis or simply Elbow Tendonitis is a common condition seen in the physio clinic. Most people with Tennis Elbow are having a real tough time with gripping, lifting, twisting, pushing and pulling and are really looking for some pain relief. It is tempting to go straight for a Tennis Elbow strap, but is this the best idea? And if you are going to get one, which one should you get and how do you use it for best effect? Let’s explore the problem…

Tennis Elbow is an overuse injury where there has been a relatively high workload placed on the muscles and tendons on the top and outside of the elbow. The pain is felt where the forearm extensor tendons originate from the Lateral Epicondyle bone and this develops because your brain perceives a threat of imminent tissue damage at your elbow from your activities. And it is not usually from elbow movements, it is normally from repetitive gripping, grasping and lifting!

Take paving for instance. To lay pavers generally requires grasping and lifting bricks or pavers again and again, and placing them in the correct position as you reach to ground level. In this task, the fingers are pointed down, the weight is a long way from your body which increases leverage, and the arm is at full stretch which potentially can tension and compromise nerves as they travel down the arm.

Paving is a common cause of Tennis Elbow pain

Now the interesting thing is that the muscles and tendons that are largely responsible for curling the fingers for gripping start on the other side (medial side) of the elbow. So why is it the outer side (lateral side) of the elbow that gets sore? It is because the strongest grip requires the wrist to be angled back into 20 degrees of extension, to allow the fingers to curl with more power. These muscles that extend the wrist are not as strong as the muscles that curl the fingers, so there is a relative power imbalance. The extensor muscles and tendons struggle to match the power of the flexors (finger curling muscles) and suffer chronic strain.

The strap functions by multiplying the force of the extensor muscles, much in the same way that a weightlifter uses a back support, and an athlete uses compression garments for performance gains. This support at the outside of the elbow allows those muscles and tendons to work more effectively and efficiently, reducing strain.

Well, not so fast. One of the main reasons that Tennis Elbow pain can last so long, is that the extensor muscles never fully recover and remain weak, and the tendons continue to suffer from wear and tear overuse degeneration. Using a Tennis Elbow brace is really just hiding the problem in plain sight. If your pain does go away eventually just by using a brace, this is more due to good luck rather than good management.

While the strap may provide pain relief during activity, the ultimate rehabilitation strategy is to strengthen the lateral elbow muscles and tendons so that they are no longer outpowered, and then do away with the strap.

You can easily trial whether a strap will reduce your elbow pain by using sports Strapping Tape. If you have hairy arms, it is very useful to shave the skin where the tape is going to be placed first, otherwise you will lose hair when you take the tape off! Before you start with the tape, test your current level of elbow pain by squeezing or lifting something that usually hurts. This gives a baseline test of discomfort. After the tape is applied you should retest this action to see if the tape has helped.

Now take a strip of 38mm (1.5 inch) Sports Tape which is long enough to go around your upper forearm with a bit of overlap.

Without twisting the skin, lay the tape about 2 fingers length away from the elbow, otherwise it will block impede movement. Wrap the tape circumferentially around the forearm at this spot, aiming for moderate compression only. It is better to go too light than too firm, otherwise it will be uncomfortable. When you make a fist, you should feel that the forearm muscles are bulging outwards against the tape.

Where to position Strapping Tape to test for pain relief

If you have less pain when you redo your test activity with the tape on, you are very likely to get a benefit from a Tennis Elbow strap. If not, try altering the tape tension. If still no benefit, the strap probably won’t help either. NB: don’t leave the tape on for more than 48 hours, and you MUST take it off ASAP if you feel any skin itching as this means the tape is causing an allergic reaction.

There are many types of straps/ braces and sleeves marketed towards relief of elbow pain.

Compression Sleeves

These pull up sleeves will provide general support and usually are not ideal for Tennis Elbow as they do not target the specific structures involved. These are often made of neoprene for extra warmth and as a bonus are fairly easy to get off and on. If you have difficulty applying the other braces recommended, this may be a good place to start.

Velcro Straps

The next step up are Velcro Tennis Elbow braces. These are usually a narrower band of firm, non-stretch webbing material with a soft covering, often with a plastic ring to allow threading the band through and pulling back on itself to stick the Velcro down. This is great to adjust the firmness of the band and the amount of compression.

Velcro Straps with a pad

The best Tennis Elbow braces have a local contact patch of a compliant contrasting material such as silicon or gel, which needs to be positioned directly over the involved muscles. These types of braces usually provide the best pain relief as they address the dysfunction most specifically and the location of greatest compression is very targeted.

Much the same as the tape, the strap should be applied 2 fingers width below the elbow crease to prevent it getting in the way, and so it is most effective. If the strap has a built-in contact patch, this must be positioned over the extensor muscle group. Push your wrist back against resistance to see and feel where these muscles run.

Apply the strap lightly at the first application, and then you can try it more tightly on subsequent days. Only use the strap during the day - when you are busy using your arm, and take it off at night. If you develop any additional pain, tingling, numbness or loss of power, discontinue the strap and seek a professional assessment from your physio.

Long term Solution for Tennis Elbow

As we said earlier, Tennis Elbow is a problem caused by relative weakness and degeneration of the wrist extensor muscles. This means that the only long term and “permanent” solution for this condition requires a full rehabilitation program. Ideally this involves strengthening exercises using a Flexbar. Stretches may be appropriate, but when these are done at the wrong stage of your condition, can actually make your pain worse. Other conditions such as nerve root irritation and radial nerve entrapment can masquerade as Tennis Elbow and will not respond to this sort of program. For best results, see your physio to have a full assessment and tailored rehab program provided for you

Summary

A Tennis Elbow strap can be a very useful way to relieve lateral elbow pain in the short term, if it is used properly. There are many choices of straps available, and the ones which provide the most localised compression support are usually more suitable than others. In the long term, rehabilitation exercise is required to make a more permanent change, and a tailored program is the best way to proceed.