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A Rubber Twist On Treating Tennis Elbow Pain

Jul 25, 2011
Originally published on July 26, 2011 1:19 pm

Larry Holzman — avid mountain-biker, skier and guitarist in a band — plays hard. And he didn't want to give it all up due to a "spot of pain" in his elbow. "This wasn't a traumatic injury," explains Holzman. It came on gradually and escalated from annoying to excruciating over the course of a couple months.

His physical therapist quickly diagnosed it as tennis elbow. Turns out, lots of people who develop tennis elbow haven't played the game in years. And some have never even picked up a racket.

"If you're having pain on the elbow on the outside of your elbow when you grip a coffee mug or pick something up with your hands — that is almost always tennis elbow," says Barton Bishop, a physical therapist at Sport & Spine Rehab in Rockville, Md.

Pain from repetitive overuse of the tendons and muscle that run from the wrist to the elbow can come from all sorts of activities. It usually happens when people grip things too hard or too long.

In addition to tennis players, Bishop sees the injury in gardeners with their shovels and trowels; painters with brushes; and golfers with clubs. In Larry's case, it was a combination of all his hobbies: from squeezing the handlebars on his bike, to lifting weights and playing in a band.

"Gripping guitars and base drums ... can really affect people's elbows," says Bishop.

When Holzman came to Sport & Spine for help, Bishop put him through a series of traditional treatments including ultrasound, strengthening and stretching exercises, cross-friction massage, heat and ice.

He also added a series of eccentric wrist exercises using a rubber bar called the Thera-Band FlexBar — ideal for the injured muscle in tennis elbow. The exercises enable the muscle to lengthen and contract simultaneously. And the FlexBar makes it simple to do this kind of stretch.

"He's actually getting his muscle to work," says Bishop. "It's a perfect exercise."

Bishop says the benefit of the FlexBar, which costs between $16 and $33, over traditional hand weights is that it helps people strengthen without recreating the symptoms. He says weights can overwork the muscle and sometimes leads to more pain.

A study by researchers at the Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital in New York demonstrated this benefit. They found that adding the eccentric wrist extension exercises using the FlexBar was effective at improving strength and decreasing pain in patients with tennis elbow. (Performance Health Brands, maker of Thera-Band, provided the FlexBars for the study but did not fund it.)

Not all physical therapists are sold on the FlexBar. "There's a variety of methods you can use to achieve the strengthening technique," says Jason Grandeo, a physical therapist at Body Dynamics, Inc. in Arlington, Va.

But he understands the appeal: The FlexBar is easy to use and you can do it at home.

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In "Your Health" today, when it's so hot out that you could fry an egg, why don't people fry, too? That story in a moment. But first, a home remedy for a very common injury - tennis elbow. NPR's Allison Aubrey reports on a new treatment, with a twist, that is helping some people heal.

AUBREY: Last week, when I met a man named Larry Holzman, who offered to be interviewed for this story, I almost turned him down, canceled the interview. My reasoning was simple: This is a story about tennis elbow, and tennis really is not Larry's game. He's into mountain-biking, skiing, playing his guitar, and he wasn't sure how these activities led to a bum elbow. He recalls the pain came on slowly.

LARRY HOLZMAN: It wasn't a singular moment, like a traumatic thing - like crashing over the handlebars on a mountain bike - that I would remember expressly.

AUBREY: What I learned from Larry and his physical therapist is that lots and lots of people who develop so-called tennis elbow haven't played the game in years. And some have never even picked up a racquet.

BARTON BISHOP: If you're having pain on the outside of your elbow when you grip a coffee mug or if pick something up with your hand, that is almost always tennis elbow.

AUBREY: Physical therapist Barton Bishop says the name could've been changed long ago. Pain from repetitive overuse of the tendons and muscle that run from the wrist to the elbow can come from all sorts of activities. It usually happens when people grip things too hard or too long. So Bishop says in addition to tennis players, he sees this injury in people who garden a lot - they're gripping shovels and trowels and in painters and golfers, who grip their brushes and clubs. In Larry's case, it was squeezing the handlebars on his bike, to lifting weights and playing in a band.

BISHOP: Gripping guitars and bass drums and constantly picking and drumming - people don't think about that often, but that can really affect people's elbows.

AUBREY: Diagnosing tennis elbow is incredibly simple. The test takes just a few seconds.

BISHOP: What you do is - Larry, I want you to take your arm straight out, and I want you to hold your fingers, like this.

AUBREY: While Larry holds his arm straight out in front of him, his palm facing down, Bishop pushes down on his middle finger and tells him to resist.

BISHOP: I just want you to not let me push down this finger. OK? And does that cause any pain in the elbow?

AUBREY: Larry stiffens his jaw just a little, but says the pain is much better than it was when he started therapy.

HOLZMAN: When I first came in, it was painful to do that diagnostic thing or to touch it.

AUBREY: But Larry's been a good patient. Every day, at home or at the gym, he takes a few minutes to do a strengthening routine. To demonstrate, he picks up a bright blue, rubber bar that's about two inches in diameter and about a foot long. It's called a FlexBar.

BISHOP: Larry, what I want you to do is take your right hand, and I want you to twist that bar with your right hand. There you go. OK.

AUBREY: If this is hard to envision, you can watch a video demonstration on NPR.org later. But the interesting thing to note here is that Larry has swapped out traditional hand-weights for the FlexBar. And Bishop explains there's a reason. Weights may overwork the muscle and lead to more pain, whereas the FlexBar makes it easy to lengthen the muscle at the same time it's contracting, working.

HOLZMAN: I mean, it actually feels good. It doesn't feel like an exercise that hurts. It feels like a really good stretch.

BISHOP: That's perfect, because he's actually getting his muscle to work, but he's not re-creating his symptoms in the elbow. That's a perfect exercise.

AUBREY: But not everybody's sold on the FlexBar. Physical therapist Jason Grandeo, who has yet to try it, says he's not convinced.

JASON GRANDEO: There's a variety of methods that you can use to achieve the strengthening technique that you're trying to apply.

AUBREY: Allison Aubrey, NPR News. Transcript provided by NPR, Copyright NPR.