Understanding and Treating Tendon Injuries: A Guide to Golfer’s and Tennis Elbow

Understanding and Treating Tendon Injuries: A Guide to Golfer’s and Tennis Elbow

Experiencing forearm pain while typing, lifting a bag, or twisting a door handle? This discomfort may be due to tendon injuries commonly known as "golfer's elbow" or "tennis elbow"—conditions that are not exclusive to athletes. Even if you’ve never picked up a racket or club, daily activities can contribute to these tendon injuries. Here, we’ll explore what golfer’s and tennis elbow are, how tendon injuries occur, and what strategies aid in healing.

What Are Golfer's and Tennis Elbow?

• Golfer’s Elbow: Pain and irritation located on the inner side of the elbow, often affecting the tendons that connect to the forearm muscles.
• Tennis Elbow: Pain on the outer elbow, involving tendons that connect to muscles on the outside of the forearm.

Both conditions are types of tendinopathy—damage and inflammation in the tendons. While their names suggest they are sports-specific, both can result from various repetitive activities that stress the forearm tendons.

Understanding Tendon Injuries: Mechanisms and Sites of Damage

Tendon injuries generally arise in two ways:

1. Acute Trauma: A single, significant force damages the tendon.
2. Repetitive Stress: Small, repetitive movements gradually weaken and damage the tendon over time.

These injuries often occur where the tendon connects to muscle or bone, areas that may have reduced blood flow, making recovery challenging. Once damaged, tendons enter a multi-phase healing process.

The Healing Phases of Tendon Injury

Healing of tendon injuries follows a structured timeline that includes three distinct phases. Understanding these stages can help guide effective treatment and management.

1. Inflammation Phase (3-7 days post-injury):
   • Blood flows to the injured area, bringing essential cells to begin tissue repair.
   • Goal: Control, but not eliminate, inflammation, as it is vital for the healing process.
2. Repair Phase (1-2 days post-injury, lasting up to 2 months):
   • Cells lay down collagen to repair the damaged tissue.
   • Collagen fibers align along the direction of movement and stress to strengthen the repair.
3. Remodelling Phase (6 weeks to 12 months post-injury):
   • Healing cells and blood supply decrease, and the collagen matures, becoming more fibrous.
   • This phase is critical for transitioning the repaired tissue to withstand regular daily forces.

Effective Treatment and Management Through Each Healing Phase

To optimise recovery, tendons must be managed differently in each healing phase, gradually restoring function and strength.

Phase 1: Inflammation Management

During the initial phase, control inflammation to alleviate pain while encouraging blood flow for healing:

• Ice and Heat Therapy: Alternate between ice (15-20 minutes on and off) and heat (10-20 minutes) to manage inflammation and ease stiffness.
• Gentle Movements: Perform light range-of-motion exercises to prevent stiffness, depending on the level of injury.

Phase 2: Controlled Loading and Strengthening

This phase focuses on gradually reintroducing stress to the tendon to promote strength and functional alignment:

• Progressive Loading Exercises: Start with non-weighted exercises and slowly increase the load, progressing to heavier resistance (70-85% of 1-rep max).
  • Exercise Types:
    • Isometric (static holds)
    • Slow Eccentric (slowly lengthening the muscle under load)
    • Isotonic (dynamic, controlled movements)
  • Keep repetitions low (within 8 reps) to focus on movement quality rather than volume.

Phase 3: Advanced Strengthening and Functional Rehabilitation

This final stage prepares the tendon for daily activities and sport-specific movements:

• Functional Movements and Plyometrics: Incorporate full-body exercises and plyometrics for those returning to sport.
• Strength and Conditioning: Continue building strength to ensure the tendon can handle regular physical demands.

A general timeline for returning to sports or full activity is approximately 8-12 weeks, allowing for progressive loading and adaptation. However, individual recovery can vary depending on the injury’s severity.

Why Professional Guidance Enhances Recovery

Due to the unique and variable nature of tendon injuries, guided treatment from an experienced allied health practitioner can improve recovery speed and quality. At Neurohealth Wellness, we use a combination of techniques to promote tendon healing, including:

• Dry Needling and Acupuncture: Stimulates blood flow and releases tension in affected muscles.
• Muscle Release Techniques and Mobilisations: Enhance tissue flexibility and reduce pain.
• Chiropractic Adjustments: Restore optimal function to the musculoskeletal system, supporting overall healing.

By following these evidence-based phases and incorporating targeted therapies, we aim to help our patients recover effectively and reduce the likelihood of recurrence.

References

• Fenwick et al., 2002. The vasculature and its role in the damaged healing tendon. Arthritis Research, Vol. 4, pp. 252-260.
• Maddulli, N. et al., 2002. Tendon healing: Can it be optimised? British Journal of Sports Medicine, Vol. 36(5).
• Docheva et al., 2015. Biologics for tendon repair. Advanced Drug Delivery Reviews, Vol. 84, pp. 222-239.
• Physiopedia contributors. Tendinopathy Rehabilitation, Physiopedia. Updated 31 August 2018.

For tailored rehabilitation and guidance through your tendon recovery journey, reach out to us at Neurohealth Wellness, your trusted partner in Northern Beaches, Sydney, for holistic, evidence-based care.

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