♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the Internet. ♪
- Hi folks, I'm Bob Schrupp, Physical Therapist,
- And I'm Brad Heineck, Physical Therapist.
- Together we are the most famous physical therapists
on the Internet.
- In our opinion of course, Bob.
- Today we're gonna talk about tennis elbow,
what is it, and how to be pain free
in four easy self treatments.
- There you go.
- I just added that word, how.
Did you see that?
- Yeah, we're gonna be English majors, yep.
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Go to the giveaway section,
we're always giving something away.
This week, giving away something really cool.
We got the Varidesk Pro Plus 36.
- [Brad] 36 inches wide.
- So, what's nice about this,
you can just use it on a regular table.
- It's for a computer workstation.
- Right, and it's got a very wide surface, deep surface,
and you got 11 different heights
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- Right, so you can either sit down in a low chair,
you can sit at a stool, a medium high stool,
or you can just stand.
- Right, and just adjust it as needed.
And this company is the leader in this area
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So if you're looking for quality,
this is where you wanna go.
- If you're gonna use it a lot
and you want it to last for years,
this is a safe bet.
- This is the baby.
Okay, I'm gonna actually move this Brad,
while you start talking.
- Very good.
Okay, so tennis elbow,
we've got a treatment that is not a new treatment,
but it's effective.
As a matter of fact,
we did a video on, a similar video,
with the same treatment
and we're gonna do one extra addition here.
Quite a few years ago
and we've had numerous and numerous comments
with people saying, "Oh, that really helped."
- Right.
- So we're gonna do it again
and this time I did a little homework
and looked at the research on this treatment.
- Excellent.
- And it's very interesting,
but at first, what is tennis elbow?
Technically it's called, or medically speaking it's called
lateral epicondylitis.
So if we take Sam.
Good morning Sam.
Hi.
Anyways, we look at the elbow,
and there's the lateral epicondyle.
The lateral epicondyle is this bone right there,
which you can feel right there.
There's usually not much meat over it or muscle
and oftentimes not much fat either,
depending on the person.
- [Bob] And if you're having tendonitis,
you can feel it when you touch that.
- Right, it's very point tender
right where the muscle connects to that bone.
And those or what muscles are responsible for
is extending the wrist and opening the fingers.
They're all connected.
And there's also some of this component,
and that's why when you make a tight fist
or you rotate something or bend the elbow even
that really can be irritating to that spot.
- Any time you grip your wrist actually goes into extension.
- Yep.
- So when you're griping a tennis racket
for you know, the name tennis elbow,
you're actually griping the entire time
and that's why you can put a lot of stress
on that muscle which attaches to it,
you know, narrows into a tendon.
- Particularly with the backhand, yep.
So anyway, it's repetitive motion.
You don't get it from one swing with the tennis racket.
- Certainly not, no.
- Numerous swings or it can be anything repetitive motion
where you're working that hand.
- Even clipping a hedge would do it.
- Sure, you bet.
- Even a computer workstation,
particularly if you're using the mouse a lot
with poor ergonomics can irritate that.
It takes more time,
usually probably a few weeks or a month or two like that.
Jerking forces.
If you have something where you jerk--
- Or vibrating, vibrating forces.
- Sure.
- That would not help it anyway.
- So people if you're you know,
got one of those type of jobs,
a labor job working hand tools
is gonna affect it as well.
So, the symptoms like I said, point tenderness,
oftentimes the muscles in here can have knots or tenderness.
They can be tight there.
Like I said, getting out of bed in the morning
oftentimes, I know when I had it,
be like oh, that's really stiff
but usually within 10 minutes of working it
it settles out and gets much better.
And then again, I remember when I had mine
if I just bumped it, if I'd be swimming in the pool
in the lap there's a little plague
and I just bump it or walk it through a doorway.
If you just bump it a little bit, oh!
It sends you through the roof.
So--
- It makes you say bad words.
- Well yeah, I didn't want to say that.
I'm trying to get away from that.
So I'm working on that.
So how do we take care of it?
What's a simple treatment you can do at home?
Well this started with Dr. James Cyriax.
I mean he--
- Considered the father of orthopedic medicine.
- Right and he's not alive anymore, is that correct?
- No, he's been gone for I'd say 25, 30 years.
Very influential in our field
and very dedicated to the field,
but he came up with a lot of techniques
that are still in use today.
- Right, this is one of them.
- And this is one of them is right.
- There was a study done when he was alive
on tennis elbow and this is a treatment they did
and on the average of the people
that the did this treatment, it was four treatments
and they were pain-free.
- Wow, that's amazing.
- So it could be less than four treatments
or it could be a couple more, but it's so simple.
It's easy to do.
So the first thing you're gonna do is
the cross friction massage and we call it cross friction
because you do a little massage--
- Cross fiber.
- A cross fiber, I'm sorry, thank you.
- [Bob] A cross fiber friction massage.
- The fibers go this direction of the muscle
and where they connect into that bone,
you're gonna go to the tender spot
and I usually use these two fingers.
You can do it however you like but you go over that spot
and it's nice to get your fore arm rested on something.
- [Bob] I was gonna say you probably even have a pillow.
- [Brad] Sure, yeah, grab a pillow Bob.
- [Bob] And you can also do a finger on top a finger
or fingers side by side.
Whatever is most comfortable for you
in which ever way you can apply the pressure.
- Now if you just had a hard day working
and irritated it all day long,
this you know may not be the thing to do
or it may be better when it's not quite so flared up.
- May want to start with ice and ibuprofen.
- Right.
- If you're allowed by your physician to have ibuprofen.
- Exactly.
But you go on that tender spot
and you just work back and forth
and it's not over the skin, you're not massaging the skin.
You actually have to push down through the skin
and what we're doing are breaking up scar tissue
and the time you do it,
now Cyriax says you can go up to 20 minutes, right?
But nobody nobody does that.
- [Bob] Nobody's gonna be able to tolerate that.
- Usually what I do and I have my patients do
is I say do it until your fingers get tired.
It's usually two to three minutes.
Maybe a little more but you have to do that cross fiber,
can you get in on that Liz?
- And then because you're not doing it too full 20 minutes,
you may want to break it up throughout the day and do it.
Now it's not only breaking up scar tissue,
but it's also getting more blood flow to the area
and by getting more blood flow to the area, stuff heals.
Now if it's really too tender to tolerate,
I mean you'll start this and it'll start to hurt so bad,
it'll get worse, worse, worse, then you stop
and it's too much right now.
But if you do it for like a minute
and it starts to even out or even decrease a little bit,
then you're golden.
- I usually tell my patients look at a clock
and by 30 seconds it should be,
maybe you're sore at first but by 30 seconds
it should start to feel a little bit better
and by a minute they see, they're like oh that feels okay
or there's an numb-ish feeling
and if you get that numb-ish feeling or it feels better
then you just keep going until your fingers get tired
and then you take a break.
- If it is too bad, where it hurts too bad,
I even have people ice it,
but then I also even have them massage the muscles along it
because these muscles are often tight too
and these you can tolerate the massage immediately.
- And when you get those muscles loosened up
that takes stress off of the injured site
right where that tendon is to the bone.
- Exactly.
- So you know, and that you can do throughout the day.
- Right, right.
No restrictions on that whatsoever.
- So let's get back to the treatment.
You've done this till your fingers are sore,
there's one more thing you want to add.
- Now you're doing that every other day, right?
- Yes, this is done not every day,
once a day every other day.
So by the fourth day that would be eight days
or seven depending on how you count.
- Yeah, depending on how you count.
- And then the next thing you do is you extend the wrist.
- This way Brad, right?
- Yep and then--
- There you go, you gotta turn it, yeah.
- There's two motion, this and what you end up like this
and you have to have a table that's about this high
so it's not too high.
A little bit lower helps
and then you just hold it here,
then you take your other hand,
let me do it here so you can see it.
Bob, want to do it from that angle
and I'll do it from this angle?
- Sure.
I'm just gonna show you, yeah, I go right below that bump.
- Right, that's the medial or the inside bone.
- Pull that bump in, yeah, you can go this way or this way,
whichever way you is more comfortable for you.
- And then you just push that direction
and you just oscillate, pressure on,
pressure off, pressure on.
Now Bob and I were talking about that.
There's a couple other very famous therapists,
McKenzie and--
- Mulligan.
They do a similar treatment.
We kind of think they might have got it from Cyriax.
- I'm guessing, I mean again, he's the father
and they have little variations of how they do it,
but they all seem to be doing the same thing.
- Right.
- And the belief is that your tennis elbow,
it may be coming from the tendons and the muscles,
but it also may be coming from the joint itself
a little bit, the pain.
- Right, so we're mobilizing the joint
to get it back where it needs to be
and again, pressure on pressure off.
Five to 10 repetitions is all.
You're not gonna go for three or four minutes,
just five or 10 repetitions
and then you can continue to use ibuprofen
if that works for you, but cold packs on there
as much as you'd like to.
You know, 20 minutes of the cold pack.
So do that treatment,
the whole treatment will take 15 minutes,
well if you count the cold pack maybe more.
- Well if you do 20 minutes or half hour
of cross fiber is good, but again, it's not gonna happen.
- We're thinking up to five minutes
at the most for cross fiber, do the mold.
- What you could do is cross fiber, do the mold,
and maybe do go back and do a little bit of cross fiber.
- Sure, your fingers got a little rest.
- Yeah, if you can tolerate so.
- So that's it, four treatments like that
every other day should get you pain free
and if you've got...
if you're not doing it properly or it's just so bad--
- You have a really chronic situation,
it can take a lot longer.
- You can try a few more days.
- Yeah.
- All right.
- Thanks for watching folks.