Exam Room – Coping With Overuse Injuries

Since we have been receiving many patients with elbow and wrist-pain issues in the clinic recently, we figured we should spend some time talking about them. Elbow and wrist injuries are typically what we call overuse injuries. The importance of understanding what an overuse injury is will be beneficial to providing the right treatment and prevention methods. There are also trauma-related injuries to the wrist and elbow, such as hitting the ground behind the ball, or – as I saw recently – trauma from hitting out of long grass and getting the club head snapped around the hosel resulting in a wrist sprain. Listed below are the common overuse wrist and elbow injuries we typically see. 

Wrist and Elbow Overuse Injuries 

Lateral epicondylosis aka tennis elbow

Medial epicondylosis aka golfers elbow

Carpal tunnel syndrome

Wrist tendinitis

When dealing with an overuse injury it is important to understand one thing: this area is becoming overused and over time there is a breakdown of the soft tissues, which include the muscles, tendons and ligaments. However, the more important aspect of overuse injuries is understanding what is the cause. Are you doing the same motion over and over again which is causing the breakdown, or is this area overworking or compensating for another part of the body which is causing the breakdown? 

Let’s take for instance you hammer a nail all day everyday. That repetitive motion will over time cause a breakdown of the soft tissues of the elbow or wrist in a fashion similar to typing, using a mouse or very commonly texting. This can over time break down the soft tissues causing an overuse injury of the thumb or carpal tunnel in the wrist. In many situations surgery is recommended to take pressure off the carpal tunnel. In reality, improving the soft tissues and modifying ergonomics is a more appropriate solution. Now that you understand how overuse injuries occur, let’s talk about golf. 

Lateral epicondylosis, also known as tennis elbow, is the most common elbow injury we see, even more than medial epicondylosis (golfer’s elbow). That is a misnomer. Golfers get tennis elbow more often and tennis players get golfer’s elbow more regularly. This typically happens more on the lead arm (left arm for a right-handed golfer). There are many different causes of this overuse injury and we could spend days on swing mechanics and why this occurs. 

The main reason, in my opinion, why tennis elbow occurs in the lead arm is because the elbow is over stressed due to a lack of lower body activity. In many cases the elbow is the weakest link and is why it gets overstressed. The wrist and elbow are small joints and can only take so much strain. When swinging 100 miles per hour, and not using the big areas like the core and pelvis for power, the elbow gets strained and over time breaks down.

Addressing the elbow pain is an important step in the recovery process, however it will only take you so far. The complete fix in this situation is to address the lower body. But first let’s talk about how to handle the pain in overuse injuries with the wrist and elbow.

Treatments for Elbow and Wrist Pain

Soft tissue work

Active release 

Graston

Cupping

Acupuncture or dry needling

Laser

Anti-inflammatory 

OTC anti-inflammatories (Advil, Aleve)

Natural anti-inflammatories (CBD, Tumeric) 

Ice (Cryotherapy, GameReady)

K-tape, wrist or elbow braces 

Rehab exercise 

Addressing the soft tissue is a critical part of the healing process. With overuse injuries there are often times adhesions, restrictions or scar tissue that has developed. Active release, graston and cupping are all treatment modalities which aim to improve blood flow and to heal these tissues by removing the restrictions and adhesions. Acupuncture and dry needling are powerful tools to improve pain, increase range of motion and improve and heal the soft tissues.

Laser is a tool we often times use to speed up the healing process. Laser helps to improve pain by reducing inflammation, improving blood flow and to increase energy and improve efficiency of the key cells in the healing process. Laser is working at the cellular level, which is why it is such a powerful tool in overcoming these injuries. 

There are many types of anti-inflammatories, which we could spend days talking about. In a nutshell, OTC anti-inflammatories are recommended by doctors for reducing inflammation and pain, which we do as well, however they are just masking the pain and in the long run might not be the best option. Many times we opt for natural remedies for pain and inflammation such as CBD and turmeric, which have little to no side effects unlike OTC medications. 

Ice is one of the oldest treatments for pain and inflammation. In the acute phase we often recommend icing as well as after activity when recovering from an injury. There are many ways to ice, from the classic frozen bag of peas, to whole body cryotherapy and GameReady – a compression ice therapy. 

Taping and bracing are common treatments  in recovering from an overuse injury to reduce strain on the injured areas. Typically tape is used on the wrist and forearm to take strain off the muscles and tendons during activity. Elbows braces are sometimes used to take strain off the tendon attachment and move the strain into the muscle. This is not a long term treatment solution as this does not address the issue or heal the injured area. Wrist braces can be worn at night to keep the wrist in a neutral position for optimal healing. 

Rehab is the last, but certainly not least, as it is the most important part of the recovery process from an overuse injury. Getting assessed will determine which areas need to be addressed. Many times strengthening the areas around the location of pain is not sound advice. In the case of lead elbow tendinitis, strengthening the elbow will often times not resolve this issue, let alone prevent it from coming back. This is why we stress getting assessed by an expert in golf mechanics and injuries to determine why the elbow is being overworked. As I mentioned earlier, learning how to use and utilize the lower body versus the upper body for power is the long term fix for an elbow overuse injury. 

Lastly, here are some tips to avoid overuse injuries 

Warmup the areas before activity with heat, stretching and soft tissue work

Ice the area after activity to reduce pain and inflammation 

Nutrition is a big player in inflammation. Watching carbs, sugar and alcohol and instead drinking water, eating vegetables and good carbs will help reduce inflammation and improve healing

Brace wrist at night for wrist or elbow pain to maintain proper alignment for optimal healing 

Do not sleep with the arms bent at night or above your head as this will reduce blood flow to the area and prevent healing.

Dr. Chris Miller treats all types of patients, ranging from average patients and professional athletes, including PGA Golfers and the Dallas Stars Hockey Team. For more info about ChiroSport Specialists of Dallas and Dr. Chris Miller please visit www.chirosportspecialists.com or call 972-239-0010.