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More elbow!! We keep it rolling this week as we take a look at the lateral elbow and dive into lateral epicondylalgia. We talk about what it is, some brief anatomy, mechanisms of injury and risks, testing, and finally, treatment.

(00:20) What is Lateral Epicondylalgia?
Lateral epicondylalgia is an irritation of the lateral elbow, in climbing this most often means the extensor tendons. Most of us know this lateral elbow pain as lateral epicondylitis, but this is misleading. Lateral epicondylitis infers that there is inflammation of the tissue, which occurs with acute injuries. Lateral epicondylalgia is more of a chronic issue and, rather, infers to a dysfunction of the tissue. It most often is referring to disorganized tissue and neovessels within the involved tendon. The neovessels within the tendon can cause an accumulation of fluid around the tissue which makes us believe there is swelling, which we may mistakenly infer to be inflammation. The disorganized healing aspect is really important in helping us understand what to do to treat it.

Anatomy: The two most most commonly affected muscles of lateral epicondylalgia are the Extensor carpi radialis and the Extensor digitorum. This will matter when we look at our treatment as well as our testing.
The extensor carpi radialis is responsible for wrist extension coupled with radial deviation, whereas our extensor digitorum is going to function to extend the fingers.

(01:02) Risk Factors and mechanism of injury
Repetitive or explosive athletic movements involving eccentric motion, in which the muscletendon unit is lengthened while contracting, may increase susceptibility to injury
Performing strenuous or exaggerated movements with degenerative or disorganized tissue further increases the risk of injury (As in, when you’re injured, you need to stop injuring the tissue further)
Work related: repetitive movement for at least two hours daily, forceful activity (managing physical loads over 20 kg)
Then, there’s the obvious…. Activities that include excess activation of these muscles without allowing for rest (e.g. rock climbing).

(01:38)Signs & Symptoms: Pain over the lateral elbow which is increased with active or resisted extension with the elbow and wrist in full extension and/or with passive stretching into wrist flexion with full elbow extension

(02:25) Testing:
Note: positive for epicondylalgia = reproduction of pain / familiar symptoms
Mills passive stretch
Cozen's Test for extensor carpi radialis
MMT at 3rd digit for extensor digitorum
Grip strength testing: if you are afflicted with lateral elbow pain you may not only experience pain with your grip strength but may also experience weakness.

Radial Nerve Entrapment Explanation (05:45)

Note: your symptoms may also be coming from the cervical spine so if you have a history of neck issues you need to see a specialist to rule this in or out.

(06:36) Treatment
Soft Tissue Mobilization: since the tissue is disorganized, manually manipulating the tissue can be effective in helping the tissue, particularly as it is remodelling. Studies have shown that an external stimulus to tissue can help with the organization of the tissue, which allows the tissue to heal with better cellular structure which may lead to improved tensile strength.
Exercise/eccentrics: slowly elongating the tissue with a load has been shown affected in many places in the body. The goal is to help the healing tissue while building strength to improve the tolerance to the activities that we perform. If you add a hold for ~5 seconds at the top of the movement, you can also help displace some of the inappropriate neovessels that are causing the increased swelling around the tissue.
Bracing can help particularly if you have a risk factor of repetitive movement for at least two hours daily with your work.
Activity modification: pay attention to your training program, climbing style, work, etc. Modify the behaviors appropriately to reduce the strain and stress you place on the tissue.

Thanks for watching and reading! Make sure to check out the two part wrist stability program in our other videos to see good overall wrist training.

Reminder, any exercise shown in this video are to be performed at the user's own risk. This information is not meant to replace direct medical intervention and if you have serious concerns you should seek professional help immediately.

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For more info visit RockTherapyPT.com
Instagram: @rocktherapypt
Jason Hooper, PT, DPT, OCS, CAFS

Filming and Editing by Emile Modesitt
www.emilemodesitt.com
Instagram: @emile166

Special thanks as always to The Wall for letting us film! @thewallclimbinggym