So why does it happen?

Tendinopathies almost always happen as a result of a tendon being asked to do more than it is currently conditioned for.  

This means, basically, that the tendons around your elbow (when pain free) are able to tolerate what you ask them to do day in and day out. Your tendons can adapt and learn to tolerate more load, however, this needs to be done gradually and they need adequate time to recover before they are exposed to the same amount of load again. 

What your tendon can handle will vary depending on who you are, your history, age, etc. But if you suddenly start demanding more of your wrist extensor muscles you may find yourself in a situation where the tendon becomes broken down instead of getting stronger, which actually weakens it, and makes it less likely to be able to tolerate things that it could before. 

Here’s an example: 

• You move house over the course of 4 days, repetitively lifting boxes etc. 
• When you get to work the next day, you notice sitting at your computer that your elbow hurts when you type. 
• Then, when you go to the gym later, you notice it hurts to grip the weights machines. 
• After a couple of weeks with no improvement, you now notice it starts to hurt even reaching to pick up a cup. 
• You start using it even less, trying not to move it, but then it hurts to type, or use it at all. 

Here are a bunch of potential things that may lead you to use the muscles at the back of your forearm more frequently, and develop this pain:

• Typing more
• Typing more with your wrist in more of a bent back position (e.g. with your forearms hanging off the desk. This happened to me after a 2 x 12h day assignment effort last year) 
• Gripping more
• Gripping something wider than you are used to (e.g. using a fat bar at the gym, changing tennis racquet handle) 
• Using your arm a lot more (e.g. moving house, gardening) 
• Lifting heavier weights 
• A weakness in your shoulder that may mean you are using this area more
• A change in your technique of a particular exercise 
• And many other things potentially.. !! 

The pain can honestly get pretty severe and it can be a pretty annoying issue to develop. But rest assured, there are things you can do!

What can I do?

Number 1: Figure out what has brought it on & do a bit less of it 

The number one thing that you need to do for any Tendinopathy is to figure out what you are doing that is using it repetitively that it doesn’t like and reduce this. This is a bit of a delicate balancing act where you want to reduce the painful thing JUST enough to allow the tendon to recover a bit, but not so much you are doing significantly less than normal, otherwise you will lose strength and capacity really quickly. 

It is ok if your tendon feels a bit sore sometimes when you are doing things, but anything that makes it very sharp or very sore for hours afterwards is probably too much. 

It really depends person to person and how bad your symptoms are (hence why it is best to seek professional advice). 

Here are some ways to reduce the load on the tendon:

• Hold things in your other hand
• Avoid having your wrist bent backwards when typing (e.g. put something small under your wrist)
• Avoid things that require a prolonged, strong, or wide grip (at least avoid doing more than you normally would of this)
• Avoid going lifting heavier things than you normally would
• Avoid anything that means you need to repetitively lift your wrist or fingers backwards 
• If you do carry something heavy, try to do it with your palm facing upwards, rather than back of hand facing upwards, as this uses the muscles on the inside of the forearm more than those on the outside/back

Note: The reduction in load/use is TEMPORARY. They are simply to offload the tendon while it is a bit more tender, and then you can gradually re-introduce them again.  

Number 2: 

If you just rest, the tendon remains ‘unhealthy’, and will probably hurt again when you try to use it. The ONLY way you can get the tendon to be able to handle being used without hurting again is to progressively strengthen it. 

Here are a few exercises you might want to add in to start to address the problem.

NOTE: NOT to be taken in place of medical advice and i advise you seek advice and guidance from a physiotherapist before starting these.

Start with isometrics for pain relief: