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Tennis elbow and Golfer's elbow are two common overuse injuries that afflict athletes, office workers, and individuals engaged in repetitive arm movements. The nagging pain and discomfort experienced in the outer and inner elbow regions can significantly impact one's daily activities and athletic performance. While traditional treatments like rest, ice, and physical therapy have been effective, there's a growing interest in exploring alternative pain management options. One such promising method gaining popularity is the use of Transcutaneous Electrical Nerve Stimulation (TENS) machines. This comprehensive guide aims to delve into the world of TENS therapy for tennis elbow and Golfer's elbow, elucidating its therapeutic benefits, best practices for application, and essential considerations for effective pain relief and accelerated healing.
Tennis elbow and golfer's elbow are common conditions that affect the elbow and are often caused by repetitive arm movements (e.g. lifting, gripping, etc.). Tennis elbow, also known as lateral epicondylitis, occurs when the tendons outside the elbow become inflamed and/or develop small tears . On the other hand, golfer's elbow, or medial epicondylitis, affects the tendons on the inside of the elbow. Both conditions can lead to pain, tenderness, and difficulty in gripping objects or performing specific arm movements. However, while those with tennis elbow experience outer elbow pain, inner elbow pain is associated with golfer's elbow instead.
How does tennis and golfer's elbow happen?
Tennis elbow is often caused by certain activities that strain the outer tendons along the elbow . Repetitive motions, such as repeatedly gripping and twisting objects with the hand and wrist, can lead to developing tennis elbow. While this occurs during tennis, it is more commonly seen in workers such as manual labourers and office workers. Movements involving the thumb and first two fingers in a pronated hand position (palm facing downwards), such as typing and hammering, are particularly aggravating.
On the other hand, golfer's elbow are also caused by repetitive activities that strain the elbow's inner tendons . Similarly, repetitive motions, such as gripping and twisting objects with hand and wrist, can lead to golfer's elbow. Likewise, while this also occurs during golf, it is commonly seen with people such as manual labourers and those who weightlift. Hand and wrist movements in a supinated position (palms facing up), such as bicep curls and throwing, can be aggravating.
Range of tennis and golfer's elbow Symptoms
The main symptoms of tennis and golfer's elbow are outer and inner elbow pain . Pain levels often increase with repetitive hand and wrist movements but can continue to ache at rest. Many people with these conditions can often pinpoint pain locations with a finger. Other symptoms can also include:
- Stiffness when moving the elbow and wrist
- Pressure or swelling along the elbow
- Weakened grip strength
Common Treatment Method for tennis and golfer's elbow
Currently, no single treatment can cure tennis and golfer's elbow. Most treatments are focused on pain management and restricting movements that might worsen the conditions, including elbow bracing, massage, lifestyle strategies, medications, topical creams and heat/ice packs. Physiotherapy can help provide relief through therapeutic exercise, taping, manual therapy and other pain relief modalities. In severe cases, your GP may recommend treatments, such as platelet-rich plasma (PRP) injections, and even refer you to a specialist. However, modern treatments, such as TENS, may provide innovative and novel strategies for symptom relief.
What is a TENS machine, and how can it help relieve tennis and golfer's elbow?
TENS machines are portable medical devices that are used to help relieve multiple conditions, including arthritis, tendonitis and even tennis/golfer's elbow . The TENS unit sends electrical impulses to the body through the skin via electrode gel pads. These impulses help block pain signals being transferred from the source of the pain to the brain. Treatment from a TENS machine can also increase blood flow and reduce swelling.
What's the best way to use a TENS machine for tennis and golfer's elbow?
A TENS conductive elbow brace is the most convenient and effective way to help ease the symptoms of tennis and golfer's elbow. The conductive brace provides a complete fit around the elbow to deliver electrical impulses comprehensively, preventing the need for multiple electrode gel pads and finding the ideal placement. Additionally, it ensures an even and more significant current distribution for a complete treatment compared to the conventional electrode pad attachments.
Here are the best practices for using a TENS unit:
Position of electrode pads for tennis and golfer's elbow
Please refer to the included manual or the advice of a healthcare professional about positioning the electrode pads surrounding the tennis and golfer's elbow. Under most circumstances, the treatment area is found between the pads' placement . For tennis elbow, the pads would be positioned around the outer part of the elbow. On the other hand, the pads would be placed around the elbow's inner part for this with the golfer's elbow.
Conductive garments as alternative to Electrode Pads
Minimise the hassle of finding the correct location of the multiple electrode pads around the elbow for tennis and golfer's elbow treatment. Instead, you can wear the TENS conductive elbow brace, which fits around the joint snuggly. This alternative prevents the need to find the exact placement and can be used for multiple elbow conditions, including golfer's and tennis elbow.
Setting the TENS Mode for tennis and golfer's elbow
Various settings on the TENS unit can be changed to treat the symptoms of golfer's and tennis elbow . You can change or select appropriate pre-selected settings depending on the TENS unit purchased. There are three primary settings include frequency (hertz), intensity (mA) and pulse width (μs). The only setting that can be changed during the treatment is the intensity which measures the strength of the treatment. A low intensity may not be able to yield a therapeutic effect, while too strong of intensity may lead to further discomfort. For the ideal treatment intensity, the user should feel a very strong and tingling sensation without irritation.
Setting the Pulse Rate (Frequency) for tennis and golfer's elbow
The pulse rate describes the number of electrical impulses delivered within a given time. The higher the frequency, the more electrical impulses. A lower frequency (usually between 2-5Hz) can provide pain relief over a longer period, while higher frequencies (between 90-130Hz) provide more immediate pain relief in a shorter period. However, an English research study  showed that using a frequency of 110Hz helped provide notable pain relief in those with elbow pain.
Setting the Pulse Width for tennis and golfer's elbow
Currently, there needs to be more research on the significance of pulse width for pain relief. However, in the same UK study, researchers recommended using the pre-programmed setting of 200μs . However, this may be adjusted based on the user's response to the TENS unit. For more guidance, speak to your relevant healthcare professionals, such as physiotherapists or doctors.
How Often Should You Use Your TENS Machine for tennis and golfer's elbow?
Currently, no single duration or frequency of treatment is optimal for tennis and golfer's elbow. This will vary from person to person depending on the severity, symptoms and the individual's response to treatment. Typically, 15-30-minute sessions should be enough to relieve pain. Treatments can be applied more than once daily, but it's essential to be mindful of side effects, such as skin irritation and any unusual lingering sensations. Research has suggested that a 45-minute treatment daily for 6 weeks showed a significant reduction in elbow pain . Please speak to a healthcare professional for further information.
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Other Tennis and Golfer's Elbow Exercises at Home
Wrist extension exercises are usually recommended to help build forearm strength and reduce elbow pain . Isometric exercises are generally the gentlest and involve the forearm muscle working against resistance without movement. Over time, concentric and eccentric exercises can be introduced. For golfer's elbow, this is the same but for wrist flexor exercises (palms up) instead.
Where and when to not use TENS machines
Where not to use your TENS machines :
- Over damaged skin (e.g. wounds, cuts, etc.)
- Over areas with altered sensations (e.g. tingling, reduced sensitivity)
- Over areas with extreme welling
- Near areas with clots or cancer
- Areas exposed to radiotherapy or radiation
- Sensitive areas not related to the elbow
TENS machines should also not be used in specific circumstances without medical clearance, such as :
- If you have an implanted medical device, such as a pacemaker, neurostimulators, bone growth stimulator, etc.
- During pregnancy
- People with cognitive or behavioural impairments
- Those who cannot consent to treatments
Are there any risks of side effects when using a TENS Machine?
Altered sensation and skin irritation are the most experienced side effects when using a TENS machine . Serious side effects are uncommon and typically occur due to misuse or specific circumstances (mentioned earlier). Although rare, more problematic side effects include increased pain, potential interaction with electronic implants, seizures in individuals with epilepsy, chest pain, stroke, blood clotting, changes in blood circulation, fainting, substantial skin damage, and burns. If you notice any side effects, it is essential to discontinue the treatment and seek medical advice from your doctor.
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- Grundy, M., & Simmonds, K. (2020). Lateral epicondylitis. Australian Journal of General Practice, 49(11), 706-710. Retrieved from https://www1.racgp.org.au/ajgp/2020/november/lateral-epicondylitis
- (2022). Tennis elbow. Retrieved from https://www.healthdirect.gov.au/tennis-elbow
- Watson, T. (2017). Transcutaneous Electrical Nerve Stimulation (TENS). Retrieved from https://www.wwmsi.com/documents/WWMSI_Transcutaneous_Electrical_Nerve_Stimulation_Tim_Watson.pdf
- Bisset, L., Paungmali, A., & Vicenzino, B. (2013). Tennis elbow. BMJ, 347, f5160. Retrieved from https://www.bmj.com/content/347/bmj.f5160.full.pdf+html
- Stasinopoulos, D., & Stasinopoulos, I. (2017). Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Journal of hand therapy, 30(1), 13-19.
- Boonstra, A. M., Schiphorst Preuper, H. R., Balk, G. A., & Stewart, R. E. (2014). Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: Variability and influence of sex and catastrophizing. Frontiers in Psychology, 5, 1-9. https://doi.org/10.3389/fpsyg.2014.00001