Are you cultivating tennis elbow — in the garden?

A little sweat and a lot of elbow grease

Gardening requires flexibility, strength, and endurance.  Moreover, it necessitates using an array of maintenance tools such as secateurs, sheers, clippers, and long-handled equipment.  These tools demand repetitive movements of certain muscles and tendons in the hands, arms, shoulders. Subsequently, gripping, clipping, shearing, and pruning strains the forearm, leading to inflammation and pain just below the elbow. Sometimes referred to as ‘tennis elbow’ or lateral epicondylitis, this condition can feel achy and painful, and becomes worsened with gripping activity.

Are your arms dirt tired?

The forearm (lower arm) is a complex assembly of 20 muscles. A portion of these muscles are responsible for bending and extending our wrists and fingers.  When this group of muscles (called wrist and finger extensors) are pushed beyond their capabilities, something ‘gives’ at the point where the muscle attaches to the bone at the elbow (the lateral epicondyle). As a result, inflammation of the muscle and tendons occurs and creates a very painful and tender region around the elbow.

Besides gardening pursuits, other activities that can lead to tennis elbow include:

• Spending considerable time typing at a keyboard
• Hammering a lot of nails
• And yes … playing tennis!

Often, the strain around the elbow that results in inflammation and pain will occur after a sudden increase in participation of these activities. For example, a weekend of enthusiastic spring gardening — after a hiatus of gardening activity –may culminate in overuse. Doing ‘too much too soon’ does not allow forearm muscle group to build enough strength to cope with increased activity.  Consequently, this leads to progressive tightening of the muscles, inability to activate and operate the muscles efficiently, strain on the lateral epicondyle (muscle attachment at the elbow), and pain!  This pain can build over time, to the point that it is constant with every hand movement. The loss of grip strength typically occurs, as well.  Even holding a cup of tea or coffee becomes challenging!

Tools for treatment and injury prevention

Tennis elbow can be difficult to treat because we rely on our hands for many tasks. Above all, the first line of treatment is REST, but this is often difficult to accomplish – particularly if you are a keen gardener!

So, what can be done to help manage this problem if you already have it or prevent it coming on?

1. STRETCH THE FOREARM MUSCLE GROUP.  This is a simple treatment and can reduce the pain. Below are two stretches that you can perform at least 3 times per day:
   

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FOREARM EXTENSOR STRETCH

1. 1. 1. Straighten your arm in front with your palm down and wrist bent toward the ground.
      2. Use the other hand to gently place pressure on the back of outstretched hand pushing towards your body and hold for 20 seconds.
      3. Feel the stretch on the top of your forearm, alternate arms.

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FOREARM FLEXION STRETCH

1. 1. 1. Straighten your arm in front with your palm down.
      2.  Bend your wrist back, with your other hand gently pull your fingers towards yourself and hold for 20 seconds.
      3.  Feel the stretch on the bottom of your forearm, alternate arms.

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2. REST FROM THE AGGRAVATING ACTIVITY.  If you are already experiencing elbow pain, you should halt the activity.

• • Start gradually. Apply the 10% rule for any new activity or activity you recognize is aggravating your arm pain. Start with a small session, and do not do it on consecutive days to begin with. After that, increase load or volume by no more than 10% each week.

3. ASSESS HOW YOU CAN CHANGE THE WAY YOU PERFORM AN ACTIVITY.

• • Wear gardening gloves and vary the width of the handles of your secateurs and other equipment you use. To recruit and distribute the load amongst various muscles, alter the width of secateur and clipper handles. This will activate a range of muscles and tendons in different ways, instead of utilizing one specific muscle of the arm.
  • Alternate between use of the right and left hand.  You can divide the strain on your forearms by alternating tasks between your dominant and non-dominant hands. Experiment with both right and left arms, independently. Hone your ambidextrous skills!

4. EXAMINE YOUR GARDENING EQUIPMENT.

• • Maintain your equipment.  Excessive resistance caused by friction of pruning shears or secateurs requires extra effort of the hand and arm. So,ensure that your gardening equipment is free of rust and is well oiled.
  • Purchase lightweight tools.  The weight of identical gardening tools varies considerably. Weight is typically attributed to the size of the equipment and the metal alloy of the tool.   Via online resources, weight specifications are typically included for products.

5. IMPROVE YOUR SHOULDER STRENGTH.

• • Perform pushups! When the muscles around the shoulders have lost strength then the muscles around the elbows and wrist compensate and need to do more. This leads to a greater chance of overuse of these muscles. A great way to strengthen your shoulders is to perform push-ups.  There are several variations of push-ups that accommodate different abilities, but it is important to execute push-ups with good form.  Review the Gardening with Care for the Neck and Shoulders post for performing push-ups safely.

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WALL PUSHUP

1. 1. 1. Stand up straight facing a wall.
      2. Take a step back and place the palms of your hands on the wall at shoulder height and shoulder width apart, keeping elbows straight.
      3. Bend your elbows, taking your chest towards the wall. Keep your body in a straight line and tighten your buttocks and abdominals. Try to keep your head from poking forward.
      4. Return to the starting position by straightening your elbows, lifting your chest away from the wall.

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