Should you wear a brace as a treatment for your Tennis Elbow? What's the best kind of brace? – Although there are a few exceptions, here's why supports like braces, splints and wraps are a bad idea for treating Tennis Elbow, and why the "best" brace may be none at all!
Yes, it’s true that most of the “authorities,” medical websites and various blogs do recommend that you wear some kind of support for a few weeks to help "rest, protect and heal" your Tennis Elbow
And, at first glance, it certainly seems like the right thing to do, (in a knee-jerk-reaction kind of way) but on closer inspection there are several reasons why those supports are not the way to help Tennis Elbow heal, (in most cases) and why they can actually hurt you instead.
Braces Article Table Of Contents:
(Links jump down the page to various sections of this article.)
- Slideshow On How Braces Can Slow Your Recovery
- Podcasts On Supports And Tendon Healing
- Why Immobilization Doesn’t Help Tennis Elbow Heal
- How Braces Can Lead To Scar Tissue
- Doesn't Tennis Elbow Need Rest To Heal?
- Exceptions When You Might Wear A Support
- The "Counterforce" Brace: Best Support For Tennis And Golf
This slideshow will give the key points on why braces are not a good way to treat your Tennis Elbow injury, starting off with a video exploring a W.S.J. news article - By: Allen Willette
This first podcast is the audio version of the first video above. (It's downloadable for later listening from my Soundcloud page.)
The next podcast is a similar but more recent discussion of a W.S.J. news article on braces. The claim being that they can relieve the pain of Tennis Elbow – (But no mention of healing.)
First of all, Tennis Elbow, (along with most other forms of "Tendonitis") is usually not the kind of injury that benefits from being bound up with some kind of restrictive "support" for days or weeks.
These "supports" don't actually support the healing of this kind of tendon injury!
In other words, the cure doesn’t fit the "disease!" (Although it may feel better temporarily.)
So, in case you’ve been wearing some kind of brace and have noticed that it feels a little better – make sure you ask yourself this question:
Does that mean it’s actually healing?
(Unfortunately, NO - It doesn't.)
It’s deceptive!... Because having less pain is one of the ways we can tell that an injury is healing and getting better.
(Of course, I completely understand this question is really easy to skip over when you’re in urgent pursuit of relief from that annoying, burning pain and you need to get on with the necessities of life.)
It’s only natural to assume that if it’s feeling better it must be getting better. It must be healing!
The problem is that even though there are a lot of things you can do to make your Tennis Elbow feel better, (like icing, resting, chasing inflammation with anti-inflammatories and, worst of all, getting Cortisone shots.)
All these so-called treatments do is trick you by easing and postponing your pain for a little while - which is exactly what braces do too.
So, WHY then doesn’t bracing and supporting your muscles and tendons (or your entire elbow) help your Tennis Elbow heal?
- If you broke your arm, then you’d have to put it in a rigid cast while the bone heals – No question about it!
- Or if you sprained your ankle badly, then you’d have to wrap it for a while (at least for a few days) – No argument there either...
But Tennis Elbow has almost nothing in common with these kinds of injuries!
Tennis Elbow is certainly not a fracture and it's not a sprain or a strain (usually) – By that I mean there is usually no major tear (strain) in the muscle or tendon that needs to be protected from movement!
(In the case of a significant tear, a brace or support probably would be needed at first - but you would probably need to get an MRI in order for a tear to be diagnosed.)
But What About The Possibility of a Smaller Tear?
A lot of Tennis Elbow sufferers really worry about that – often because the pain is so sharp or relentless.
Well, that’s always a possibility, but the truth is the severity of the pain and its persistence often has little to do with it.
Pain does not necessarily = TEAR! In other words, just because it hurts like hell for weeks or months doesn’t mean there’s a tear – large or small – Often there isn’t.
However, for arguments sake, even if there is a small tear, from my understanding and what the leading-edge sports medicine approach seems to favor, is to either keep it free and mobile - or brace it for a very short time after the injury, and then start moving it again as soon as possible
We’re talking about mere days of bracing (in the case of a small tear) followed as soon as possible by gentle movement rather than weeks of bracing and immobilization.
But let’s get right back to the typical case of Tennis Elbow now.
Tennis Elbow is a tendon injury, and most of the time the injured tendons are NOT badly torn in one big, traumatic event – They’re damaged gradually.
The Key Issue And Biggest Risk To Injured Tendons
And the key problem is that Tendons heal much more slowly, in part because they have a much smaller blood supply
So slowly, in fact, the biggest risk with tendons is that they don’t heal at all – and that they gradually break down instead.
THAT'S what’s really going on more often than not in the typical case of Tennis Elbow! – Gradual breakdown, stagnation and degeneration (regardless of whether there's a tear or not.)
It’s an insidious, weakening or "decay" of the collagen protein that the tendon is made of, where the normal, expected healing response fails to keep up with the breakdown.
Technically, it’s called 'Tendinosis' and there’s no longer any scientific basis for continuing to use the tired, old term of TendonITIS or referring to inflammation (not the problem) any longer.
So it’s a mistake to treat Tennis Elbow as if it were an Acute injury that’s swollen and inflamed, like a sprained ankle or a broken bone.
Especially by immobilizing it!
The key thing to always remember is the fact that Tendons heal slowly – once again, mostly because they have much less of a blood supply.
And the last thing you want to do is to reduce that circulation and blood supply to your tendons even more as they’re trying to heal. What they need is the opposite.
How Braces Reduce Circulation And Slow Tendon Healing
Unfortunately, reducing circulation is exactly what wearing a brace, splint, strap or any other kind of so-called support tends to do where you’re wearing it – Two ways:
- First, indirectly, by restricting the movement of your muscles, tendons and elbow joint. Less movement = Less circulation, because muscle movement is essential for good blood flow (and lymph flow, which is completely dependent on movement.)
- And second, by directly compressing the tissues and blood vessels in that area. And, yes, even if it’s not that tight. Naturally, the tighter and more restrictive it is, and the longer you wear it the worse it is.
The other big downside with supports is that the compression and reduced mobility tends to encourage sticky 'adhesions' or scar tissue, which further binds and restricts your muscles and tendons.
I’m sure you will agree losing your flexibility to a bunch of nasty scar tissue and having your healing process stall are the last things you want!
Muscles and tendons actually need gentle movement and mobility to heal – (except right after a major tear, which I’ve already mentioned is rarely the case with Tennis Elbow).
Gentle movement during most if not all of the healing process helps the repair process and helps to prevent excessive Scar Tissue build up.
Yes, but only in the sense that you should try to avoid the kind of stressful, repetitive motions and activities that caused your injury in the first place and which would likely aggravate it.
Not in the sense that you shouldn’t move the area at all. (See the following article and video for more about the question of rest.)
In the classic words of Dr. Nirschl (an Orthopedic Surgeon and thought leader in Tennis Elbow research) "Absolute rest is rust”
On his website, linked to below, he says, quote:
“All tissues, particularly injured tendons, require tension and motion to maintain health. Total immobilization is obviously contra-indicated as it results in muscle atrophy, weakness, and decreased blood vessel supply.”
Dr. Nirschl also states that immobilization of the elbow joint itself leads to limited mobility, stiffness and potentially “loss of motion and function.”
Of course, there is a significant difference between a hard, inflexible cast or rigid brace that allows little or no movement of the elbow, and either the sleeve-type brace or the strap-type support both of which do allow some movement...
But, the simple fact is, it doesn’t take very much compression to begin to slow circulation, especially the lymph flow – And, once again, circulation along with frequent, gentle movement is essential to the healing process of muscles and tendons – Especially with Tendinosis.
And too little circulation, movement and overall "stagnation" in the area is your enemy - Potentially causing more degeneration of your tendon.
That's not to say they have no place and no role whatsoever, though!...
Yes, there are exceptions. It may make sense to wear a brace:
- In the case of a tear – As mentioned above, if you’re sure you’ve suffered a significant tear (you had an MRI or sonogram and a tear was diagnosed)...
- When playing tennis / golf – While you’re playing tennis or golf (or some other sport) and you're still recovering (See below)...
- Heavy exertion – OR possibly while you're engaging in some kind of short-term forceful activity, like hammering nails, moving furniture or digging in your garden.
In these cases, your goal is to protect your injury (somewhat) from the risk of further damage – while you're doing something strenuous involving sudden, dynamic, forceful motions.
But only for short periods while exerting yourself, and never the rest of the time, while you're walking around, sitting at home, sleeping or while you’re working – (if that work involves doing something repetitive and lower intensity.)
One other possible exception might be the "neoprene sleeve" type of support.
I'm not keen on the idea, but I've heard they can be helpful when it comes to keeping the area warm, which is certainly beneficial for circulation, but I'm still a bit skeptical, since I worry about the compression factor from the elastic Neoprene.
Again, in conclusion, I'm 99% convinced it's best to completely abandon the idea that using a support for days, weeks or months will help your Tennis Elbow heal.
There was an article in the Wall Street Journal a while back about braces - Especially the "Counterforce" Brace.
And I do partially agree with that article that the Counterforce Brace has a place – Except that that place is strictly on the tennis court or the golf course – And not while at rest.
The article's assertion was that braces and bands can relieve the pain of Tennis and Golfer's Elbow, by applying compression to the forearm muscles or by limiting the mobility of the wrist.
(But I think it’s worth pointing out that the article didn’t raise the question of healing at all, and only mentioned the word once, stating in a general sense that Tennis Elbow takes a long time to heal, whereas “pain” or “pain relief” was mentioned 11 times.)
The article also states that Doctors claim it’s perfectly safe to wear a brace all day long...
But, now that you've seen a different perspective here, I'm sure you'll be asking: Is this really safe? Is this really a good idea?
Again, I do agree that it may make sense to wear one temporarily while you're playing golf, tennis or some other racket sport (Lacrosse, ect.)
IF you decide to keep playing while your injury is still healing, or for a short time as you’re just starting to get back into the game after completing your rehab.
So, if that's your choice, (some can get away with continuing to play and some can't) THIS is the best kind of brace to wear:
This type of brace is more of a strap that encircles the upper forearm an inch or two below the “Tennis Elbow spot” where the muscles transition into tendons.
It should be obvious this is a temporary, interim measure, though; a crutch, if you will, which should be abandoned as soon as possible.
The strap alters the normal function of the muscles and tendons it compresses and any time you alter your ‘biomechanics’ this way – especially while engaged in a sport or while working – there are tradeoffs, like the emergence of compensation patterns, that can cost you more in the long run than they’re worth for the short term gains they provide.
If you’re tired of chasing your Tennis Elbow pain with things like braces, ice and pills – without ever managing to break the cycle – Then take a look at my program and learn how to help yourself make a full recovery and finally heal...
Learn To Treat And Heal Your Own Tennis Elbow Right Here:
I'll be your personal tutor guiding you through easy-to-follow lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home.
Just watch the videos, follow along and start putting an end to your elbow pain today.
Learn more, and get started here: Tennis Elbow Self-Help Program