Gardener’s Elbow……Is that a thing?

Well not technically.  Gardener’s elbow is not a medical condition but it refers to a multitude of problems in the forearm and hand that you can experience at this time of year while catching up on yard work and planting your garden.  

You may be familiar with back and shoulder pain that can accompany yard work but wrist, hand and elbow pain can stop you in your gardening tracks.  It commonly happens at this time of year when you go full throttle into gardening activities after months of winter activity that did involve using these muscles with nearly as much effort or frequency.

What is Gardener’s Elbow?

Gardener’s elbow can be a combination of symptoms of tennis elbow, golfer’s elbow or both from gardening or yard work.  

1. Golfer’s Elbow: ( Medial Epicondylopathy)

Pain in your inner elbow when your palm faces forward.  This is where the tendons of your wrist and hand that help you flex your wrist and grip attach.

2. Tennis Elbow: (Lateral Epicondyolopathy)

Pain in the outer elbow when your palm face forward. This is where the tendons and muscles of your wrist and hand that help to extend your wrist attach.

3. Gardener’s Elbow

Symptoms of Gardener’s elbow could be either or both of the above.  Pain can even be located in the n the thumb and finger when such overuse injuries can involve overuse of the finger and thumb muscles.

Gardener’s Elbow Causes

These conditions are due to overuse and repetition combined with lack of preparation for the muscles, tendons and other connective tissue in our body to do the work.  Gardening and yard work often entail specific types of activity like shoveling, gripping tools, and carrying heavier weights/loads.

Symptoms of these conditions include:

• –Stiffness/Soreness-can last for several days even after gardening
• –Weakness/Fatigue—you start to feel less grip strength, holding tools or carrying
• –Burning/stabbing—pain that is apparent with activity or at rest in your elbow, wrist, hand, fingers or thumb

Activities can cause Elbow, Hand, Forearm or Wrist Pain

1. Carrying and Lifting

Carrying and lifting bags of soil, fertilizer, mulch, buckets of water.  When your shoulders and larger muscles groups are not strong enough to support the weight, you may take up the slack with the small joint/muscles of the wrist and forearm.  

Think about what you might do if you are carrying a bag that is slipping slowly out of your hands. Usually you will grip the bag harder and more forcefully with your fingers and hands.  If you are doin this repeatedly without attention to how much you are gripping, the repeated gripping can lead to elbow pain.

2. Digging and Pulling

Digging and pulling weeds can cause pain for many of the same reasons as above.  We often apply more force in the hand and fingers in our attempts to get the work done or if the soil is hard and resistant to movement.  

3. Gripping and squeezing

Repetitive gripping and holding can cause deconditioned muscle to get tight and painful because you are requiring them to repeatedly contract and relax with high frequency.

How do overuse injuries happen?

Here is usually the sequence of events that occur with overuse injuries:

1. Muscle Tension

Less than ideal postures can cause our muscles to compensate.  We can also do small motions over and over causing muscles to hold increased tension.  

2. Muscle Adhesion

When the muscles and tissues are tight for increased periods of time, we can’t just stretch the tissue out.  The tissues that get stuck—this can happen over time but more quickly in areas that are tight and fatigued. With prolonged tension, comes decreased circulation to the area and decreased oxygen to the tissue.  This causes the collagen fibers that make up the tissue to gradually stick together. The more adhesion, the more the muscle becomes restricted.

You can’t just relax the muscle at this point, you may need to coax it to change.  This is where physical therapy can come into help. The extra time that you take at this stage can help you to prevent the next step.

3. Tendon Damage (Tendonitis)

In the beginning, the pain may be intermittent or fleeting.  Stress to the tendon happens gradually over time. Pain in the initial red flag that something is wrong.  If we pay attention and rest it, there can be recovery without damage though there still may be weakness. We usually choose to ignore the pain though and this is where the problem can come in.  With continued stress, the healing process fails and can lead to a state of degeneration.

4. Tendonosis/Failure

Unfortunately this is what most chronic tendon injury suffered are facing.  If you had had pain for 4-6 months, you may be experiencing degeneration or this stage of dysfunction.  Instead of regeneration, you get degeneration.

CHANGING TREATMENT APPROACH

While RICE (Rest, Ice, Compression, and Elevation) used to be standard protocol for these types of injuries, the jury is still out and recent research is supporting the following:

LIMIT use of the following:

• —Oral medication based anti-inflammatories: They can suppress inflammation which is needed for healing.  Instead consider natural anti-inflammatories like tumeric, ginger, and other spices can be helpful in anti-inflammatory management but don’t prevent the inflammatory process fro happening.  
• —Icing: Ice can help with pain and severe inflammation but ice long term can reduce circulation which can also limit the inflammatory process.  Use it if needed for pain and severe inflammation but consider but consider heat to the area if the issue becomes more chronic and the area feels stiff.  Warm the area regularly to stimulate circulation.
• –Lotions and creams: Putting creams on to numb or decrease pain may psychological feel like they are helping but typically they irritate the skin and serve a counter irritant that distracts our brain from the pain.
• –Cortisone shots: These can be damaging for tendons.  Recent research and literature report that steroid injections could be damaging to tendons and mask the dysfunction which can be damaging to the healing process as well
• –Braces and splints: Support can lead to additional scar tissue. Compression can cause more adhesions in the process mentioned above. Tendons often heal slowly due to low blood supply.  Immobilizing them decreases their blood supply. In the case of a tear, the area may need to be protected with a brace. Allowing the area be to freely moving may encourage gentle activity with rest and limited movement would still allow circulation and the tendon to heal slowly.

CONSIDER INSTEAD these Treatment Approaches

• –Avoid repetitive motion to the area that caused the injury not avoid moving the area at all.
• –Mobilize the areas with care.  Try gentle massage to the muscles in the forearm and hands to facilitate blood flow and circulation but not to the point of pain.
• –Gently stretch and move the wrist and hand instead of immobilizing them with a brace.
• –Refrain from freezing or over icing the muscle and tissue.  Use ice to control only excessive inflammation.
• –Try warming the arm in the shower or under the faucet to stimulate circulation.
• –Allow the inflammatory process to run it’s course instead of suppressing it.
• –Speak with a professional for more specific instruction and more treatment that is tailored to fit your needs.

AVOID Overuse Injuries by:

1. 1. Taking breaks to stop and rest when you are working outside especially if you are just getting started this season.  Stop the problem before it begins.
2. 2. Stretching in a preventative fashion to ensure that you optimize your muscle tension before, during and after your tasks.  
3. 3. Taking an Epson salt bath to soak after your work.  Magnesium in the Epsom salt can help to relax the muscles decreasing muscle tension.
4. 4. Considering how much you are using the small joints and muscles of your wrist and hand relative to your shoulders and your core.  You may be weak in the shoulder and legs and overdoing the work with your small joints because they don’t have the support from the core, shoulders and legs.  Remember it’s all connected!
5. 5. Listening to your body! If you are starting to feel these symptoms, your body is sending you a warning sign to make a change.  The therapists at Rebalance can help you figure out the best plan of attack to solve the problem.

If you are experiencing these symptoms, physical therapy can help.  Click here to set up a complementary phone consultation to discuss your symptoms with one of our therapists.

Reference: Web reference; Allen Willette. How Gardening Causes Elbow Pain and how to Treat it.  Tennis Elbow Classroom. March 28, 2019