Are Your Tendons Gasping for Breath? Tips to Regain and Maintain Health of the Upper Limb

Tennis elbow, of course, isn't limited to tennis players. It's fairly common in the martial arts community, and I certainly warded off my own cases of the affliction during years of practice with a heavy sword. Rock climbers, rowers, golfers, weight lifters, manual laborers and even medical staff, parents and caregivers (who have to lift infants or patients) are often afflicted with tendon pain in the elbows, wrists or shoulders.

In addition, there's been an interesting trend in our clinic with "spontaneously generated" tennis elbow, unrelated to athletics. "It just happened!" is a refrain I am hearing in an unusual number of cases. A big part of our job as acupuncturists is trying to get to the root cause of any condition, so it's not easy to ignore this kind of "mystery."

"Tendinitis" vs. "Tendinosis"The suffix "-itis" refers to inflammatory conditions, and for a long time it was assumed this was the case with a tender, painful tendon disorder like tennis elbow. However, this view was updated about three decades ago, and now we know that tennis elbow and similar forms of "tendinosis" or "tendinopathy" are actually a degenerative condition. For reasons that can have to do with both over- and underuse, the tendons are gradually losing the elasticity and alignment of the collagen (tendon proteins) which is necessary for proper function.

Often tendinosis is painless for some time, but as it progresses, the body's pain receptors start to kick in as a warning system. Your innate intelligence is saying, "Please do something different, before this tendon breaks down so much that it ruptures!"

​Unfortunately some physicians still have not incorporated the updated view of tendinopathy and will treat this type of pain with NSAIDs (aspirin, ibuprofin, naproxen etc) and corticosteroid injections. Both of these approaches actually increase the risk of further degeneration and even tendon rupture, by contributing to collagen degeneration and preventing its proper repair.

On the other hand it's possible that systemic inflammation can play a role in tendinopathy. Poor diet, stress, smoking, alcohol, and other chemicals can affect the ability of collagen to properly remodel after the microtearing associated with repetitive strain. At its worst, systemic inflammation actually contributes to a "hypoxic" environment in the body, meaning your tissues are starving for oxygen. For this reason, to enable healing and proper tissue repair we always we recommend eating an organic, anti-inflammatory diet (low in sugar, refined carbs and cheap vegetable oils) and avoiding exposure to chemicals as much as possible. Supplements like turmeric, ginger, boswellia and fish oil can assist in mitigating systemic inflammation without inhibiting tendon repair. Acupuncture can also help balance the body to address systemic inflammation.

Some antibiotics, particularly the Cipro family, are also known for causing rapid collagen degeneration and even tendon rupture. On the regular I'll see a "spontaneous" case of tendinopathy, such as tennis elbow or plantar fasciosis, arrive in clinic a month or two after the patient has taken a course of antibiotics.

Neurovascular compression and hypoxiaA noted characteristic of tendinopathy is hypoxia, meaning the collagen degeneration is associated with a lack of oxygen reaching the tissue. As acupuncturists we specialize in restoring proper circulation and oxygenation to the body. The most common structural causes of hypoxia in the upper limb that we see include: 

Forward-rotated shoulder posture 
Forward head posture; and 
Keeping the elbow in a flexed position for much of the day.

This trifecta of modern posture very effectively closes off proper circulation in the upper limb. One of our first tasks during an acupuncture treatment for tennis elbow and similar conditions is to open up the neck and shoulder, improving oxygenation and the quality of nerve conductivity to the arm. Just this can help a great deal.

We also select points related to the pathway of pain, and sometimes will needle directly into the tendon insertions and add direct moxibustion. The acupuncture needles create a micro-dose of "positive" inflammation that can stimulate better local circulation to the tendon attachment. It usually takes several treatments but acupuncture does help this condition heal nicely, especially when combined with an anti-inflammatory diet, postural correction and movement therapies.

Corrective measures for posture
Tennis elbow and other similar tendinopathies are your body's cry for help to change something about your movement patterns. Considering that forward-rounded shoulders, forward head posture and perpetually flexed elbows is a common feature of modern life in most of us, and a likely contributor to hypoxic tissues, let's talk about some ways to reverse this.

My acupuncture teacher Kiiko Matsumoto gives the following advice to open up the neck, shoulders, and elbows: Try to sit with your palms up as much as possible. This means pretending you are holding a bowl in the palms of your hands, letting the backs of your hands fall to your lap near your torso. If you do this properly you can feel the bottom edge of the shoulder blades move together, opening up the shoulder joints. When I've been typing or working over the treatment table for a while and sit this way, I'll feel a gentle stretch in my pectoral area as the corners of my shoulders move apart and back.

To enhance the effect, squeeze your pinky and ring fingers, which helps to activate the under-utilized underside of the arm. Master Kiiko even recommends carrying shopping bags in this fashion-- palm forward, thumb out. It's an antidote to the usual palms down, elbow flexed position.
What other ways can you incorporate to regularly reverse your head forward, elbow flexed, palms down position? We all need to take regular stretch breaks in order to prevent repetitive strain and conditions that result from Qi stagnation. Let's text less, and move more! Here are a few of my favorite strategies. We'd love to hear what works for you.

While typing/using mouse, take the opportunity to straighten and shake out the elbows during "thought breaks" or when your browser is loading.

Keep your head over your shoulders and spine as you use the computer. A good test is whether your ears are in line with your shoulders. Keeping your hips upright, by sitting up on your sits-bones and keeping your tailbone back behind you, will help your upper body line up effortlessly.

The shoulders always creep forward when doing activities in front of the body. So, every few minutes shrug your shoulders and rotate the scapula back again, then let them slide "off" your back.

Type in different positions. If you work at a computer all day, get a standing/movable desk! Sitting all day long, even in the most "ergonomic" position, will hinder proper circulation.

Adjust your car seat and steering wheel to allow a tailbone-back position so that your head can stack over your hips. Your car seat should be almost vertical, and the base of your skull should be able to feel the headrest as you drive. Keep your shoulders down and relaxed, shoulder blades back, and elbows relaxed as you drive.

If driving or using a computer for a long period, take a stretch break at least every hour to gently rotate your wrists, elbows, neck and shoulders. Tension is the enemy! Breathe deeply into the front of your pectorals and neck (Your lungs can actually reach up above the collarbone to give you a great stretch. Try it!)

Bring your smartphone to your face, not your face to your smartphone! And try not using it so much!

So back to that mystery of why so many more "spontaneous" cases of tennis elbow? Well, for the first time since I started practicing, I now find many of my patients are still bent over their smartphones when I come into the room to start their treatment. This might have something to do with it.