The Tennis Elbow Trigger Point Index

This is a list of the muscles that refer pain to the back of your elbow, listed in alphabetical order.  These are the same muscles that mimic pain commonly mistaken for tennis elbow. There are only 10 of them, so go through each one and see if they have trigger points affecting your condition.

The trigger points are marked with green dots and the referred pain patterns are highlighted in red.  Though most of the trigger points presented here have their primary pain associated with parts of the forearm and hand, all of them can cause pain on the outside of the elbow.  Work through them ALL before deciding that you are free of trigger points.

If this helps you and/or you are interested in trigger points, I recommend you buy a copy of Clair Davies’ The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. This excellent work presents the science and information regarding trigger points in layman’s terms, with everything you need to cure yourself of trigger point pain.

Anconeus

The Anconeus muscle is located right behind the elbow.  It works primarily to compliment the triceps’ extension of the elbow, and to support the elbow joint.  It most often gets trigger points when there’s an impact to the elbow, or repetitive elbow motion. 

As the diagram at the side indicates, a trigger point in it sends pain to the back of the elbow.  You can feel it when you rotate your hand to the side, to shake hands or turn a doorknob. Remember, your muscles should feel springy, like freshly cooked noodles.  If this is harder than fresh noodles and hurts, work on it gradually.  Try using your hand immediately after the massage to see if there’s improvement. 

Brachioradials

It is easy to get this confused with the Aconeus muscle and the Supinator, but just work forward of the elbow on the inside of the forearm.  And, when in doubt, if it’s painful and hard, work on it.  You can see the trigger point shown in the diagram to the right with the hand palm up, and the referred pain pattern below.

Extensors
           
The hand extensors are made up of Extensor Carpi Radialis Longus (#1), Extensor Carpi Radialis Brevis (#2), Extensor Carpi Ulnaris (#3), the Extensor Digitorum (#4 & #5), and The Extensor Indicis (#6).  While the Branchioradialis, the Supinator, and the Aconeus muscles also fall into the category of hand extensor muscles, they are individual enough to warrant separate sections.

The extensors have the job of bending back the hand, and the fingers.  Any gripping action or lifting of the hand involves them.  They attach to the Lateral Epicondyle of your humerus and have long tendons that attach the muscles to the fingers in your hand.

The Extensor Carpi Rasialis Longus is one of the muscles responsible for bending the hand back toward the thumb, like lifting a glass to drink, as well as being attached to your index finger.  The Extensor Carpi Radialis Brevis is attached to your middle finger and is responsivle for raising it.  The Extensor Carpi Ulnaris is responsible for movements involving cocking the wrist back and lifting of the little finger. Extensor Digitorum has three different tendons and which attach to and aid in the movement of the middle, ring, and little fingers. The Extensor Indicis attaches to the index finger and is primarily responsible for the index finger’s movement.

A good way to find which muscle you’re pushing on if you’re confused is to place one hand on the back of the forearm while lifting a single finger.  This will give you a good feel for which finger is doing what.  To massage these points, instead of working them with the fingers of your other hand (and thus stressing the forearm muscles on the other side of your body), try placing one forearm on a table the use the other arm’s elbow to press on the trigger points.  Use care if your forearm is especially tender, but by using the boney end of your elbow to massage your forearm and leaning when you massage (using your upper body weight instead of muscle) you can give your other hand a rest and place a good amount of concentrated pressure wherever you need to.  So, track down the painful parts of your muscles and get to work massaging them.

Supinator

This muscle is responsible for turning the hand upward, and assists the biceps when lifting an object upward.  It is made up of two different planes of fiber that work together and between them lays the radial nerve. When the two layers of muscle get tight and hard, it sometimes compresses the radial nerve.  This leads to pain, tingling, and numbness in the hand.  By massaging the tight muscles to relaxation, you can relieve the tension on the radial nerve.

Supraspinatus

The Supraspinatus lifts the arm and works with the other three rotator cuff muscles to hold the shoulder together.  Trigger points in this muscle will make your arm painful and weak, as well as making any overhead movements painful or impossible.  It is located right at the top of the shoulder blade. 

To massage this muscle, reach down and to the opposite hip with the arm connected to the shoulder you are massaging.  This will shift the shoulder blade and give you access to the muscle.  Use a tennis ball, Theracane, or other massage tool to reach the muscle.  If you do not even have a tennis or other hard ball handy (to put in a sock and lean on against a wall) find a corner, such as in a doorway, in your house.  You can press this muscle and others in your shoulder against the sharp angle of the corner if you have no other means of massaging it.

Triceps

This is the large muscle on the back of your upper arm, responsible for straightening your arm.  It attaches to your forearm bone (the ulna) and is one of the muscles most responsible for pain in a repetitive ‘casting’ or ‘swinging’ motion, seen in tennis, fly-fishing, and Japanese swordsmanship.  Hold your arm in front of you and move your forearm back and forth as if doing a ‘karate chop’, and use your other hand to feel the tricep on the bottom of your arm relaxing and contracting.

There are several different trigger points that are common to the triceps.  They are numbered in the diagram at the side, along with their corresponding referred pain patterns.  It should be noted that if any of these trigger points are particularly well established, they can refer pain to the little and ring fingers.  As well as this, if number 3 is tight enough it can compress the radial nerve, and number 4 will make the elbow quite sensitive.   Also, it can be seen that some referred pain goes to the inside of the elbow, which is commonly mistaken for ‘golfer’s elbow’.

There you have it, all the muscles that could cause your tennis elbow pain.  You can now find out more information about trigger points or look at the more orthodox methods of tennis elbow treatment.