Table of Contents

1. Introduction
2. Understanding Lateral Epicondylitis
3. Recognizing the Symptoms
4. Effective Treatments for Lateral Epicondylitis
   • Ice Massage
   • Cross-Friction Massage
   • Wrist Extension Isometrics
   • Wrist Flexion Isometrics
   • Eccentric Exercises
   • Wrist Flexion/Extension Stretches
5. Useful Products for Bowhunters
6. Smart Modifications to Your Routine
7. Summary

Introduction

As archers and bowhunters, we’re all familiar with the thrill of drawing a bow, locking onto a target, and experiencing that adrenaline rush as the arrow finds its mark. Yet, if persistent elbow pain has cast a shadow over this thrill, we understand the frustration and discomfort it brings.

In this blog post, we’ll delve into a prevalent concern for archery enthusiasts: elbow pain, specifically lateral epicondylitis, and explore effective strategies to manage it, ensuring continued hunting pursuits with reduced discomfort.

Lateral epicondylitis, commonly known as tennis elbow, is a frequent issue for bowhunters. However, with a well-structured and consistent routine incorporating progressive exercises, this condition can be addressed, allowing a full return to the joy of bowhunting with confidence and less pain.

Understanding Lateral Epicondylitis

Lateral epicondylitis, commonly known as “tennis elbow,” arises from the repetitive strain placed on the forearm extensor muscles.

For passionate bowhunters, the repetitive motion of drawing and releasing the bowstring can lead to micro-tears in the forearm’s muscle and tendon junction, resulting in the persistent pain characteristic of lateral epicondylitis.

This condition is characterized by pinpoint tenderness at the lateral epicondyle of the humerus, located just above the elbow joint on the outer side of the arm—hence the term “lateral.”

Bowhunters, particularly feeling the impact in the elbow of their draw (or dominant) arm, endure this discomfort due to repetitive stress on the forearm extensor muscles, particularly the extensor carpi radialis brevis muscle, though other muscles may also be involved.

Recognizing the specific muscles at play is key for crafting an effective treatment plan, a task in which a skilled physical therapist plays a crucial role. Collaborating with a physical therapist not only helps pinpoint the exact muscles contributing to the elbow pain but also establishes the groundwork for a personalized and efficient recovery strategy.

It is essential to identify the root cause of the pain rather than merely addressing the symptoms. This approach expedites the recovery process and ensures a swift return to the tree stand, unencumbered by the constraints of discomfort.

A knowledgeable physical therapist becomes an indispensable ally, not only in recognizing lateral epicondylitis symptoms but also in guiding individuals toward a comprehensive and enduring recovery.

Recognizing the Symptoms

To alleviate discomfort in the elbow, it’s crucial to be aware of specific signs and symptoms linked to lateral epicondylitis. These indicators can manifest swiftly after an extended practice session or gradually over time as the muscles endure repetitive stress.

1. Pain with Gripping and Shooting

Pain associated with gripping and shooting is commonly centered on the outer part of the elbow and may extend into the forearm during these activities.

The sensation can vary, ranging from sharp and stabbing to a more persistent, achy dullness along the affected forearm and elbow. Notably, this discomfort is not limited solely to moments involving archery; it can manifest during everyday activities such as brushing teeth, holding a cup, or typing on a computer.

There are effective strategies to help manage and alleviate this discomfort. We’ll explore these in a few minutes.

2. Decreased Elbow Range of Motion

Pain can significantly impact muscles and tendons, leading to a cascade of effects that compromise the range of motion at the elbow. When discomfort arises, muscles and tendons may tense up, creating tightness that restricts the natural movement of the joint.

This decreased flexibility not only hampers the fluidity of motion but can also trigger compensatory patterns to cope with the pain. 

In the context of shooting a bow, these compensations can manifest as altered body mechanics, potentially placing undue stress on other muscle groups and joints. Such compensation patterns not only compromise the precision required for accurate shooting but also elevate the risk of injury.

The strain imposed on the musculoskeletal system, particularly the tendons and associated structures, increases the vulnerability to conditions like tendinopathy and other overuse injuries, such as lateral epicondylitis. 

Addressing pain promptly and implementing strategies to restore proper range of motion is crucial for maintaining optimal performance and minimizing the risk of injury when engaging in activities like bow shooting.

3. Decreased Grip Strength

Grip strength serves as a valuable predictor of overall strength and conditioning, as well as a “useful indicator of overall health,” a point emphasized in this comprehensive literature review.

For individuals grappling with lateral epicondylitis, a decrease in grip strength is a significant concern, second only to the pain experienced at the lateral elbow.

If decreased grip strength occurs, a release with a wrist strap emerges as a beneficial solution. By employing such a release, the demand on the wrist and finger extensor musculature decreases, subsequently reducing stress on the hand, wrist, and finger extensor muscles.

Neglecting the pain at the lateral elbow can lead to strength deficits that hinder success in archery and bowhunting. Don’t let lateral epicondylitis stand in the way of tagging your target buck this winter.

4. Pain at the Lateral Elbow

As anticipated, lateral epicondylitis can be quite painful and, understandably, it occurs most frequently in the dominant arm. This observation is supported by the American Academy of Orthopaedic Surgeons.

While lateral epicondylitis commonly impacts the draw arm for bow hunters, it’s important to note that it can indeed affect both arms. The repetitive actions of gripping and drawing the bow contribute to the development of lateral epicondylitis symptoms.

5. Pain with Extending Index and Middle Fingers

A practical method for assessing whether lateral epicondylitis is the underlying cause of elbow pain involves the use of Maudsley’s test. This straightforward and commonly employed clinical tool helps determine if an individual’s pain corresponds to lateral epicondylitis.

To conduct the Maudsley’s test, resist the extension of the middle (3rd) finger of the hand. This resisted movement places stress on the extensor digitorum muscle and tendon, typically causing discomfort at the lateral epicondyle of the humerus, just above the outer part of the elbow. A “positive” result occurs when the test reproduces pain at the lateral elbow.

It’s important to note that this blog post is intended for educational purposes only and should not be considered a diagnostic tool or a substitute for medical advice. If you have concerns about your symptoms, it is recommended to consult with your local primary care physician.

Now that we have identified the symptoms and understood the problem, let’s explore practical tips for effectively managing and alleviating elbow pain.

Effective Treatments for Lateral Epicondylitis

Various treatment options are available to alleviate elbow pain caused by lateral epicondylitis. It’s essential to recognize that different individuals respond uniquely to these treatments. I often emphasize to my patients that what proves effective for one person may not yield the same results for another.

However, in the case of lateral epicondylitis, a gradual exercise program focusing on the strengthening of the wrist and finger extensor musculature, along with comprehensive arm strengthening, tends to yield the best results and long-term outcomes.

Let’s explore a few treatment options that have demonstrated efficacy in reducing pain associated with lateral epicondylitis.

1. Ice Massage

Ice massage proves highly effective in managing lateral epicondylitis pain, primarily because the discomfort is often localized to a specific area. This method is particularly beneficial for addressing pain in smaller regions of the body, and lateral epicondylitis typically responds well to the analgesic effects of ice.

Here’s a simple way to perform an ice massage:

Fill a Styrofoam cup about ¾ full with water and place it in the freezer. Once frozen, tear off the bottom of the cup to expose the frozen ice. Hold the top of the Styrofoam cup (rather than the ice itself) while massaging the affected area for 5-10 minutes.

An ice massage typically progresses through four phases:

1. Cold: The initial sensation is obviously the cold.

2. Burning: As you rub the ice in small circles, the area may feel like it’s burning.

3. Aching: Following the burning sensation, an ache may develop. Keep going!

4. Numbness: The final phase during an ice massage. Ah! Finally, finished.

These phases can be remembered by the acronym CBAN (Cold, Burning, Aching, Numbness). The entire ice massage process usually takes 5-7 minutes, making it a convenient option for those with busy schedules or a lack of patience for longer ice pack sessions.

These reusable ice cups available on Amazon can help save money!

2. Cross-Friction Massage

Optimal healing relies on a sufficient blood supply, and increased blood flow is key to effective pain relief and recovery in musculoskeletal conditions. Blood carries essential oxygen and nutrients to the tissues, fostering the healing process.

A cross-friction massage is a great method to enhance blood flow to the wrist and finger extensor musculature. These muscle fibers run lengthwise along the forearm. To stimulate blood flow effectively, perform a gentle massage perpendicular to the direction of these fibers, promoting healing.

Here’s how to conduct a cross-friction massage:

1. Apply a small amount of coconut oil or unscented lotion to the affected area.

2. Use a blunt object, such as the handle of a butter knife, to apply pressure in a perpendicular direction to the muscle fibers of the wrist and finger extensor musculature.

3. Apply firm pressure and rub back-and-forth for 3-5 minutes, or as tolerated.

It’s important to note that increased redness in the treatment area is a normal response and indicates an increase in blood flow— a positive sign for healing. When done correctly, this technique should not cause bleeding or heightened pain.

Tools like these are VERY handy for massage techniques.

3. Wrist Extension Isometrics

Isometric exercises involve holding a weight in a fixed position, causing the muscle to work without any movement in the arm, hand, or wrist.

Unlike concentric and eccentric muscle contractions where the muscle fibers shorten or lengthen, isometric exercises keep the muscle in a stationary state.

This type of muscle contraction is generally non-painful, applying sufficient stress to the muscle and tendon to stimulate blood flow and kickstart the healing and strengthening processes.

Here’s how to perform wrist extension isometric exercises:

1. Place your forearm on a table with the hand and wrist hanging off the side.

2. Hold a dumbbell or hammer in your hand, keeping the wrist up parallel to the forearm.

3. In this position, the wrist extensor musculature engages in an isometric contraction while holding the weight in a static position.

4. Hold this position for 30 seconds, then rest for 1-2 minutes, and repeat this process 5 times.

It’s crucial to emphasize that pain should diminish with each repetition. Gradually increase weight or resistance within the bounds of discomfort tolerance.

Based on past experiences, individuals often mention experiencing mild to moderate discomfort during the initial repetition, which tends to decrease to a mild level in subsequent repetitions.

4. Wrist Flexion Isometrics

The wrist flexion isometric exercise is performed in a position similar to the wrist extensor isometric exercise, but with the palm turned up towards the ceiling.

Here’s how to do the wrist flexion isometric exercise:

1. Place your forearm on a table with the hand and wrist hanging off the side, palm facing up.

2. Hold a dumbbell or hammer in your hand with the palm facing up.

3. Perform an isometric contraction by holding the weight in a static position for 30 seconds.

4. Rest for 1-2 minutes and repeat this process 5 times.

It’s essential not to overlook the other muscles in the forearm during the recovery process. Incorporating exercises for wrist flexion and shoulder movements is crucial for achieving a comprehensive and full recovery.

5. Eccentric Exercises

Eccentric exercises are highly effective in alleviating symptoms associated with lateral epicondylitis. In eccentric muscle contractions, the muscle fibers lengthen while maintaining control over resistance throughout the entire range of motion.

These exercises have demonstrated effectiveness in enhancing strength, making them particularly advantageous for addressing tendinopathy and diverse musculoskeletal conditions.

To perform an eccentric muscle contraction for the wrist extensor musculature:

1. Place your arm on a table with the hand hanging just off the side, similar to the position for the wrist extension isometric exercise.

2. Hold a dumbbell or hammer in your hand with the palm facing the floor.

3. Use the opposite arm to assist in extending the wrist and lifting the weight towards the ceiling, keeping the forearm flat on the table.

4. Once you reach full wrist extension, release the weight with the opposite hand and slowly lower it in a controlled manner.

5. Utilize the opposite arm to assist the hand and wrist back to the starting position.

6. Repeat this process 12 times, rest for 1-2 minutes, and perform 3-4 sets.

It is advisable to advance to eccentric exercises as early as feasible, often guided by pain levels. An all in one dumbbell set is highly recommended for home gyms – and this adjustable dumbbell set is the best on the market. 

6. Wrist Flexion/Extension Stretches

Lateral epicondylitis can lead to tightness in the wrist extensor musculature, restricting movement in the hand, wrist, or elbow. Gentle and progressive wrist flexion/extension stretches are crucial for promoting healing in this area.

Start with wrist flexion/extension stretching with the elbow bent. As pain and soreness improve, progress to stretching with the elbow straight. Use the opposite upper extremity to flex and extend the wrist, adjusting to your comfort level.

Hold each stretch for 15-20 seconds, repeating 2-3 times. Incorporate these stretches several times throughout the day, based on your tolerance.

My personal routine begins with a brief cross-friction massage to enhance blood flow and warm up the tissue. Subsequently, I engage in isometric exercises targeting both the wrist extensor and flexor muscles. If I observe improvement in pain, I may progress to wrist extension exercises. Once I achieve a satisfactory muscle pump through these exercises, I conclude the session with a cool-down, incorporating static stretches, each held for 10-15 seconds.

Useful Products for Bowhunters

While strengthening and stretching exercises stand as the primary treatment for lateral epicondylitis, several products can assist archers in alleviating elbow pain, enabling them to continue enjoying bow shooting and hunting season with reduced discomfort.

1. Epicondylar Counterforce brace

These affordable braces enhance comfort during activities that aggravate lateral epicondylitis, like shooting a bow.

Placed perpendicular to the muscle fibers at the wrist extensor musculature’s muscle belly (1-2 inches below the elbow), they offer support and reduce strain during shooting.

Counterforce braces absorb and redistribute forces along the wrist extensor musculature, reducing pain and promoting healing.

Caution: Avoid overtightening to prevent further pain and nerve injury.

2. Alternative Release with Wrist Strap

Compound bow shooting requires the use of a release aid, and preferences vary. Index finger releases, which come with a wrist strap, and handheld, hinge, or resistance-activated releases without a wrist strap are available.

While some argue that non-wrist strap releases are more accurate, they can be challenging to master and may increase the risk of developing lateral epicondylitis.

Using a release with a wrist strap has the potential to alleviate stress and pain at the lateral elbow, facilitating the ability to continue shooting.

3. Kinesiotape:

Application of kinesiotape along the forearm extensor musculature can benefit certain individuals.

Applied parallel to the muscle fibers and running the forearm’s length, kinesiotape supports the musculature, improving comfort during aggravating activities.

Similar to counterforce braces, kinesiotape is a valuable tool for managing lateral epicondylitis and can be a helpful addition to your toolkit.

I am fully supportive of exploring solutions to alleviate pain, and if an affordable product can effectively reduce pain and enable continued activity, it is certainly worth giving it a try.

Smart Modifications to Your Routine

Finally, we’ll explore adjustments and practices that can significantly contribute to managing and alleviating lateral epicondylitis, commonly known as tennis elbow, for archers and bowhunters.

These modifications range from reducing shooting volume and incorporating alternative strength training to adjusting draw weight.

1. Decrease Shooting Volume

Lateral epicondylitis often results from repetitive activities that strain the hand and wrist muscles. Archers and bowhunters, shooting high volumes of arrows in one session, are at increased risk.

If one experiences lateral elbow pain during or after shooting, consider reducing the number of arrows per session or taking a break for a few days. Use this time for other hunting preparations, such as setting up tree stands, trimming trees, or scouting.

Short-term rest promotes healing, reducing the risk of chronic elbow pain.

2. Focus on Alternative Strength Training

If lateral elbow pain hinders bow shooting, alternative strength training can address deficits elsewhere. Research suggests that weakness in the rotator cuff muscles is often present with lateral epicondylitis.

Refine upper extremity muscles, especially the shoulder girdle, to expedite recovery and lower long-term injury risks.

Improved general strength and conditioning enhance accuracy, leading to more successful hunts. Alternative exercises targeting the core, legs, and hand-eye coordination maintain peak condition without heavy gripping.

3. Decrease Draw Weight

Lowering draw weight is a strategy to alleviate lateral elbow pain and resume shooting. Reduced draw weight lessens stress on hand and wrist muscles, easing discomfort and fostering healing.

As elbow pain diminishes, gradually increase draw weight over a week or two to prevent exacerbation. Patience and consistency are crucial in managing lateral epicondylitis.

By incorporating these modifications, treatments, and products into a normal daily routine, one may relish the outdoors without elbow pain secondary to lateral epicondylitis. 

Summary

In this blog post, the prevalent concern of elbow pain, specifically lateral epicondylitis, affecting bowhunters has been addressed. By examining symptoms, causes, and providing practical tips, archers and bowhunters are prepared to navigate the woods with enhanced accuracy in the upcoming hunting season. These guidelines create a path for enjoying the great outdoors without the hindrance of elbow discomfort, enabling the pursuit of passion with renewed confidence and enduring comfort.

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