The tennis elbow strap, also known as a counterforce brace, is a non-invasive device for managing discomfort associated with tendon irritation in the elbow joint. It addresses lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow), which involve irritation at the tendon attachment points on the outside or inside of the elbow bone. This simple strap offers immediate, temporary relief by reducing the mechanical forces that pull on the irritated tendons during forearm activity. It is intended to be used as a support tool during tasks that typically cause discomfort, allowing individuals to maintain activity levels.
How Counterforce Bracing Works
The primary function of a counterforce brace is applying targeted compression to the forearm muscle belly below the elbow joint. When the wrist and hand muscles contract, they generate significant force that transmits through the tendon to its anchor point on the epicondyle, which is the site of pain. The strap acts by applying pressure to the muscle tissue, effectively creating a new, artificial insertion point for the muscle-tendon unit.
This compression redirects the muscular forces away from the irritated tendon origin on the bone. By distributing the load over a wider area of the forearm muscle, the strap reduces the localized strain at the damaged tendon attachment. This mechanism lessens the stress placed on the irritated tissue, resulting in a noticeable reduction in pain during gripping or lifting activities. The brace does not heal the underlying condition but instead alters the force dynamics to provide symptomatic relief during use.
Precise Placement and Securement
The effectiveness of the strap relies entirely on its precise placement, which should be on the muscle belly and not directly on the bony prominence of the elbow. To find the correct position, first locate the point of maximum tenderness, which is typically the irritated tendon attachment on the outside or inside of the elbow. The strap must be placed approximately one to two finger-widths, or about one inch, toward the wrist, below this most painful spot.
If the pain is on the outside of the elbow (lateral epicondylitis), the padded section of the strap should rest over the forearm extensor muscle group on the top of the forearm. Conversely, for medial epicondylitis (pain on the inside of the elbow), the strap must be rotated so the pad is positioned over the forearm flexor muscle group on the underside of the forearm. The cushioned part of the brace must be situated directly on the muscle tissue, not over the bone or the joint crease.
To secure the strap, extend the arm straight out and gently flex the forearm muscles as if making a fist, which helps to identify the muscle belly. Fasten the strap while the forearm is relaxed to ensure a proper fit without excessive constriction of the muscles. Once secured, the strap should remain stationary during forearm movement and should not slip down toward the wrist or up toward the elbow joint.
Determining Correct Tension and Duration of Use
Setting the correct tension is important for both safety and effectiveness, requiring a balance between support and circulation. The strap should be snug enough to remain in place and provide a tangible reduction in discomfort when the forearm muscles are activated. However, it must not be so tight that it restricts blood flow or causes discomfort at rest.
Signs that the strap is fastened too tightly include:
- Sensation of numbness, tingling, or throbbing in the hand or fingers below the brace.
- Skin below the strap showing discoloration, such as becoming pale or blueish.
If these symptoms occur, the brace must be immediately loosened. The appropriate tension is achieved when the strap provides counterforce during activity yet feels comfortable enough for extended wear without causing circulatory or neurological symptoms.
The counterforce brace is intended to be a support tool. It should primarily be worn during activities that involve repetitive gripping, lifting, or forceful forearm movements that typically provoke pain. Wearing the strap during periods of low activity, such as resting or sleeping, is discouraged as it can lead to muscle dependency and negatively affect circulation. Using the strap selectively during high-demand tasks helps to manage the load on the tendon while allowing the tissue to rest and recover during periods of inactivity.