ArmLock FAQs
Some frequently asked questions about the ArmLock.
How do I know if the ArmLock brace is right for me?
- You have been assessed by a health care professional and have determined that it is not a ligament issue, (radial collateral ligament), or an elbow arthritis issue or an issue stemming from the nerves in your neck or arm.
- Your tennis elbow stems from repetitive tasks: Gripping, pinching, squeezing or holding your fingers on a mouse or keyboard.
- You reviewed the self-assessment test and have confirmed that you have tight dorsal forearm musculature.
- Your condition has been longer than two months in duration. The active inflammatory stage has come and gone.
Can I use the ArmLock to prevent getting work-related (tool use, computer mouse use) tennis elbow?
Yes! If your work is very demanding of your hands and arms, the ArmLock is designed to help keep your muscles and tendons limber.
Is the ArmLock covered by my insurance plan?
The ArmLock is a licensed medical product covered by many health care plans in Canada. It has a rigid component which is often required for bracing coverage. A prescription as well is often required. It is best to contact your specific insurer to see what is required.
My ultrasound shows that I have a tear. Will stretching tear it more?
This is a very reasonable fear, but it is extremely unlikely. Based on the cross-sectional area of the common extensor tendon (tennis elbow tendon) and the general strength of human tendon, we know that its strength is between 200 to 400 pounds, meaning it would take 200 to 400 pounds of tension before tensile failure (a tear or rupture). The ArmLock applies at maximum approximately 0.5% of this tension, roughly equivalent to the tension applied to tendons during yoga. And this is only at the beginning when the ArmLock is first applied! As you relax with it, the tension goes down in the muscles as the crimp is pulled out of the tendon. You are in control! Keep it gentle. It is the strong ballistic movements that cause muscle and tendon tears, no gentle passive stretches.
Is heat good to use with the ArmLock?
Yes! If you have an electric blanket or a hot water bottle, putting it on the back of the forearm does help stretch the tissues. It is not essential, but helpful.
How long before I start to feel better?
Based on research from the University of Alberta, patients had increasing, progressive improvement over the 12 weeks of the study. What I have found with my patients, however, is quite a varied response. Some get remarkably better after just a few days. Some have to stick to the program longer to feel the effect. What has to be emphasized is that it takes time for the body to respond to a physical stimulus, and that this time is different for every person. One workout with weights will not bulk you up. One yoga session will not make you more flexible. But if you stick with it, you will see a noticeable difference. Similarly, 30 minutes with the ArmLock, day by day, week by week, can make a huge difference.
How should I feel after stretching for 30 minutes?
The release of the stretch can be more uncomfortable than the stretch itself. It often takes several minutes for the arm to “bounce back”. This is normal. After several days, this gets easier and easier and the muscles loosen up. First time is the worst! I suggest that you start with 10 minutes the first day and build up from there.
Educational FAQs
Curious about the science behind the ArmLock?
If my ultrasound does show a tear, will stretching even help?
Just as a leg fracture (after resting for several weeks) requires progressive loading to make the bone stronger, tendons also require tension to stress the injured area into healing. In the chronic state of tennis elbow, rest is not enough. The cells are present within the “tear” already, they just need to be tensioned to tell them to get stronger. You can learn more about this here.
Is longer than 30 minutes better?
We do now know. That would require another study.
Is stronger tension better than gentle tension?
No! If you go too aggressive, you will not stick with the program. It may also irritate more than facilitate healing. We want a gentle amount of tension: 1 to 2 pounds. Do a test by attaching the ArmLock strap to a weight of 1 to 2 pounds and then pull on it gently until it moves. This is how gentle you need to be when fitting the brace around your bicep. This therapy is a low load prolonged stretch. Duration is the key to getting the muscles to relax and to stimulate healing (there is a lot of research related to this!). The key takeaway is duration matters more than stronger tension!
Why stretch with a tight, closed fist?
Prior teachings suggested overuse of the wrist extensor, specifically Extensor Carpi Radialis Brevis (ECRB), as the primary culprit of tennis elbow.(17) The finger extensors, however, constitute up to 45% of the wrist extension moment potential.(18) Anatomical dissection has found that both the wrist extensor, specifically ECRB, and the finger extensors (EDC) converge to form a common tendon. It could be inferred therefore that any pathology associated with the wrist extensor origin would therefore have to be treated as common to both the EDC and ECRB.(17) A more recent anatomical analysis analyzed thirty-nine cadaver arms and found that the index and middle finger extensor tendons converged with the wrist extensor (ECRB) at the lateral epicondyle, whereas the ring and little finger did not.(19) Therefore, a contraction of either muscle group, wrist extensor or finger extensor, independent of the other, or pathological shortening in response to repeated trauma, would increase tension on the common extensor tendon, and in the case of tennis elbow, elicit pain. A study of tennis elbow patients looked at pain on resisted extension of the middle finger (Maudsley’s test) which was found to be positive in a significant portion of the subjects with tennis elbow. (20) Their conclusion was that the finger extensors may play a greater role in tennis elbow than previously appreciated. In managing tennis elbow, the importance of targeting the finger extensors becomes unmistakable.
How do soft tissues, such as tendons, heal?
Soft tissues like tendons, ligaments, and fascia heal by gradually adapting to mechanical stress. This process is often explained by Davis’s Law, which describes how fibrous connective tissue remodels in response to controlled tension, much like bone adapts under load according to Wolff’s Law.
For tendon remodeling to occur, the tissue must be exposed to enough strain for a long enough duration to stimulate change. Research suggests that this may require approximately 4% elongation of the collagen tissue. That level of stretch can be achieved through low load tension over a longer period, or through higher loads for a shorter time, but the latter may increase the risk of re-injury.
This is why rest alone or prolonged protective splinting may not provide enough mechanical stimulus for optimal tendon recovery. In many cases, a carefully controlled tensioning approach may better support healing and remodeling.
How does a low-load, prolonged stretch affect pain?
The sustained, gentle stretch provided by the ArmLock is like yoga for the arm. By allowing the arm to experience “safe discomfort”, the brain accommodates to this tension, allow the nervous system to “relearn” that tension is not inherently threatening. If you’d like, you can learn more in this article.
Is there more than one kind of tennis elbow?
Absolutely! There are several reasons for pain on the outside of the elbow. This is why a thorough assessment by a skilled medical practitioner is essential! The ArmLock is very specific for repetitive strain induced tennis elbow, specifically pain from repeated gripping, squeezing, carrying, pinching, mousing or keyboard work. Note that all these activities involve repetitive muscle contractions, which can lead to some very restricted forearm musculature. If you’d like, you can learn more in this article.