Following on from our last post about Golfer’s Elbow, in this blog, we explore its close cousin, Tennis Elbow. What it is… and more importantly how to treat Tennis Elbow.
What is Tennis Elbow?
Tennis elbow is medically known as lateral epicondylitis, extensor tendinopathy or lateral elbow tendinopathy.
Despite the name, this is not a condition exclusive to tennis players. According to Lai, et.al (2018), in the US, only 5-10% of people who present for treatment actually play tennis.
Lateral epicondylitis occurs when there is an inflammation of the tendon whereas lateral elbow tendinopathy is where there is no sign of inflammation.
Both conditions develop due to overuse or overloading of the muscles that are responsible for extension of the wrist, specifically the extensor carpi radialis brevis (ECRB) tendon.
Extension is what happens you bend the wrist backwards. This is in opposition to flexion (bending the fingers towards the forearm). If you have pain when you bend your wrist forwards, you may be suffering from Golfer’s Elbow.
Muscles responsible for extension movement of the wrist have their attachment on the bony part (lateral epicondyle) at the outside of the elbow and it is at this location most people will feel the pain.
When the wrist extends (bends backward) under load the force at the attachment may be more than the tendon can withstand and as a result micro-tears develop in the tendon.
Professions including dentists, carpenters, gardeners and musicians often present with more of these symptoms due to the repeated hand movements required in their jobs.
Damage to the tendon can cause an inflammatory response that leads to pain as well as loss of function to varying degrees.
What Are The Symptoms of Tennis Elbow?
The main symptom is pain over the lateral (outside) aspect of the elbow. This pain is often described as a burning type of pain that if left untreated will get worse.
If the aggravating activity continues, the pain may spread down to the wrist and may also increase in intensity and duration.
Other symptoms can include weakened grip strength and difficulty opening jars.
The cause can be due to either inflammation of the tendon or degenerative changes from wear and tear.
It is not uncommon for acute inflammation to progress and become a chronic condition. This can occur due to incomplete healing of the initial injury, poor blood flow or inadequate treatment.
What Causes Tennis Elbow?
The main reason that Tennis Elbow happens is due to repetitive strain and overuse, such as
- Gripping too tight on a racket
- Incorrect lifting techniques or
- Occupational tasks that involve gripping and lifting.
A sudden increase in volume of work or training can lead to this type of injury since the tendon is not allowed adequate time between force loading to rest and regenerate.
How Do You Diagnose Tennis Elbow?
The diagnosis of lateral epicondylitis or lateral elbow tendinopathy is achieved by taking a thorough client history as well as using a number of special physical tests.
These tests should be performed by a qualified health professional, and may include;
- Resisted wrist extension and resisted extension of just the middle finger. Both these tests will put an increased force through the tendon, so if they reproduce the pain it is considered a positive test.
- ‘Mills manoeuvre’ is a neural tension test that may be used to check for nerve involvement.
- Palpation of the muscle and tendon over the lateral epicondyle to identify tender areas.
In some cases, there may be a need to further investigate using diagnostic tools such as MRI, EMG or X-Ray.
How To Treat Tennis Elbow?
In the acute stage the preferred management/treatment would include
- rest from the aggravation activity
- compression and
- visit to the GP or physiotherapist for diagnosis and more specific treatment.
Rest from the aggravating activity is very important early on. It is an indicator of how successful treatment will be and it has also shown to be very important in preventing acute tennis elbow developing into chronic tennis elbow.
Ice can be applied to the area post activity to ‘settle’ inflammation and manage pain.
Compression can be in the way of compression sleeve or a specialist elbow brace which helps disperse the forces over a broader area. This in turn will allow the injured tendon to rest.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may be suggested to manage the inflammation in the acute stage.
For patients who present with a more chronic lateral elbow tendinopathy the initial treatments are nonsurgical and include
- Physical therapy
- Shockwave therapy
- Braces and/or
- Steroid injections.
Some of the more recent biologic treatments, such as platelet-rich plasma (PRP), autologous whole-blood injections (ABIs), and stem cell therapy, are becoming more available. Only in some cases will surgery be necessary.
Can I Treat Tennis Elbow Myself?
A good physiotherapists or remedial massage therapist can apply effective soft tissue techniques that help decrease the tension in the muscle tendon unit as well as some specific cross fibres techniques to work on the affected part of the tendon.
They can also address areas that may be contributing to the problem such as the neck or shoulder and go over in detail what some of the aggravating factors including ergonomics and training load.
Although it might seem very painful and that it won’t get better, 80% of patients report feeling an improvement in their symptoms at 12 months post injury.
There are also specific exercises that you can do to help heal quicker and we suggest that you book an appointment so that that we can assess and give you individualised advice.
If you would like to find out more about Tennis Elbow and if we can help, please call us on 02 8021 8430 or book an appointment with us.