Tennis elbow (referred to in medical lingo as lateral epicondylitis and now lateral epicondylalgia… what a mouthful) is the most common overuse injury of the elbow. Approximately 40% of people will get tennis elbow at some point in their life. The condition tennis elbow is actually a tendinopathy (problem with the tendon) involving the muscles that help to extend the wrist and forearm.
Contrary to popular belief you don’t have to be a tennis player to get this pesky condition! In fact, only 5% of patients with this injury actually play tennis.
The most common signs and symptoms of tennis elbow are:
- Pain over the outside area of your elbow.
- Pain which radiates upwards along the upper arm and downwards along the outside of the forearm.
- Pain which is worse with activities that involve raising your wrist. Eg using the computer mouse or raking leaves. Or gripping, eg. raquet sports or opening a door.
- The onset of pain with tennis elbow is usually 24-72 hours after the provocative wrist activity Eg Painting the house.
- You may experience a general weakness in your ability to grip and to extend your wrist during lots of everyday activities that have nothing to do with sport.
What Causes Tennis elbow?
Tennis elbow is best thought of as a tendinopathy caused by overuse of your wrist and forearm muscles. This is primarily caused by any activity that repetitively overloads the tendon or when the load being applied to the tendon puts too much stress on the tendon too quickly for it to withstand leading to microtrauma. For instance, maybe you spent a few hours painting your house over the weekend. It wasn’t too hard at the time, but because this is an unfamiliar activity it may be too much, too soon, and overload the tendon in your elbow leading to irritation and microtears.
The main risk factors that can lead to developing tennis elbow are:
- Age: people over the age of 30 are at greater risk of developing tennis elbow.
- People with tennis elbow are more likely to have upper limb injuries Eg rotator cuff tendinopathy or carpal tunnel syndrome.
- More common in occupations involving repetitive use of the hands (>2 hours per day), tool use and regular lifting.
- Tennis elbow is more common in people who play racquet sports Eg tennis, squash, golf.
How does Physiotherapy Help?
Although tennis elbow is a self-limiting condition it can be a difficult one to completely cure. Generally, tennis elbow will last somewhere between six months to two years if left untreated – half of all patients report not being fully recovered at the 12-month mark. Additionally, recurrence of the injury is very high. That’s why it is vital to immediately seek treatment from our team of experienced physiotherapists here at Fixio. After an accurate diagnosis of tennis elbow, we’ll get started with treatment during our very first session to make sure this injury doesn’t hold you back for long.
The main aspect of treatment during the initial phase of tennis elbow is to help settle the pain. We can assist with that through a number of different treatment techniques.
Some of the techniques we may use are:
- Activity modification to reduce aggravation e.g. initially reducing the amount of tennis you play on the weekend to help let the pain settle
- Ice for pain relief
- Manual therapy, including soft tissue massage and joint mobilisations around the neck, shoulder, elbow, and wrist
- Neurodynamic nerve stretching to help loosen any tight nerves in the surrounding area and relieve irritation
- Taping/bracing to offload the wrist extensor tendons
- Using non-steroidal anti-inflammatory drugs (in conjunction with your G.P.)
Once the acute painful stage has begun to settle, the body needs to start building the functional capacity in the tendon. We do this by implementing a gradual strengthening program in conjunction with slowly building up towards all your regular activities that it hinders such as rock climbing, surfing, swimming and of course… tennis!