Tennis elbow is caused by overloading, or overuse of the extensor muscles of the forearm. Causes can include (not just tennis!):
The common extensor tendon is usually affected, in particular a muscle called extensor carpi radialis brevis. This muscle holds the wrist still during gripping movements and hand function (Bisset, 2019). It is a tendon problem, so joints are not involved.
If you see a Doctor or Physiotherapist, they do an assessment to rule out other causes of your symptoms. Commonly, people report:
You do not usually need a scan to diagnose tennis elbow. On ultrasound, there can be tendon degeneration with tennis elbow. However, this is also seen on asymptomatic people, and therefore is a normal ageing process (Bisset, 2019).
We can prescribe an exercise program specific to your level of fitness and injury which is what will help you recover from tennis elbow and help prevent it from returning. This will be progressed and changed as your injury improves. Physio treatment can release tight muscles or joints that maybe contributing to the injury. We can also strap your elbow or fit a brace which can give pain relief. This is an example of two exercises that can help tennis elbow.
Isometric exercises:
You can try these exercises holding a broom or stick you have at home (not heavy). You should aim to hold for 3×30 seconds, a few times daily. Do not force through pain. This is a static muscle contraction, so there isn’t any movement. One is pronation (palm facing down), the other is supination (palm facing up).
Eccentric elbow extension exercise:
Try this pain free range (shouldn’t flare up that evening or next morning), and every second day.
https://www.youtube.com/watch?v=DAwG2z0p58I
A Physiotherapist or Doctor can help rule out other causes of the pain.
Bisset (2019) suggested that rest (avoiding aggravating factors) should be for 6-8 weeks. If it is not improving, start exercising and strengthening the tendons after this point.
Exercising in to pain does not help symptoms (Bisset, 2019).
You can use pain free grip strength (PFGS) as an outcome measure for improvement rather than maximal grip strength (Bisset, 2019).
Manual therapy can change pain e.g. mobilisations with movement during gripping (Bisset, 2019). Bisset provided a second podcast for treatment of lateral elbow pain on the clinical edge website – www.clinicaledge.co
Bisset, L. 2019. Lateral Elbow Pain. [online]. [Accessed 30th August 2019]. Available from: http://www.clinicaledge.co
Physiopedia. 2019. Lateral Epicondylitis. [online]. [Accessed 30th August 2019]. Available from: http://www.physio-pedia.com
Janaka specialises in treating sporting and complex spinal injuries and has a keen interest in manual therapy and acupuncture completing post-graduate courses in osteopathic manipulation and muscle energy techniques.
full bio +Helen has practiced in the private sector for the past 8 years and has extensive experience in specialty areas including sporting injuries, spinal dysfunction, Pilates, pregnancy and post-natal assessment, treatment and rehabilitation.
full bio +Katie has a client centred holistic approach to rehabilitation and believes in providing patients with hands-on treatment and also long term self management advice if appropriate for their musculoskeletal problem.
full bio +Niamh has a keen interest in injury prevention in the athletic to ageing population. She believes in empowering patients to self-manage their condition through education and effective exercise prescription
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