What is Tennis Elbow?

Tennis elbow, also known as lateral epicondylalgia, is when pain develops around the bone on the outside of the elbow. Golfers elbow, medial epicondylalgia, is similar, but on the medial side of the elbow.

Tennis elbow is caused by overloading, or overuse of the extensor muscles of the forearm. Causes can include (not just tennis!):

• Repetitive upper limb activities
• Computer use
• Heavy lifting
• Repetitive vibration
• Racket sports
• Throwing sports (Physiopedia, 2019)

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.

How do you diagnose it?

If you see a Doctor or Physiotherapist, they do an assessment to rule out other causes of your symptoms. Commonly, people report:

• Pain on the outside of their elbow around the lateral epicondyle (without referred pain)
• Pain with gripping or picking things up
• History of overloading/overuse and a gradual onset – the amount of overload which causes pain would vary person to person (Bisset, 2019).

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).

What can I do?

• Avoid aggravating activities or positions – if you cannot totally avoid these, try changing position regularly, or have mini breaks
• Lift with the palms facing up
• Exercise pain free range only

What can a Physio do?

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

Differential diagnoses include:

• Posterior interosseous syndrome
• Elbow osteoarthritis
• Fractures – associated with trauma
• Neck pain with referred nerve root pain
• Fibromyalgia
• Golfers elbow

A Physiotherapist or Doctor can help rule out other causes of the pain.

Notes for Physios:

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

References:

Bisset, L. 2019. Lateral Elbow Pain. [online]. [Accessed 30^th August 2019]. Available from: http://www.clinicaledge.co

Physiopedia. 2019. Lateral Epicondylitis. [online]. [Accessed 30^th August 2019]. Available from: http://www.physio-pedia.com