In this blog, Physiotherapist Luke from our Burnside practice provides an overview of tennis elbow, a common injury among our clients. Keep reading to learn more about what tennis elbow is, how it’s caused, the symptoms you may experience, and how our physiotherapists can go about treating the injury and get you back to feeling your best.
What Is Tennis Elbow?
Lateral epicondylitis (aka tennis elbow) is a repetitive stress injury that can result in inflammation and/or micro tears of tendons from forearm muscles that attach at the elbow. Muscles that attach to the outside of your elbow (lateral epicondyle) are affected in this condition. These muscles work to extend your fingers and wrist and this group of muscles are labelled as your forearm extensors. There are multiple forearm extensors which attach to the lateral epicondyle but damage to the forearm muscle, the extensor carpi radialis brevis (ECRB) is the most common cause of pain. This muscle helps to stabilize the wrist and forearm when straight. When it’s overloaded or overused, not only can micro tears form in the tender attachment to the elbow, but friction of this muscle on your radius and forearm bones can lead to increased damage to this muscle if overused.
How Does Someone Get It?
Contrary to what the name would suggest, tennis is not the only cause of this pathology and as a result, athletes are not the only people subject to this injury. Most individuals who suffer from tennis elbow are aged between 30 and 60, but activities such as your job, choice of exercise or sport may increase your risk of suffering from tennis elbow. Many people who suffer from tennis elbow often work in jobs or playing in sports with repetitive or high strain tasks involving the forearm muscles and wrist extension such as:
- Working at a computer, Artists, Weightlifters, Plumbers, Butchers, Carpenters, and Tennis players
You would assume the most common cause is from tennis, but studies show that only 5% of tennis elbow comes from racket based sport. There are some specific movements and wrist positions in tennis which cause tennis elbow. For tennis or any other racket sport, some of these actions include:
- Playing too often without change of position (eg. all shots are right hand backhands)
- Playing or practicing too longer or much longer than normal
- Rackets or equipment that is too heavy for your forearm to tolerate for long periods of time
- Rackets or equipment that is either too small or large for you – this may affect wrist positioning and cause overuse of your forearm extensors
Symptoms of Tennis Elbow
Symptoms can range from mild to very severe. Symptoms typically begin as mild and progressively worsen as time passes without treatment. Tennis elbow can last between 6 and 8 weeks but in some cases longer depending on factors such as workplace duties, sport, frequency of treatment and other rehabilitation factors. As a result, it is imperative to begin treatment of tennis elbow early before symptoms worsen. The most common sign of tennis elbow is pain on the outside of the elbow or forearm either during repetitive tasks or a short burst of over use. Other the common symptoms include:
- Weakened grip, Pain with wrist stretching, Tenderness on the outside of the elbow and forearm, Pain that is worse with gripping or general use of your wrist, Swelling of the elbow or forearm, Redness or increased temperature of your forearm or elbow, and Loss of wrist range of movement
How Can It Be Treated?
Rest / Modifications
The easiest and most often first appropriate step is to cut back on activities which are causing your pain or discomfort. This may involve completely stopping a given task or movement which is causing your pain or adjusting your technique to reduce strain on your forearm extensors. This is much more common for work or sport, where often completely cutting out the task is unreasonable or not an option. In some cases, adjustments in lifestyle or movements can completely stop tennis elbow related pain from occurring. Ice packs can be used if pain has flared up or straight after you first feel pain. This provided pain relief and reduction of inflammation usually within 1-2 days of the first signs of pain.
Massage / Dry Needling
Another option to reduce your pain can be achieved through massage or trigger point dry needling. Either or both of these techniques focused on your extensor muscles and tendons can provide pain relief. Rocktaping or kinesio taping acts to facilitate and improve your body’s healing process while providing support to surrounding muscles and joints.
Specific strengthening and stretching of the affected muscles of tennis elbow is an important part of the rehab process. Once pain has diminished, this is a good time to begin exercises at the discretion of your physiotherapy to reduce your pain, while increasing your capabilities again with wrist/forearm.
Bracing / Support
Appropriate bracing or taping may help reduce stress on painful areas and provide relief of pain. Common bracing options include elbow traps or braces, as well as compression garments. Similarly, taping techniques can reduce pain and increase function if required.
Of all treatment techniques and options, physiotherapy is one of the most effective. Other less common treatment options include steroid injections, medications, shockwave therapy, surgery or ultrasonic tenotomy (TENEX).
I Think I Might Have Tennis Elbow, What Should I Do?
Diagnosis of tennis elbow can be made by a physiotherapist based on your symptoms and findings through a physical assessment. Additional investigations such as an MRI or x-ray may also provide diagnosis of tennis elbow but may also rule out similar presenting conditions such as arthritis, nerve compression or referred pain.
See a physiotherapist here at Core, the sooner the better! The earlier treatment can begin, the quicker symptoms can reduce and you can get back to doing what you love without pain!
This blog was written by Luke Mrowka (Physiotherapist), from our Burnside practice.
Dersarkissian, E 2020, WebMD. Available at: https://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis
Verhaar J.A.N., 1994. Tennis elbow. International orthopaedics
Mayo Clinic, 2021, Tennis Elbow. Available at https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987