Tennis Elbow: Symptoms, Causes, Treatments
Tennis Elbow which health professionals are now usually referring to as ‘lateral elbow tendinopathy’ is a common condition characterised by pain on the outer side of the elbow. This condition has also previously been referred to as ‘lateral epicondylalgia’, which simply means pain at the lateral epicondyle of the elbow, the bony connection point of the extensor muscles of the forearm. Tennis Elbow arises from the overuse or strain of the tendons that attach the forearm muscles to the elbow. Despite the name, tennis elbow can affect anyone who performs repetitive gripping or wrist extension activities, not just athletes. Understanding the nature of this ailment involves distinguishing it from other potential sources of elbow pain and recognising the signs, causes, and effective treatments. This blog will explore the intricacies of tennis elbow, providing insights into its symptoms, underlying causes, and comprehensive treatment strategies to help alleviate discomfort and promote recovery.
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This blog will cover the following topics on Tennis Elbow:
What is Tennis Elbow?
Before delving further into tennis elbow, we may consider some other possible diagnoses that may be presenting as elbow pain. Due to the closely woven shape of the lateral forearm and elbow, pain may arise from a myriad of possible structures. The articulation between the radial head and proximal ulna lies closely beneath the tendons of the finger and wrist extensors. In addition, branches of the radial nerve pass through the lateral forearm therefore some other diagnoses may include; referred pain from the cervical or thoracic spine (see Thoracic outlet Blog), synovitis, joint instability, or combinations of these issues. For further anatomy of the elbow please refer to our elbow condition page.
Tennis elbow refers specifically to pain arising from a tendon origin. The wrist and finger extensors (responsible for straightening and opening the fingers and wrist) come to a Common Extensor tendon at the lateral elbow. Movements requiring gripping and stabilising of the hand and wrist put loads on the tendons, in cases of rapid increases in load or repetitive loading patterns, the tendon may become overloaded and irritated.
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What are the signs and symptoms of tennis elbow?
Pain usually presents in the lateral elbow, the proximal forearm, and may cross the elbow joint to the distal humerus. Pain is commonly associated with gripping, wrist extension, and pronation/supination of the forearm as one would enact while opening a jar or turning a screwdriver. There may be tenderness to the touch along the lateral elbow and weakened grip strength, likely from pain inhibition of the working muscles and tendons.
Causes of Tennis Elbow
Tennis elbow often occurs without traumatic incident, after an activity of increased wrist extension or stabilisation and gripping. Another common way to develop lateral elbow tendinopathy is from a sudden heavy loading of the tendon, such as lifting a heavy object or taking up a new sport and/or returning to a sport after a prolonged period away and swinging a racquet. The majority of cases are reported in people aged 40-60 years.
Sport is a common place to develop tendinopathy, namely racquet-based sports such as tennis, squash, or badminton, as well as sports requiring gripping a stick such as hockey. Furthermore, jobs requiring repetitive manual labour and tool use such as carpentry, mechanical repairs, or production line work.
Tennis elbow can affect anyone who performs repetitive gripping or wrist extension activities, not just athletes
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Treatment options for Tennis Elbow
Collaboration between patient and practitioner to determine the specific strength and functional impairments is important in choosing the best combination of treatments for the patient. Exercise is paramount in the treatment of tennis elbow, while other forms of treatment are primarily for short-term management, tissue healing, and pain relief.
Exercises
for Tennis Elbow:
- Strengthening of wrist extensors and the whole upper limb
- Improve flexibility as required
- Followed by a graduated return to activity
Additional Treatments
for Tennis Elbow:
- Taping/ Bracing
- Dry needling/ Acupuncture
- Manual therapy: joint mobilisation with movement, digital ischaemic pressure, trigger points
Reducing Risk of Tennis Elbow
Maintaining the strength and flexibility of forearm extensors through strength exercises and gentle stretching may help to reduce the risk of developing tennis elbow. When playing sport, it is important to prepare the lateral elbow extensors with warm-up exorcises. Finally, when beginning a new sport or returning to a sport after a prolonged break, managing the load on the forearm extensors and gradually increasing demand on the tendons may help adjust to the load and reduce the risk of developing tennis elbow.
Book in with your PhysioTec physiotherapist to help diagnose and form a treatment plan best suited for your tennis elbow.
Experiencing pain in your elbow after playing sport or engaging in other repetitive activities? If the symptoms described in this blog sound familiar, you might be dealing with tennis elbow. Come visit us at PhysioTec, where our physiotherapists can assess your condition and create a customised treatment plan to help you recover and return to the activities you enjoy!
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Author
This blog was written by Tyler Cultum, one of our Sports and Strength & Conditioning Physiotherapists. He has broad interests in sports and musculoskeletal physiotherapy, with special interests in strength and conditioning, the shoulder and hip. You can read more about Tyler here.
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References:
- Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med 2009;43(4):252–8
- Coombes BK, Bisset L, Connelly LB et al. Optimising corticosteroid injection for lateral epicondylalgia with the addition of physiotherapy: a protocol for a randomised control trial with placebo comparison. BMC Musculoskel Disord 2009;10(1):76
- Ng G. The effects of forearm brace tension on neuromuscular performance in subjects with lateral humeral epicondylosis: a review. Int J Sports Med 2005;6(2):124–9
- Pienimäki T, Karinen P, Kemilä T et al. Long-term follow-up of conservatively treated chronic tennis elbow patients. A prospective and retrospective analysis. Scand J Rehabil Med 1998;30(3):159–66
- Vicenzino B, Hing W, Rivett D et al. Mobilisation With Movement: The Art and the Science. Sydney: Churchill Livingstone, 2011