Tennis Elbow

If you have pain on the outside of your elbow, when lifting or gripping, its highly likely you have tennis elbow, also sometimes referred to as lateral epicondylitis. If its stopping you from completing daily tasks or your job, or returning to your sport, we can offer you help in getting it under control.

What is it

Tennis elbow is an overload-overuse condition in which the muscles of the forearm are affected that connect to the outside of the elbow. ( the lateral epicondyle) However only a small proportion of people actually get the condition from playing tennis.
It commonly occurs in 40-60 year old adults after an unaccustomed activity or increased amount of activity involving the repeated backwards extension of the wrist.

The injury seems to be degenerative rather than inflammatory. The fibers within the attaching tendons fray. Today the injuries usually are referred to as tendinopathies, or distressed tendons rather than true inflammation.

Why does it happen

Although under a common term there are many classifications of tennis elbow.
Studies show that it is often due to damage to a specific forearm muscle called the extensor carpi radialis brevis (ECRB) which helps stabilize the wrist when the elbow is straight. When the ECRB is weakened from overuse, microscopic tears form in the tendon attachment and this leads to pain.
Interestingly the ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Although this is not a serious condition, tennis elbow can be quite disabling and can last for up to 2 years. A speedier recovery will depend on treatment and whether the aggravating activity is able to be stopped or modified.

It is often associated with repeated activities of the hand including; gripping, lifting and carrying or activities such as typing, painting, using a screwdriver, wringing wet clothes, vigorous spring cleaning, carrying buckets and picking up bricks.

An “Insidious” Tennis elbow occurs without any recognized repetitive injury.

What are the symptoms?

Symptoms vary from mild discomfort to pain disturbing sleep. The outside of the elbow is tender and there may even be swelling. Pain can extend further down the forearm as well. In addition to pain with activity there can be reduced strength and grip as even holding a cup of tea can be a challenge once it is severe.

How is it treated

There are five common stages to work through when addressing a tennis elbow injury:

  1. Decrease pain
  2. Reduce the reactive tendinopathy
  3. Speed up the healing process
  4. Maintain current fitness and strength
  5. Minimise further damage to the injured area

Some aspects of our Physiotherapy management program

  1. Stretching
  2. Joint Mobilisation
  3. Soft Tissue Massage
  4. Hot/Cold Therapy
  5. Dry needling
  6. Kinesiotaping / Splints/ braces to unload or limit the painful tissue
  7. Progressive loading and Strengthening program

It is important that once the pain has been settled, strength exercises are prescribed in order to keep the tendon strong. This will help to prevent the pain from returning. Isometric exercises can help with early pain relief and form the beginning of a tendon loading program.The strengthening programs purpose is to restore normal musculoskeletal function and reduce pain caused by the injury.Strength, stamina and mobility should be improved by the exercises once the pain and inflammation are under control.

Note: A helpful tip with Activity Modification - Try not to lift with your palm facing down

Lifting with your palm facing down aggravates just about every type of tennis elbow. So imagine you are going to pick up the bag of groceries. You can put your hand straight on the bag and lift it with the palm down OR you can turn your palm up and slide your hand under the handles and lift with the palm up.

Every time you lift with the palm facing down you aggravate the injury. Protect it. Lift with the palm up. Think about the further application. Reaching into the back seat to pick up the computer satchel. Picking up the groceries, toys, a bucket and so on. Holding the hands ‘up’ just off the keyboard all day. Even a backhand in tennis that uses too much wrist to deliver the power is loading the forearm in the same way.

Home treatment you can generally start

  • Activity modification with Lifting with palm up
  • Reduce or stop precipitating activity
  • Ice 20 mins 2 x day
  • Gentle forearm stretches.

If after 2 weeks you are no better or worse, visit our Physiotherapists for a full assessment and to get your treatment program underway.

You might also be interested in our guide on common sporting injuries and their prevention. Get a FREE copy of our Physiotherapist E-book - Dealing with 9 common sports injuries, prevention, self management and treatment principles

Common Sporting Injuries