WHAT – Tennis elbow – also known as Lateral Epicondylalgia and is often referred to as epicondylitis or tendinopathy. Tennis elbow is diagnosed by signs of localised pain over the outside epicondyle more commonly know as the elbow bone. The pain is made worse with resisted wrist extension and grip. It is also referred to as an overuse injury – where sports or activities with repetitive movements lead to tendinitis of the common forearm extensors (muscle on the top of the forearm) where they originate at the lateral humeral epicondyle E.g.; consistent forearm shots in tennis display the motion that causes tennis elbow.
There is a high precedence of people being misdiagnosed with tennis elbow as it is often mistaken for pain stemming from the neck, often C5-6, and the pain refers down the arm via the radial nerve. Adequate testing and re-testing is needed to ensure you are treating the cause and not just the areas of referred pain.
WHO – Tennis elbow affects around 1-3% of the population and 40% of those people play tennis, hence where the name came from. It is predominately in people ages 35-55 years and can last anywhere from 6 months to 24 months.
- stiffness in the elbow in the morning
- occasional night pain
- dropping of objects – weak grip strength
- pain with palpation of the lateral epicondyle
- pain with active/resisted extension.
RISK FACTORS – repetitive manual tasks or handling of heavy loads will initiate and continue to stir the muscles that attach at the lateral epicondyle. The risk is increased by a working posture of arms raised in front of the body, coupled with repetitive forearm twisting or rotating motions. Further increased by high gripping force. People prone to more than 20 hours of computer work a week are at risk, this increases in line with years of use.
OUTCOMES TREATMENTS patients are looking for pain relief at rest and whilst doing activities, improved function, reduced sick leave needed to be taken during flare ups and to avoid adverse events. Myotherapist’s aim to reduce the pain in the elbow, encourage tissue repair, help restore the normal range of motion of the elbow joint, muscle length and strength whilst also restoring normal neurodynamics. Some treatment options include;
- In the early phase of tennis elbow ice and heat can work with inflammation and the chemicals associated with the pain transmission in the nerves, whilst heat can encourage fresh blood flow to the area.
- Cortisone injections – proven to be beneficial in the short term however can be painful and are associated with an increased risk of long term recurrence, especially if more then one injection is given. It is more beneficial to understand what is causing it and make changes in your daily life (strengthening muscles)
- Low level laser therapy may be beneficial but is not always available.
- Combined physiotherapy and Myotherapy treatments give medium term relief and show significantly better outcomes than steroid injections in the long term. These include manual therapy, exercise prescription, Kinesio taping, Dry Needling, home exercise and advice leaflets.
- Severe cases – 12+ months, there is limited low level support for injecting blood plasma or for persistent cases can undergo surgery – this involves your GP.
- Advice with prescribed over the counter pain medication is recommended as the first line of treatment for most cases.
- In the early acute stage it is important to take adequate steps to avoid aggravating the area more. Certain activities such as lifting heavy weights or objects should be avoided. Objects should be lifted close to the body, with elbow bent and palm facing upwards. Avoid repetitive gripping and twisting activities with the arms. Always take regular breaks to give the upper limb adequate rest. Should be seeking light duties at work whilst the inflammation is at its worst.
- Speak to a doctor or pharmacist about NSAID medication to help with the inflammation.
Rest is very important in the early stages of tennis elbow as continuing to use the arm will only flare the area up and increase pain and longevity of injury.
Involves all movements that stretch/loosen and strengthen the forearm extensors and flexors as well as the biceps and trapezius muscles.
Lateral Neck stretch for trapezius muscles (ear to shoulder). Perform on both sides of neck. For a deeper stretch gently pull neck at 5-10%
Flexor and extensor strengthening – use a light weight for resistance to help stretch and strengthen the forearm muscles and wrist. This can be performed without the weight and you can use your opposite hand to bend the wrist forwards and backwards for wrist extension and flexion stretching.
Wrist and forearm extension and flexion. Grip a rolled up towel and twist in opposite direction.
Supination and Pronation of forearm – keep elbow by your side to avoid injury to your shoulder. Start without the weight if there is pain.
**If you are experiencing pain, discomfort or an injury you are unsure of please seek professional advice from a doctor or your Myo/Physio as this is general advice and is not to be used in replacement of**