What is Tennis Elbow?
Tennis elbow or lateral epicondylitis is a condition where the forearm tendons begin to strain from overuse. Repetitive irritation of the tendon can lead to more pain and tenderness through the elbow.
Before going any further, let’s go through the anatomy. The extensor carpi radialis brevis (ECRB) and extensor carpi radialis longus (ECRL) are the main muscles involved. They are located along the top of the forearm.
As seen in the image above, these are the muscles start from the elbow and attach to the base of our 2nd and 3rd digits, respectively. Tendons are connective tissue which bridges the muscles to the bone. The ECRB and ECRL are primarily responsible for wrist extension or bending of the wrist backward.
In activities that require repetitive wrist movements, constant stretching and contraction of these muscles begin to create strain through the tendons of the ECRB and ECRL. As a result, microscopic changes in the forearm tendons occur (e.g. tears, thickening of the tissue, etc.).
Tennis Elbow Symptoms
A common question asked by those with tennis elbow. For the majority of cases, the hallmark of tennis elbow is sharp outer elbow pain. Not to be confused with golfers’ elbow, which is more consistent with inner elbow pain. Generally, those with this condition will also find:
- Pain when extending the elbow
- Tenderness along the outside elbow if bumped or knocked
- Aggravation with wrist movements
Tennis Elbow Causes
Tennis elbow is usually caused by overuse. Repetitive movements and strenuous activity strains the forearm muscles, including the ECRB and ECRL.
Sudden increases in activity, such as starting a gym program or moving houses, can trigger the onset. Ignoring the pain and continuing to perform aggravating movements can cause ongoing pain. This is why seeking physiotherapy treatment is recommended immediately after pain develops.
Some everyday activities which might cause tennis elbow includes:
- Gripping and lifting activities (e.g., weight lifting, manual labour, twisting/turning jars, etc.)
- Repetitive wrist movements (e.g., typing, writing, opening doorknobs, etc.)
- A sudden increase in physical activity (e.g., upper body gym exercises, increased office work, etc.)
As seen in the graphic above, the radial nerve is a known culprit for tennis elbow. As seen in the image above, radial nerve originates from the neck and travels near the outer surface of the elbow. During this journey, the nerve can be compressed by structures, including the bone and overlying muscles. When this occurs, the affected nerve can mimic the symptoms associated with tennis elbow.
Diagnosing Tennis Elbow
Other Elbow Pain Conditions and Differential Diagnosis
Although tennis elbow is the most common reason for elbow pain, other conditions can often be mistaken for it. Each of these types of injuries needs needs to be managed differently. Consulting with a health professional, such as a physiotherapist or doctor will help differentiate between the following injuries:
- Golfers Elbow
- Olecranon bursitis
- Referred pain from the neck
- Radial head instability
How to Treat Tennis Elbow
The majority of patients with this condition can be managed through rehabilitation and without the need for surgery. Your physiotherapist will provide you with an exercise program and daily recommendations. Below will be a detailed outline for the best tennis elbow treatment and strategies that you can use.
Physiotherapy is typically the gold standard for tennis elbow treatment. Usually, consistent therapy needs to be followed over 3-12 months or until the condition settles. During a consultation with a physiotherapist, you will typically be provided with:
- A physical examination
- Hands-on treatment (e.g., soft tissue massage, electrotherapy, dry needling, etc.)
- Specific rehabilitation and home exercise program
- Strategies to modify daily activities
Tennis Elbow Pain Relief:
For those with persisting symptoms, the following treatment strategies can be used to subdue pain. Although undergoing physiotherapy and rehabilitation are pivotal for recovery, these strategies can also temporarily ease your discomfort.
2. Ice/heat therapy
Although patients report mixed results, ice and heat packs are another option to help with temporary pain relief. Ice or heat therapy can be applied for 15-20 minutes at a time to ease your symptoms. Typically, ice packs should be considered when the injury is acute and has just started. Whereas heat packs are recommended for when the problem has occurred for a longer period of time.
3. Pain relief medication
If the elbow pain continues to persist, taking NSAIDs or anti-inflammatories can be an option for short-term relief. Over the counter medication, such as Voltaren and Neurofen can be considered if appropriate. Consulting with your GP or physician is recommended for specific advice about medication.
Tennis elbow support:
3 Exercises for Tennis Elbow
For long term management of this condition, forearm strengthening and flexibility exercises are the standard gold treatment. Below are three typical exercises we recommend in the first stage of our tennis elbow rehabilitation program. As your pain begins to resolve, more advanced exercises will be included to continue your progression.
Your physiotherapist will be able to determine the appropriate amount of repetitions and weight.
1. Isometric Exercises:
2. Wrist Pronation/Supination:
3. Wrist Extension:
Tennis elbow can be a very tricky condition to manage. If left untreated, there’s a chance it can become chronic and worsen over time. The earlier you seek treatment, the more likely you’ll recover quicker
Looking for a Physiotherapist?
If you’re someone with a nagging back pain or a sports injury from Melbourne (VIC, Australia), you’re in luck. Currently, we’re operating from The Movement Hive in Doncaster East. With multiple treatment rooms and a functional gym, we’re dedicated to helping you achieve the best outcomes.
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