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Tennis Elbow: signs, symptoms and how physiotherapy can help

What is Tennis Elbow?

Tennis elbow, also known as Lateral Epicondylitis, is a common condition characterised by pain at the outside of the elbow with movements of the wrist and hand. The pain is usually localized to the tendon of a small muscle of the forearm just below the elbow called Extensor Carpi Radialis Brevis (ECRB). This muscle is responsible for extending the wrist back into a “stop” position and is active when gripping and moving objects.

While the term ‘tennis elbow’ is used because this is a common injury for tennis players, anyone who performs repetitive tasks with their hands and wrists can be susceptible, including office workers and manual labourers.

What are the signs and symptoms?

The cardinal sign of tennis elbow is pain felt on the outside of the elbow, particularly when making wrist movements or when gripping an object. Symptoms may occur suddenly or appear gradually over time. In the early stages, pain may be present with activity and quickly go away with rest, however, as it progresses the pain may be more constant, lasting for longer and occurring with smaller movements. If pain has persisted for three months then it is considered to be a chronic condition.

As with most injuries, the longer an issue has been present, the longer it usually takes to resolve. Other symptoms can include night pain, stiffness in the elbow and forearm, weakness, numbness and pins and needles. As symptoms progress, simple tasks such as lifting a cup can be painful, which can have a significant impact on your lifestyle.

What causes it?

While tennis elbow was originally thought to be due an inflammation process, it appears that this is not the case, rather there is an increased sensitivity to the area along with changes to the blood supply and disorganization of the collagen fibres that make up the tendon. These changes are an adaptation to excess loading of the tendons attaching to the elbow, particularly the ECRB.

Most of the time, this happens because of small repetitive movements that are done with poor ergonomics or technique. If the health of the tendon tissue is compromised, this can also contribute to the development of tennis elbow. Poor nutrition, disuse, inflammatory diseases and aging can all mean that the tendon is less able to adapt to forces and are a risk factor for the development of tennis elbow.

How can Physiotherapy help?

Your physiotherapist will first confirm that you are indeed suffering from tennis elbow, which is an important step as some neck conditions can present with similar symptoms. Once the diagnosis has been confirmed, they will determine the severity and causes of your particular condition, likely testing your grip and individual muscle strength.

Your physiotherapist can also identify any muscle tightness, postural or ergonomic flaws and joints stiffness that may be contributing to your condition. Treatment may include, fitting of a brace, dry needling, strengthening with eccentric exercises and stretching. Depending on the cause of your tennis elbow, your physio may suggest a change in the setup of your desk, workplace, or grip technique of your racket or hand-held tool. Eccentric exercises load the muscles in a very specific way and research has shown that these exercises can help strengthen tendon tissues, reducing symptoms of tennis elbow.

It is normal for tennis elbow to take a few weeks or even months to heal. If conservative management is not having a good effect, your physio can help you speak to your doctor about other management techniques. As tennis elbow is a progressive condition that generally does not resolve on its own, it is recommended to seek treatment sooner rather than later, as recovery is much faster when started early.

The information in this article is not a replacement for proper medical advice. Get in touch with one of our Physios for an assessment of your individual condition.

Caboolture Physical Therapy Centre – serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.
Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow – What is it?

What Is It?

Tennis elbow is a condition that affects many people, particularly in middle  age, characterized by pain at the outer elbow. Symptoms  include pain, occasional swelling and reduced grip strength.

Usually the pain begins gradually,  noticeable only during activities, then progressively becomes worse. In severe cases, pain might even be experienced at rest. As the muscles involved have the job of stabilizing the wrist and raising the wrist and fingers, this condition can have a huge impact  on day-to- day activities. The condition is common  with tennis players, but can affect anyone and usually begins after a period of increased activity where strain is put on the tendon and it cannot cope.

What causes it?

Tendon tissue has a poor blood supply compared  to muscle and during a period of increased activity the tendon sometimes can’t adapt quickly  enough. The tendon that attaches the muscles of the forearm  to the elbow develops micro-tears and the collagen fibers become disorganized. This degenerating tendon is even worse at absorbing  forces and so a painful  cycle begins.

Many people notice symptoms after a sudden increase in activity, such as a holiday tennis match, a weekend of gardening,  or painting the house however not everyone can pinpoint an activity or event.

It seems that increased age, poor technique, posture and starting a repetitive activity suddenly without training make developing this condition more likely.

How do I treat it?Tennis Elbow (Lateral Epicondylitis)

For some people, symptoms will resolve with a little rest. For others, more targeted therapy is needed. Latest research has found that a very specific exercise program  of eccentric strengthening exercises can be highly effective in treating tennis elbow.  Along with analysis of technique  and postural factors, which may be aggravating the disorder,  eccentric exercises have been shown to help tendon tissue reorganize itself and become stronger.

As this is a degenerative condition, treatments such anti inflammatory pills and corticosteroid injection are not always helpful.  There are a few medical  options for treatment such as shockwave therapy or more recently Platelet Rich Plasma Therapy, which enhances the body’s own ability to heal. For very severe cases, surgery to remove the degenerating tissue has also been shown to be successful.

What are eccentric exercises?

Eccentric exercises are muscular contractions with act alongside another force but control  it, or slow it down. For example, when you lower something heavy to the ground instead of letting it fall. It is thought that this type of exercise stimulates the cells of the tendon to align and strengthen, stimulating the healing process.

Once the tendon begins to regenerate, other stretching and strengthening exercises can be incorporated. In severe cases where rehabilitation fails, surgery to remove the affected tissue might be recommended usually is successful.

As always, every case is different and individual analysis is essential for optimal recovery. Your physiotherapist can perform specific tests in the clinic  to confirm  the diagnosis and advise you on the best course of action.

Caboolture Physical Therapy Centre – serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.