Tennis Elbow

What is Tennis Elbow?

The most common elbow condition is “tennis elbow”. While it can certainly be caused by racquet sports, it is extremely common any sport or occupation that involves gripping or throwing eg weightlifting, hockey, canoeing and baseball.

 Where Is Tennis Elbow Pain Felt?

Sharp pain over the outside bump of the elbow, especially with gripping or resisted middle finger straightening.  This bump is known as your lateral epicondyle. The medical term for tennis elbow is “lateral epicondyalgia” – painful lateral epicondyle or “lateral epicondylitis” – inflammation of the lateral epicondyle.
Tennis ElbowAs the condition deteriorates, the entire forearm may become tender and go into spasm. Unfortunately, delay is not good. The longer you experience pain the more likely it is that you’ll develop compensatory problems in your neck, shoulder or forearm

What’s the Cause of Tennis Elbow?

Like most overuse injuries, it is most commonly caused by repeated microtrauma. You may not have allowed the initial very small injury to heal, thus continuing to play continues to injure.

Common Causes Include:

  • Unaccustomed arm use. eg painting a fence, hammering, lots of typing, increased training.
  • Excessive force gripping or wringing activities
  • Poor forearm muscle strength, flexibility, nerve tightness
  • Poor technique (this may be a poor tennis shot)

How is Tennis Elbow Diagnosed?

Your physiotherapist or doctor regularly diagnoses these injuries. X-rays are often normal. An ultrasound scan may show tears within the tendon.Research has shown that the neck joints of C5 and C6 are common referrers of pain down to the elbow. Always ask your physiotherapist or doctor to examine your neck for tenderness. Your symptoms may be cured by only treating your neck!

 What’s the Best Treatment for Tennis Elbow?

During the acute phase, rest is vital. “No Pain … No Gain” as with most injuries is wrong.

Follow the R.I.C.E.R. Principle Apply a cold pack 3 to 5 times daily to reduce inflammation and pain. Anti-inflammatory medication or gels may work very well.

Research has shown that Physiotherapy is better than cortisone injections in the medium to long-term. Aswell as increasing healing rate, your Physiotherapist will ensure the optimal recovery environment is present.

In the early phase of healing massage and electrotherapy modalities such as ultrasound, laser and electrical stimulation (eg TENS machine ) may be used. They have been shown to have minimal long-term effect, but can have short-term benefits such as pain relief and muscle relaxation that can assist with your exercise abilities, sport and day to day life.


Prevention & Treatment

Sporting or movement technique is important. Poor technique causes increased stress on the muscles, tendons and elbow joint.

Other ways to prevent tennis elbow:

  • Decrease the amount of playing time or aggrevating activities

  • Stay in overall good physical shape

  • Strengthen the muscles of the forearm, upper arm, shoulder and upper trapezius

  • Use equipment appropriate to your ability, body size, and muscular strength

  • Gentle stretches and progressive strengthening exercises

  • Eccentric exercise using a rubber band (extension)

  • Eccentric twisting – grasping a rubber bar, twisting it, then slowly untwisting it.

  • Joint/ Soft Tissue manipulation directed at the elbow, wrist and spine

  • Dry needling has been gaining popularity in various types of tendinopathies

  • Tennis Elbow Brace to help unload and compress affected structures

  • Trial of Anti Inflammatories (speak to your GP)

Novel Approaches to Tennis Elbow

Neural Mobilisation

Twisting Exercises

When Should You Use a Tennis Elbow Brace?

A tennis elbow brace can be very effective from the moment you put it on. In these instances, the brace will dissipate the stressful gripping forces away from your injured structures.

Tennis elbow braces do not work in 100% of cases. In stubborn cases, you have a high likelihood of referred symptoms from your neck. Only a thorough examination of your neck, shoulder, elbow and upper limb nerve structures will confirm your diagnosis and direct which treatment options will assist you the quickest.