Tennis Elbow – What It Is and How To Fix It

By
By Lakeview Physio
Barbara Ward
,
BScPT, BPE, Certified Gunn IMS Practitioner, Spinal Manipulation, FCAMT
on
Joint Pain
June 13, 2020

If your lateral elbow pain is not improving it is important to be assessed by a physiotherapist to help manage these factors.

How Do I Know if I Have Tennis Elbow?

Typical symptoms of Tennis Elbow (lateral elbow tendinopathy) are:

  • Tenderness when you press on the outside bony part of your elbow
  • Pain when you use the muscles that move the wrist, index and middle fingers in an extension motion.
  • Pain with gripping an object

What Causes Tennis Elbow?

Tendon break down can be the result of overuse, underuse, and excessive forces that leave the tendon in a weakened state.

What is Tennis Elbow?

Tennis elbow is a condition where the tendons that attach to the outside of your elbow become sore and make the elbow and hand difficult to use.  It results in pain on the outside of your elbow.  Tennis elbow used to be called lateral epicondylitis suggesting there was inflammation involved but research has found that there is rarely any inflammation present, so this term is not entirely accurate.  Instead, another term more often used is lateral epicondyalgia.  

Which muscles or tendons are involved?

If you are interested in a little anatomy, the common extensor origin (made up of the tendons of extensor carpi radialis brevis, extensor digitorum communis, extensor carpi ulnaris and extensor digiti minimi) is affected in Tennis Elbow (see diagram).  The muscle most commonly affect in this group is the extensor carpi radialis brevis.

What Should I do if I Think I Have Tennis Elbow?

If you have mild symptoms the chance of your symptoms resolving are good.  If your symptoms have not improved in 6 weeks, it is best to seek the help of a medical professional.  If you have severe symptoms it is likely it will be more difficult to improve, and it is wise to seek treatment early.

Exercise has proven to be effective!

Initially it is important to control the load on the tendons by stopping or modifying provocative activities and addressing any ergonomic issues that may be putting excessive load on the tendons like awkward wrist positions when using the computer or tablet.

Later it is essential to start a graduated exercise program to stimulate tendon remodeling and address muscular weakness, imbalance and coordination.  It is clear from research that exercise is the cornerstone of recovering from Tennis Elbow.  The type and dosage of exercise will depend on what stage of healing the tendon is at.

Other treatments that may help

There is some evidence to suggest that manual therapy, acupuncture, laser and orthoses may be beneficial in the short term.  Nitric oxide patches and platelet rich blood plasma (PRP) injections may also help.

Treatments that do not have evidence that helping

Ultrasound, phonophoresis and shock wave therapy have not proven to be effective to date.

Treatments that may be detrimental

Even though corticosteroid injections can offer some short-term relief they have consistently shown poorer long-term outcomes.

Complicating Factors

There are other things that can complicate recovery from tennis elbow: neck and shoulder issues, a large tear in the tendon, changes in pain processing mechanisms, muscle weakness and imbalance, or work related issues like handling heavy repetitive loads.  If your lateral elbow pain is not improving it is important to be assessed by a physiotherapist to help manage these factors.

Summary

The two key treatments that are proven to help lateral elbow tendinopathy are

  • load management
  • appropriate prescribed exercises

If you have mild lateral elbow pain that has not improved in 6 weeks or severe lateral elbow pain, see a physiotherapist for assessment and treatment recommendations.

References:

Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of physiotherapy, 61(4), 174-181.

Coombes, B. K., Bisset, L., & Vicenzino, B. (2015). Management of lateral elbow tendinopathy: one size does not fit all. Journal of orthopaedic & sports physical therapy, 45(11), 938-949.

Coombes, B. K., Bisset, L., & Vicenzino, B. (2009). A new integrative model of lateral epicondylalgia. British journal of sports medicine, 43(4), 252-258.

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