Tennis elbow is inflammation of the muscles and tendons of the forearm as they attach to the humerus (upper arm) bone. The term tennis elbow is now rarely used in the medical profession these days. This is because pain in this area is caused by a wide range of activities and not just limited to tennis players. These activities can include anything which requires prolonged gripping and/or excessive use of the wrist such as hammering, driving screws, weight lifting, playing certain musical instruments, canoeing, gardening , cleaning, driving and, of course, racquet sports. Therefore, you may hear tennis elbow be referred to as lateral epicondylitis or extensor tendinopathy. Tennis elbow causes pain when the lateral epicondyle (outermost part of the elbow) is touched and also if the elbow is straight and the hand is moved forward and back at the wrist. The pain is exacerbated by gripping activities and in some cases simple things like turning a door handle can cause intense pain.
Ensure the item that you are gripping, whether it’s a tennis racquet, a hammer, or a canoe paddle, is the correct size for your hand. If it is too small it will cause you to grip too hard. If you are returning to a sport such as tennis after a long absence ensure you’re gradually increase your game time so that the muscles of the forearm have time to grow stronger and adapt to the new activity. Tennis elbow is often triggered with a long weekend spent cleaning, gardening and performing D.I.Y tasks around the house. Hence, make sure you take regular breaks and stretch the muscles which work move the wrist. Two effective stretches can be seen below.
For those who have suffered from tennis elbow in the past it may be a good idea to wear a tennis elbow compression strap. They work by preventing the wrist extensor muscles (that run along the outer side of the forearm) from contracting fully, thus reducing the strain on the elbow. Importantly, these are only of benefit during activity and should not be worn around the clock.
Research has demonstrated that tennis elbow is most effectively treated by use of a range of treatment methods designed to treat all aspects of the injury.
The first stage of treatment should start with a thorough assessment of the specific causes of the injury and any underlying mechanisms that may have predisposed the individual to the injury such as tight or weak muscles and incorrect/ill fitted or poorly used equipment. Tennis elbow can also stem from the neck as this is where the nerves that supply the muscles of the wrist and forearm begin.
Once the assessment has been carried out initial treatment aims to reduce any inflammation that may be present. Depending on the severity of the condition, this may be alleviated simply by rest, electrotherapeutic modalities used by your physiotherapist or with the use of anti-inflammatory medication or a corticosteroid injection. However, in longstanding cases where there is degeneration of the extensor tendons, anti-inflammatory medication, especially corticosteroid injections, should be avoided. This is because they can hinder tissue healing and in fact cause more degeneration.
Once any inflammation has been dealt with the attention turns to the muscles of the forearm. At this stage massage, trigger point therapy and dry needling are all very effective to help lengthen and relax any tight muscles of the forearm and wrist. Other treatment methods performed by your physiotherapist such as specific taping techniques, mobilisations of the radius bone of the forearm and advice on ways in which activity can be modified to allow for pain free movement are also very effective in this stage of recovery.
The final part of tennis elbow rehabilitation is an eccentric strengthening programme for the muscles that move and extend the wrist. It’s crucial that the load and number of repetitions are carefully recorded and progressively increased under the supervision of your physiotherapist. This ensures that the overload on the tendon is carefully controlled and gradually increased. This will ultimately ensure that the muscles are better able to deal with the loads that are placed on them during your given sport or activity. When carried out in combination and under careful supervision the above treatments can help you find a lasting pain free solution to the often debilitating condition of tennis elbow.