Tennis elbow (TE), lateral elbow tendinopathy or lateral epicondylagia, is an overload injury of the forearm extensor muscles of your wrist, and their tendon attachment into the bone at the elbow. The name of this condition may be misleading, as while it does affect many tennis players – you don’t need to be smashing serves or slicing backhands to suffer from TE. Tendinopathies often occur due to a repetitive overload, causing tendon irritation or inflammation and can lead to micro, or macro tears in the tendon.

TE is often the result of a new or unaccustomed physical activity usually involving repetitive or sustained gripping or extension of the wrist, such as spending the weekend painting the house, using a hammer or lifting weights.

Accumulative or repetitive loads such as excessive computer use can also lead to TE, or jobs that involve repetitive one-sided movements such as gardeners, electricians and trade workers.

Often, however, the onset may be gradual and hard to identify a specific cause.

What are the main symptoms?

TE often presents as tenderness on the outer forearm and elbow, and can develop into a persistent ache that can radiate towards the hand. Alongside pain, you may notice weakness in grip strength and pain with daily activities, such as lifting objects or opening a jar. The condition usually starts quite mild, which means often people delay seeking treatment.

Not all elbow pain comes from tennis elbow, so it is important to get it assessed properly to determine what is causing your pain and how we can manage it.

What can a physio do for your tennis elbow?

While other treatments such as manual therapy, local massage or dry needling can provide great short term pain relief for TE, recent evidence has shown that exercise is the most effective intervention for reducing pain and restoring strength and function of the elbow.

Once the pain is under control, we look to progress the strengthening exercises. We primarily focus on the wrist extensors and forearm supinators, however there is good evidence to suggest strengthening through the whole upper limb can lead to better outcomes.

Treatments may include;
● Education and advice
● Isometric exercises (activating the muscle without it changing in length)
● Progressive strengthening exercises
● Stretching
● Activity modification amd technique advice
● Manual therapy
● Bracing and strapping

It is important to highlight that most acute tennis elbow injuries last around 12 weeks, however if left untreated, the recovery window can extend up to 2 years.

It is also important to note that, according to research, corticosteroid injections are not recommended. They may provide some short term relief, however can affect recovery timeframes and can cause greater rates of recurrence further down the track.

What can you do at home?

• Activity modification – particularly with lifting. Try to avoid lifting with your palm facing down, as this tends to aggravate any tennis elbow condition. Instead, try lifting with your palm facing upwards (e.g your grocery bags)
• Reduce or stop aggravating activities in the early stages.
• Set your workstation up ergonomically. Raise your screen up on a stand or books, use a separate keyboard and mouse, and use a gel mouse pad for wrist support.
• Take regular breaks to stretch and move your neck, back and wrist.
• Ice 20 minutes 2x daily.
• Gentle forearm stretches.

If you continue to experience pain in your forearm, visit our physiotherapists for a full assessment and treatment program.

References;

• Karanasios, S., Korakakis, V., Whiteley, R., Vasilogeorgis, I., Woodbridge, S., & Gioftsos, G. (2021). Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. British journal of sports medicine, 55(9), 477-485.
• Mostafaee, N., Divandari, A., Negahban, H., Kachooei, A. R., Moradi, A., Ebrahimzadeh, M. H., … & Daghiani, M. (2020). Shoulder and scapula muscle training plus conventional physiotherapy versus conventional physiotherapy only: a randomized controlled trial of patients with lateral elbow tendinopathy. Physiotherapy Theory and Practice, 1-12.