Tennis Elbow

Tennis elbow, otherwise known as lateral epicondylalgia, is a common elbow injury affecting many, not limited to tennis players! It is a type of tendinopathy, which is when the tendon, which attaches some of the forearm muscles to the bone on the outside of the elbow, becomes irritated from either a direct injury or trauma, or more commonly from repetitive overload.

What are the symptoms?

Tennis elbow is usually characterised by the following symptoms:

- Pain on the outside of the elbow close to or on the bony prominence, which can refer down into the forearm also and is usually tender to touch

- Reduced power in the forearm and hand i.e. difficulty lifting a saucepan or kettle or pushing open a door

- Pain is usually worse with repetitive tasks, i.e. when using a PC mouse, wiping windows, using a screwdriver

- The forearm and elbow may feel stiff first thing in the morning

- There may be pain as you straighten the elbow after having had in bent for a period of time

What are the causes?

Tennis elbow is most commonly caused by repetitive strain on the tendon, which over time causes micro-trauma to the tendon and eventually it will begin to feel weak and become painful.

Despite the name, tennis elbow is not limited to tennis players, and is actually very common among office workers from repetitive mouse work and typing and also among other manual workers such as builders, painters & decorators and plumbers. Repetitive twisting and reaching motions within these roles contribute to tennis elbow.

Tennis elbow used to be called tendonitis, but we now know that there is very limited active inflammation involved in the pathology, and it is in fact the weakening of the tendon which causes pain as nerve endings become sensitised and the tissue becomes stressed beyond its tolerance.

How is it treated?

The most important aspect of treatment for tennis elbow is to strength the tendon, as it is the weakening of the tendon which causes it to become painful.

Initially symptomatic relief is important; there are several approaches which can help with this, depending on the severity of the pain:

- Topical pain relieving gel

- Ice application

- Wearing a tennis elbow strap, which helps to offload the tendon

- Soft tissue massage to relieve any tension in the forearm muscles

In some instances where the symptoms are resistant to improvement with the above methods, it may be appropriate to consider either extracorporeal shockwave therapy (ESWT) or an cortisone injection for pain relief.

The strengthening aspect is crucial for long term recovery and prevention of the problem re-occurring in the future. A physiotherapist will prescribe an exercise routine for you to practice daily; this will vary initially depending on your tolerance to loading the tendon.

It may also be necessary to modify your activities which could be aggravating your pain for a short time, whilst allowing time and the exercises to help the tendon recover.

How long will it take?

Unfortunately tendon tissue doesn't have a very good blood supply, so unlike a ligament sprain or muscle strain, it can take slightly longer to recover. It is anticipated that you will notice some improvement to your symptoms within 2-4 weeks of being treatment, however it can take several months of strengthening to resolve the symptoms completely.

If you are experiencing elbow pain and would like some advice on how to best manage this, get in touch today!