What is Tennis Elbow?
Tennis elbow is a common term used to describe lateral elbow tendinopathy. It is a common musculoskeletal condition affecting many people, not just tennis players. Tennis elbow is often a result from overuse of the wrist extensor muscles, which leads to collagen disorganisation and tendon pathologies near the lateral epicondyle of the forearm.
Tennis elbow can present differently depending on the stages of tendinopathy (reactive tendinopathy/degenerative tendinopathy). Therefore it is best to consult a physiotherapist to help decide the best approach towards rehabilitation.
Having tennis elbow can be frustrating. Luckily, evidence has shown that specific exercise therapy and manual therapy can lead to decreased pain and a greater recovery rate.
![LMHHealth. (2020). Lateral Epicondylitis [Image]. Retrieved from https://www.lmh.org/get-care/orthokansas/elbow/lateral-epicondylitis-tennis-elbow/](https://static.wixstatic.com/media/23ac3b_189ffdbe32da484bbd3a5e755ae36cbd~mv2.png/v1/fill/w_71,h_40,al_c,q_85,usm_0.66_1.00_0.01,blur_2,enc_auto/23ac3b_189ffdbe32da484bbd3a5e755ae36cbd~mv2.png)
LMHHealth. (2020). Lateral Epicondylitis [Image]. Retrieved from https://www.lmh.org/get-care/orthokansas/elbow/lateral-epicondylitis-tennis-elbow/
Signs and symptoms
People with this condition often experience pain over the lateral epicondyle when the wrist extensor muscles are loaded such as gripping, lifting, finger extension. Aside from pain, this condition also affects your ability to work and play sports.
In more severe cases, people can experience pain when coming to contact with hot/cold temperatures (thermal hyperalgesia).
Técnica Gavilán. (2016). Treating Lateral Epicondylitis with ISTM [Image]. Retrieved from https://medium.com/@tecnicagavilan/treating-lateral-epicondylitis-with-istm-f1642904f881
Can surgery fix it?
Surgery is an option for the management of tennis elbow. However, research evidence has shown that surgical management of tennis elbow is no more effective compared to non-surgical treatment. Therefore, it is important for you to discuss with a physiotherapist to identify the best possible approach.
Physiotherapy treatment
There are many types of treatment available for tennis elbow such as manual therapy and exercise therapy. Physiotherapists often combine different types of treatment in order to achieve the best results.
Manual therapy
Evidence has shown that manual techniques such as mobilisation with movement can produce short-term clinical benefit on reducing pain and improving grip strength. This technique may be carried out by a physiotherapist for 6 to 10 repetitions.
Coombes, B., Bisset, L., & Vicenzino, B. (2015). Lateral elbow mobilization with movement [Image]. Retrieved from https://www-jospt-org.libraryproxy.griffith.edu.au/doi/full/10.2519/jospt.2015.5841
Exercise therapy
Exercise therapy is often considered as the core of tendinopathy rehabilitation. Early rehabilitation often includes pain-free isometric contraction of the forearm muscle. This activity can be carried out via resting the arms on the table and slowly lifting the middle knuckle.
Bisset, L. (2015). Sensorimotor palm-slide exercise [Image]. Retrieved from https://www.researchgate.net/figure/Sensorimotor-palm-slide-exercise-for-retraining-of-wrist-extension-With-the-forearm_fig6_282046495
As you progress through the exercise program your physiotherapist will be closely monitoring your progression. Below is an exercise progression example where your physiotherapist will now introduce concentric and eccentric muscle contraction of the forearm with additional weight from a dumbbell. The physiotherapist may also introduce strengthening exercises to target your shoulder muscles (rotator cuff) to help you gain better control of your arm movement and prevent future injuries.
Saint Luke's. Wrist Extension [Image]. Retrieved from https://www.saintlukeskc.org/health-library/wrist-extension-strength
What you should do when you are experiencing tennis elbow?
consult a physiotherapist
rest
follow the exercise program given by your physiotherapist
give it time to heal!
If you have any questions about tennis elbow or would like to book a time to see our physiotherapists, click here!
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References
Coombes, B., 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. doi: 10.2519/jospt.2015.5841
Dimitrios, S. (2016). Lateral elbow tendinopathy: Evidence of physiotherapy management. World Journal Of Orthopedics, 7(8), 463. doi: 10.5312/wjo.v7.i8.463
Bateman, M., Littlewood, C., Rawson, B., & Tambe, A. (2017). Surgery for tennis elbow: a systematic review. Shoulder & Elbow, 11(1), 35-44. doi: 10.1177/1758573217745041