Understanding Tennis Elbow

Tennis elbow—or lateral epicondylitis—is a painful condition that develops due to repetitive motions such as swinging a tennis racket. It is an overuse injury that occurs when tendons or muscles in the forearm that extend toward the elbow become overworked. As the elbow is basically located in the middle of the upper extremity, it is feasible that weak muscles involving the shoulder and wrist can also impact as causal factors for tennis elbow. When these muscles are weak the body naturally tries to compensate, resulting in the forearm muscles and tendons being overloaded.

This particular issue is typically reported by tennis players, but it may also become a problem for anyone who repeatedly swings the arms while working or playing certain sports. Mechanics, factory workers, professional cleaners, gardeners, golfers, bowlers, and basketball players may experience this condition due to repetitive arm movements. Women also tend to suffer from tennis elbow more often than men.

The symptoms usually develop in the dominant arm and include: 

• Pain or burning in the elbow that gradually worsens 
• Pain that intensifies when an object is squeezed or lifted 
• Sharp pain or a weak grip while trying to grab an object 
• A dull ache that worsens while moving the wrist (e.g., opening jars or doors) 

There are several strategies that help manage tennis elbow symptoms. Mild to moderate pain can often be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen. These can be found in both oral and topical form. It is also important to rest the elbow to reduce the risk of further injury. If these strategies do not provide relief and this issue becomes chronic, physiotherapy may be recommended. 

Physiotherapy is beneficial because it helps an individual maintain mobility in the elbow, even though the activity that caused the injury may need to be avoided for a short period of time. Physiotherapists specialize in demonstrating strength training techniques and stretching exercises and the whole upper extremity that accelerate natural healing processes and restore normal range of motion. A specific form of exercise that helps increase strength and mobility for the forearm muscles—while reducing pain—is eccentric exercise.

An example of eccentric exercise is a gentle lifting technique that involves the use of a light dumbbell, a canned product, or a full water bottle. The exercise, which is usually guided by a physiotherapist, consists of the following steps:

• Sit in a chair with an armrest while holding the dumbbell or water bottle.
• Place the arm holding the item downward onto the armrest.
• With the palm facing down, begin to slowly lift the wrist and then return it to the resting position in a controlled manner.
• Repeat this movement about 10 times.

This type of eccentric exercise should be performed about 3 to 4 times a day.

In addition to demonstrating these types of techniques, a physiotherapist may recommend the use of a tennis elbow brace to disperse the stress on the common extensor mechanism at the elbow while the muscles and tendons are healing. Muscle stimulation, manual massage, and shock wave therapy may also be a part of the therapeutic routine.

Speaking with a professional who can ensure proper tennis elbow management is one of the keys to long-term improvement. The techniques that are demonstrated during physiotherapy can also help reduce the risk of recurrence. Furthermore, research shows that people with tennis elbow who work with a skilled physiotherapist may recover fully without having to undergo any invasive form of treatment. If you’ve been struggling with pain due to tennis elbow, the licensed physiotherapists at North Hill Physiotherapy are experts at developing optimal pain management regimens.

References

1. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006; 164(11):1065-74. 

2. Weber C, Thai V, Neuheuser K, Groover K, Christ O. Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis. BMC Musculoskelet Disord. 2015;16(1):223. 

3. Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clin Rehabil. 2014;28(9):862-72.  

4. Croisier JL, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007;41(4):269-75. 

5. Ng GY, Chan HL. The immediate effects of tension of counterforce forearm brace on neuromuscular performance of wrist extensor muscles in subjects with lateral humeral epicondylosis. J Orthop Sports Phys Ther. 2004;34(2):72-8. 

6. Gündüz R, Malas FÜ, Borman P, Kocaoğlu S, Özçakar L. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison. Clin Rheumatol. 2012;31(5):807-12.