Lateral Epicondylitis – Busting Some Myths About The Tennis Elbow, And What Can Be Done For It

It was previously believed to be solely an inflammatory condition. Instead, lateral epicondylitis, or what is commonly known as tennis elbow, has been shown to be a degenerative condition. It is caused by repetitive strain, or overuse of the forearm muscles.

Tennis elbow develops when the tight band of tendons of the forearm muscle repeatedly rub over the bony prominence at the elbow (lateral epicondyle). This happens during the bending and straightening of the elbow. Overtime leading to micro-tearing of the tendon, and subsequently inflammation and pain.

Imagine a tight rope repeatedly being rubbed over a rock, snapping back and forth. Over time, the fibres fray and eventually fail. This mechanism is similar to most degenerative tendon processes, including that of the Tennis Elbow.

Why Does This Tendon Degeneration Happen?

In order to do simple daily activities such as carrying a handbag, our forearm muscles need to work. Likewise, any task that requires force to be generated through the elbow to the hand would demand a certain amount of force. This force generated from the forearm muscles.

Therefore, people whose job or sport requires gripping, coupled with movement through the elbow, would be at risk. An example of such sport is tennis. However, contrary to popular belief, tennis elbows not only afflict tennis players. They also affect athletes such as cricketers and weightlifters, where there are similar physical demands.

For others who are more sedentary, it can be as simple as a weekend of spring-cleaning, where you are repeatedly carrying boxes and moving furniture back and forth when pain in the elbow hits you.

Any excessive exertion that the forearm muscles are not used to can put one at risk of developing tennis elbow. This is regardless of the duration of exertion.

What Are The Signs And Symptoms Of Tennis Elbow?

All degenerative overuse tendon conditions go through similar phases. It typically begins with inflammation from the initial irritation of the tendon. Over time, it progresses to degenerative changes occurring. Eventually, the tendon fails. This depends on how well it is managed in the early stages.

The accompanying signs and symptoms of the tennis elbow can be described in two phases. They are: the early stage and the progressive stage.

Early phase:

• A dull ache in the elbow at rest or with minimal movement
• Night pain or resting pain- a distinctive characteristic of an inflammation taking place
• Sharp pain with the exertion of their arm such as carrying a handbag or hitting a ball with a racquet

Progressive phase:

• Worsening pain around the elbow with no position of relief
• Sharp pain with simple low-load day to day tasks such as turning the doorknob or shaking hands
• Weakness in the arm (holding chopsticks may seem impossible and uncomfortable)

How Can Physiotherapists Help?

The early phase of tennis elbow is known as the inflammatory phase. Pain is managed through rest and medication. Movements involving repetitive movements around the elbow should be avoided. This will allow the inflammation to settle down. Electro-modalities -like ultrasound- and regularly icing can also be used to speed up the healing process. Athletes who are heavily involved in sports that heavily rely on their elbow and wrist will have to rest completely for a couple of weeks.

It is also necessary for tight muscles in the forearm to be released at this stage. This will helpto offload the tension on the tendon, reducing the tautness around the bony prominence. Taping techniques can facilitate a further reduction of the irritation around the elbow.

As the condition gradually improves, exercises to strengthen the tendon should be done. This is to prevent recurrence of this condition. A physiotherapist would be able to ascertain when it is appropriate for you to start on these exercises without potential flare-ups of the inflammatory response. The ultimate goal is to have pain-free movements, and for return to sport and occupation as quickly as possible.

After understanding the mechanism of the tennis elbow, the following video is a demonstration of a great stretch to release the tightness of the elbow extensor muscles.

Experiencing elbow or wrist pain? Click here to find out more about physiotherapy for elbow or wrist pain relief and how Core Concepts can help