Tennis Elbow – Main Causes and Symptoms

Tennis Elbow develops when the tight band of tendons of the forearm muscle repeatedly rubs over the bony prominence at the elbow (lateral epicondyle) during bending and straightening of the elbow.

Imagine a tight rope repeatedly rubbed over a rock, constantly 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.

This leads to micro-tearing of the tendon, and subsequently inflammation and pain.

Why does tendon degeneration happen?

In order to perform simple daily activities such as carrying a handbag or opening a jar of peanut butter, our forearm muscles need to work. Similarly, any task that requires force to be generated through the elbow to the hand would demand a certain amount of force to be generated from the forearm muscles.

Therefore, people whose job or sport requires gripping coupled with movement through the elbow, like tennis, would be at risk of developing this condition. However, contrary to popular belief, tennis elbows not only affects tennis players but also sportsmen 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. Simply, any excessive exertion that the forearm muscles are not used to, can put one at risk of developing this condition regardless 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 and over time progresses to degenerative changes occurring and the eventual failure of the tendon, depending on how well managed in the early stages.

The accompanying signs and symptoms of the Tennis Elbow can be described in two phases.

Early-stage Tennis Elbow

• 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 exertion of their arm such as carrying a hand bag 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 the Tennis Elbow often referred to as the inflammatory phase. Pain managed primarily with rest and medication. Avoid repetitive movements around the elbow to allow the inflammation to settle down. Electro-modalities such as ultrasound and regularly icing speed up the healing process. Sports athletes who are heavily use of their elbow and wrist; such as tennis players or cricketers will have to rest completely for a couple of weeks.

At this stage, the forearm tight muscles released to help offload the tension on the tendon, reduce the tautness around the bony prominence. Taping techniques can facilitate further reduction of the irritation around the elbow.

As the condition gradually progresses, exercises that strengthen the tendon prevent recurrence of the 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 to return to sport and occupation as quickly as possible.