Tennis elbow ...whats all the racquet about ?

Updated: Feb 10


Tennis Elbow, or Lateral Epicondylalgia is the most common elbow injury that we treat here at Arana Hills Physiotherapy. It can be quite a stubborn condition to treat and does require patience and perseverance to get it sorted out.



What is Tennis Elbow?


Typical tennis elbow tends to involve the common tendon origin of the forearm extensor muscles, typically the extensor carpi radialis brevis (ECRB), and the Extensor carpi radialis longus, the one that lifts the pointer finger up.



It appears that it is often due to an overload of a weak tendon resulting in it becoming reactive and painful. This site of pain is usually localised to the origin of the tendon and can cause the fibres within the tendon to become weaker thereby reducing efficient loading and causing further irritation and pain.


Sometimes it's more than just the tendon.



Running close to the muscles that make up the forearm is the posterior interosseous nerve, (PIN). This nerve is a deep branch of the radial nerve and is at risk of compression or irritation as it makes its way through the muscular tunnels of the forearm. This can lead to it being sensitized and create a deep ache that can either be mistaken for tennis elbow or is part of the painful presentation.







Who is at risk?


Tennis Elbow usually affects those aged between 30 and 50. It is of no coincidence that this is also the age where we start to see a spike in tendon related disorders in other parts of the body e.g. shoulder, achillies tendinopathy, plantar fasciopathy etc.

It is therefore likely there are some age related changes within the tendon that contribute to the development of this issue. Here are the populations that seem to suffer from this type of issue;


  • Middle aged males in the manual labour population, with a history of repetitive lifting, such as jackhammering or carpenters.


  • Middle-aged office workers requiring repetitive duties with poor wrist positioning such as typing or using the mouse


  • .Middle-aged population who play racket sports frequently and with improper equipment or poor technique.


Can you spot the recurrent theme ?



How can Physiotherapy help?


Physiotherapy can assist in identifying the particular causes and triggers of tennis elbow and this is very important as the more accurate the diagnosis the better the chance for a great outcome. Treatment is usually based around the following types of treatment;


Manual therapy techniques, acupuncture and strapping can all be used to relieve pain and promote better function. This can certainly make day to day activities more tolerable and get you on the path to a full recovery.


Targeted strengthening and stretching exercises to build up the strength of the tendon at the elbow as well as general upper limb strength are important.


A Swedish study showed that performing daily eccentric exercise, using an appropriate weight to maintain a pain free movement, resulted in a significant decrease in tennis elbow symptoms, with 56% reporting being pain free at the six-week intervention point. This was in comparison to the control group, where 79% of subjects still complained of elbow pain.





In more long term cases a course of Shockwave therapy can be useful to stimulate the repair process and dampen the pain. This is usually used in more persistent and long term cases and is used in conjunction with a good rehab program.


It is not unusual to find cases of tennis elbow that have a neural element due to irritation of the posterior interosseous nerve as well as having contributing factors from the cervical and thoracic spine. It is therefore important to address these regions in treatment either with direct manual techniques and home exercises.


Crucial to managing tennis elbow is advising the correct technique for lifting and gripping when playing sports.  It is often recommended to lift with a supinated forearm, ‘palms up’, and a neutral wrist to reduce the stress and load on the tendon. This is usually a short term measure.


What about other interventions such as injections or surgery ?


Evidence suggests that cortisone injections into the elbow have a very poor long term outcome and that if they are successful in the short term the recovery will be longer than if conservatively managed. Surgery is rarely indicated for tennis elbow but in severs cases or ones that are not responding it has been used to varying degrees of success. The majority of cases respond well with appropriate advice and physiotherapy however the time frames can be quite long depending on how long you have had it for.


Give us a call if you have an elbow that's been giving you a bit of a serve ( boom boom ), you can book in to see us here.



Dave

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