Elbow pain is never fun.
Elbow pain can be surprisingly debilitating. Most people come to see us once they have trouble typing, lifting their coffee mug, or lifting their child. If the pain is on the outer part of your arm, it’s generally called “Tennis Elbow”. It’s called this because it was generally associated with having poor backhand technique while playing tennis.
What is Tennis Elbow?
Lateral epicondalygia, also known as tennis elbow, is a condition where the extensor tendons of your forearm become overused. This causes pain and tenderness with movement such as gripping an object. The pain is thought to be caused by the tendon swelling or thickening, and may eventually result in tendon degeneration.
Basic anatomy of the outer elbow area.
Tennis Elbow Isn’t Always Caused by Tennis
Tennis elbow is commonly caused by repetitive overuse of your wrist and forearm. A typical cause is a sudden increase in loading of the tendon over a short period of time. For example, if you’ve been inactive all winter and start playing tennis daily as soon as the weather gets warm. Some examples of tennis-related predisposing factors are poor technique, grip size and heavy racquet and ball.
Poor ergonomics (work setup) can contribute to your elbow pain.
This condition is not exclusively caused by playing tennis; repeated actions such as wringing clothes or manual work (particularly with twisting movements such as using a screwdriver) can cause tennis elbow to develop as well. Excessive computer work with poor work setup can also be a cause of this elbow pain.
In most people, tennis elbow affects your dominant arm (the one you write with). Continued use of the affected arm can lead to microscopic tears in the tendon and scarring.
Signs & Symptoms
Pain on the outside of the elbow region that can extend into the muscle belly of the forearm muscles. Decreases in range of motion and loss of strength may be experienced.
What else can it be?
Other conditions that have a similar presentation to tennis elbow include radial tunnel syndrome (a trapped nerve in a similar area), potential radial head fracture if there has been trauma to the area, elbow joint restrictions and C6/C7 radiculopathies i.e. a nerve coming from the neck. There can also be other conditions in this area but the ones mentioned are the ones more commonly seen in physiotherapy practice. We can help figure out what the cause is and get you on a path of moving better!
Treatment and Management
Managing tennis elbow generally involves a 12-week evidence-based approach. (Which means that we use what science tells us the best approach is.)
The goals are reducing pain, improving range of motion and increasing strength. Of course, we work to help you achieve your goals – whether that’s lifting your coffee mug, working without pain or playing tennis!
Modalities like ultrasound, shockwave and needling can help with tennis elbow.
Rest is often recommended for initial load management to reduce pain associated with tennis elbow. Activity and/or equipment modification may be tried in an effort to alleviate symptoms and enhance recovery. These modifications include restricting work-related duties that could potentially aggravate the condition, limiting athletic participation such as reduced practice time or ending the season early, and reducing activities involving repeated wrist flexion and extension against resistance.
Elbow straps can help reduce pain!
Summary of physiotherapy techniques used to treat tennis elbow include:
- Education about activity modification
- Joint mobilizations to the elbow joint or neck if needed
- Mulligan techniques – involves your physiotherapist using something like a belt while getting you to perform pain free grip movements
- Dry needling, acupuncture & electrophysical agents i.e. ultrasound, shockwave therapy
- Frictioning the tendon – hands-on techniques performed by the physiotherapist and patient; this can help with pain management and improving blood flow to the area
- Strengthening program – eccentric exercises can help accelerate the tendon healing
- Bracing / taping the area to help offload the affected structures
If you have any questions about elbow pain or would like us to help you move better, book with us! We would love to be part of your journey back to good movement!
References:
https://thephysiospot.ca/
