What is tennis elbow? 

Tennis elbow, also known as lateral epicondylitis, is a common painful condition of the elbow that affects between one to three people in every 100. The condition is a type of tendinopathy and typically presents itself as inflammation and pain occurring on and around the lateral epicondyle, a bony bump on the outside of the elbow, where the tendons attach to the bone. 

This condition most commonly affects individuals between the ages of 30 and 50 years old, but it can occur in all ages, in both men and women, and in both arms (however the dominant arm is usually more prevalent). 

The condition usually develops gradually and, depending on how severe it is, can last between six months and two years. 

What are the symptoms? 

• • Pain and tenderness on the outer side of the elbow and at times, the pain may even travel down the forearm.  
  • Pain and/or weakness with gripping, writing, and twisting movements of the forearm, as well as lifting and carrying items. 
  • Pain when the forearm muscles are stretched and tender spots in the forearm muscles.  
  • In some cases, neck stiffness and tenderness, and signs of nerve irritation like numbness and pins and needles. 

What causes it? 

Despite its name, most people don’t get it from playing tennis. Sports such as tennis are commonly associated with this condition, but the problem can occur with many different activities. Tennis elbow is thought to occur due to mal-adaptations to the tendon. This is often caused by overloading the tendon through repetitive gripping and grasping activities such as hammering, painting, and typing. Other contributing factors may include unaccustomed hand use, weak forearm muscle strength or tight muscles, and/or poor technique. 

Although less common, a direct blow to the elbow may result in swelling of the tendon that can lead to degeneration. This can make the elbow more susceptible to an overuse injury. 

How is tennis elbow diagnosed? 

Your physiotherapist or doctor can clinically diagnose your tennis elbow. After obtaining a detailed history and performing some special tests, they may determine a provisional diagnosis of tennis elbow. It is important that your physiotherapist also assess your neck and upper limb neurodynamic as referred pain from the neck and reduced nerve mobility can mimic tennis elbow. Failure to do so may result in a lack of symptom improvement. 

An ultrasound scan or MRI are the best tests to identify tendon changes and adaptations, but are often not necessary. X-rays are of little diagnostic benefit. 

Managing your symptoms 

Most people who have tennis elbow find that their symptoms get better when they rest their arm and take-over-the counter pain medications. If you do this and still have symptoms after six weeks or so, visit your GP or physiotherapist. 

Generally, the most helpful approach is to implement strategies that reduces pain. This may include changing the way you are doing things.  

Ways to try to reduce the pain 

• • Rest your elbow and arm as much as you can. Avoid or modify activities and movements that make your pain worse. If you need to lift something heavy, bend your elbows and make sure the palms of your hands are facing upwards. 
  • Use anti-inflammatory, non-steroidal or ‘cold’ gels or creams, which can be rubbed into the painful area. 
  • Apply an icepack or a bag of frozen peas wrapped in a tea towel on your elbow may temporarily relieve the pain. Avoid putting the ice pack directly onto your skin to avoid causing damage to your skin. Only use it for about 20 minutes every three to four hours. 
  • Stretches can also give relief. 
  • Use a tennis elbow brace. You may find this is helpful to “offload” the area and allow you to continue with normal activities. 

The role of physiotherapy 

Physiotherapy has been shown to be effective and helpful in the short and long-term management of tennis elbow. 

Physiotherapy aims to:

• • Reduce elbow pain. 
  • Facilitate tissue repair. 
  • Restore normal joint range of motion and function. 
  • Restore and improve muscle length, strength and movement patterns. 
  • Normalise neck function and upper limb neurodynamic. 

These goals can be achieved in various ways and, following a detailed assessment of your elbow, arm and neck, your physiotherapist can discuss the best strategy for you to implement based on your symptoms and your lifestyle. 

Physiotherapy treatment may include gentle mobilisation of your neck and elbow joints. Other treatment options available include elbow taping, muscle stretches, neural mobilisations, massage and strengthening. 

If you think you have tennis elbow come visit us at Elevate Physio and Pilates in Balwyn for an initial assessment, where we provide a comprehensive evaluation, explain the diagnosis, and highlight the different management options! 

Written by Mo Bhatnagar (Clinical Myotherapist)