A Physiotherapists Guide To Tennis Elbow
INTRODUCTION
The following is a guide to understanding Tennis Elbow, its symptoms, who is vulnerable, how it is diagnosed and the recommended treatment.
TENNIS ELBOW
“Tennis Elbow” is a broad term often used to describe pain or discomfort on the outside of the elbow. This pain has occurred from overuse of the hand, wrist and forearm musculature. The term “Tennis Elbow” was given after a high proportion of tennis players developed the condition through repeated stress of the common extensor tendon of the elbow. Despite the origin of its name, Tennis Elbow is not limited to the tennis population 1.
Tennis elbow occurs either acutely or gradually over time. The bony part on the outside of the elbow (lateral epicondyle) is where the muscles and tendons converge to form a common tendon. This tendon attaches to the bony prominence and they permit movement of the hand and wrist (Fig 1).
Figure 1: (http://www.bristolhandsurgery.co.uk/wp-content/uploads/2015/03/tennis-elbowjpg.jpg )
Health professionals will define tennis elbow as an extensor tendinopathy; this refers to pain and possibly inflammation around the lateral epicondyle. Another common term used to describe pain around the elbow, is ‘golfer’s elbow’. This is referring to pain on the inside of the elbow (medial epicondyle) and is also known as flexor tendinopathy.
Tennis elbow is prevalent on the side used for repeated gripping, high levels of resistance and movement at the wrist. This is why the condition most commonly affects people on their dominant side, though, can occur in both arms 2.
Symptoms of Tennis Elbow
Symptoms vary from person to person, common presentations include:
- An ache or pain experienced during or after gripping or squeezing objects
Aching or pain around the area of the lateral epicondyle may slowly develop over time. The onset of pain can also occur quickly, though this is not common
- Aching or pain is worsened by forcefully moving the wrist. Some activities may include handling kitchen utensils like:
- Using a knife to cut firm vegetables
- Opening a jar or a door
- Turning on the taps
- Using carpentry tools or gardening tools that require you to grip or twist
- Cleaning tables and windows.
Who gets Tennis Elbow?
Tennis elbow has been found to affect between 1% and 3% of the population and the incidence for repetitive tasks is 30% and among tennis players has been extremely high, with up to 40% of tennis players being affected during their careers 1 .
Tennis elbow more commonly occurs in men than women and is frequently present between the ages of 30 and 50 years. However, Tennis Elbow can affect people of any age 3.
Despite being highly prevalent among tennis players, Tennis Elbow may affect anyone who participates in work or leisure activities involving repetitive use of the elbow, hand and wrist. The likelihood of tennis elbow occurring from these other activities is increased by the force during gripping as part of the action.
How is Tennis Elbow diagnosed?
Tennis elbow can be diagnosed by your Physiotherapist. During the consultation, your Physiotherapist should ask you a number of questions about your symptoms before they take you through a series of tests to determine the source of pain.
Only a small proportion of people require other imaging such as an ultrasound or CT. This will typically be because the symptoms may not fit the expected diagnosis. Other structures may be involved, or a person may not be responding to the usual management of the condition.
Treatment
Tennis elbow is successfully managed with Physiotherapy treatment and a rehabilitation program. Other possible treatment includes cortisone injections, and in severe cases, surgery if there is no improvement with conservative means.
The management of tennis elbow is tailored to an individual and will be influenced by your medical history, pain levels, hand and wrist function and other medications you are currently taking.
The goals of treatment are to:
– decrease and eliminate pain, swelling and inflammation
– promote healing around the muscle and tendon
– change or modify the loads on the elbow
– restore function, movement and strength to the elbow, forearm and wrist
How to Reduce Pain and Promote Healing of Tennis Elbow
Some modalities to reduce pain would include:
- Regular application of ice to the area
- Taping the elbow, or using a brace, as per your Physiotherapist’s instructions
- Taking anti-inflammatories (NSAIDS), in consultation with your GP
- Avoiding movements that cause unnecessary pressure or stress through the forearm muscles and elbow
When the pain and discomfort have begun to subside, your Physiotherapist will take you through some specific exercises to stretch and strengthen the muscles and tendons surrounding the elbow. There will be specific movements that you will be advised to avoid. This will include any activity that causes pain to the elbow either during or afterwards.
Your recovery may also be assisted with taping of the elbow / forearm or the use of a specific brace fitted by your Physiotherapist.
What is the recovery rate for people with Tennis Elbow?
Generally, 95% of people will make a full recovery with Physiotherapy treatment and management. Around 5-10% of people require surgical intervention to repair the muscle and tendon around the elbow. In the 5% who undergo surgery, 80-90% experience pain relief and restoration of function 1.
Written by Sophie Halsall-McLennan, Fresh Start Physiotherapy
- Bisset,L., Vicenzino, B., Sesto, M., MacDermid, J. (2013) Tennis Elbow: The Evidence, The Science And The Clinical Experience
- Brukner, P., & Khan, K. (2009). Clinical Sport Medicine (revised 3rd Ed.). McGraw-Hill, North Ryde.
- Skirven,T., Osterman, A., Fedorczyk, J., & Amadio, P. (2011). Rehabilitation of the Hand and Upper Extremity (6th). Elsevier. Philadelphia
About The Author
Sophie Halsall-McLennan is the owner of Fresh Start Physiotherapy and has a special interest in Hand Therapy and Shoulder Rehabilitation. She has a Bachelor of Physiotherapy from Charles Sturt University, over 13 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a lecturer at Deakin University.
