Tennis elbow is a chronic inflammation of the extensor tendon at the bony part of the outside of the elbow (the epicondyle) and is also known as ‘lateral epicondylitis’. Tennis elbow can be the result of direct trauma but more often occurs over weeks or months of repetitive use of the extensor tendons at the elbow originating from the Extensor Carpi Radialis (ECRB) tendon. These tendons are active when twisting or gripping with the wrist. Affecting around 3 people in every 100, it's a common condition and certainly not restricted to tennis players.
Symptoms and presentation
Intial signs of tennis elbow are tenderness and pain when pressure is applied to the bony part of the outside of the elbow. This can develop into a dull constant pain or a sharp shooting pain that extends along the forearm or into the upper arm both at rest or when lifting an object or extending and twisting the wrist.
The wrist and forearm may feel weak and there may be some stiffness in the elbow joint. Some swelling can occur.
Treatment for tennis elbow varies and is largely dependent on the severity and how long you've had symptoms. Rest is obviously a key part of recovery and avoiding the activities that aggravate the condition will allow the tendon tissue to heal.
For an acute injury that has occurred within a few weeks it's important to treat as early as possible or tennis elbow may become chronic and last for months.
If your symptoms are mild you can treat tennis elbow without medical intervention.
Rest your elbow and tendon.
Have your palm facing up rather than down when lifting objects. This puts less strain on the muscles of the forearm and therefore the tendon.
If rest is not an option take regular breaks from activities which cause discomfort and pain.
Pain medication in the form of paracetamol or ibuprofen will give relief and reduce inflammation. (Do not take for extended periods of time.)
One of the most important ways to aid recovery and avoid re-injury it to incorporate progressive exercises to slowly increase your muscle’s strength without causing additional damage. Eccentric exercises prove effective in the majority of cases and your Hillcliff trainer can advise you on the best exercises to incorporate into your programme. If you are seeing a physiotherapist we will work closely with them to discuss the best approach to set you on the road to recovery.
It may take seven to ten weeks to see a notable reduction in pain and an improved grip. It's important to stick with it for at least this long and to progress at the recommended rate. Treatment focused only on relieving pain rather than correcting the muscle weakness and bad habits that might have caused the condition will not help prevent it making an unwelcome return sometime in the future.
In cases that don't respond to rest, medication or strengthening exercises, it may be necessary to be referred for a steroid injection. These can provide immediate relief but do wear off over time. They may be a quick fix solution but do not provide the long term relief and reduced risk of re-injury that a strengthing programme will. If a steroid injection is necessary it is still vital to strengthen to avoid recurrence. Those who don't respond to an injection may ultimately be referred for surgery.
Modifying any activities that have led to the development of tennis elbow is an obvious way to prevent it happening again. This will include taking rest periods or retraining any muscle imbalances to take the strain off the wrist or elbow. If tennis elbow has actually been caused by playing tennis then it may be helpful to change your grip technique, grip size or string tension.
The 3 most effective ways to prevent lateral epicondylitis are:
* A thorough warm up
* A structured stretching routine including both the flexors and extensors of the elbow and wrist
* A strength and conditioning programme for the forearm and wrists including for example, squeezing a tennis or stress ball and wrist curls using a small weight with the forearm pronated and supinated.
Muscular imbalances may occur further along the kinetic chain which need addressing, possibly in the shoulder or core muscle strength.
A movement analysis by your trainer will assess where any potential imbalances and weaknesses lie and a full fitness programme can be designed to address any issues and minimise the risk of further injury.
Strength and conditioning programming is a key feature of both treatment and prevention of tennis elbow. Contact us to find out how we can help you with a personalised fitness programme.