Do you think you have “Tennis Elbow”?
Aidan Rich, APA Sports and Exercise Physiotherapist
“Tennis elbow” (also called common extensor origin tendinopathy or lateral epicondylitis) is a common condition causing pain on the outside of the elbow with activities such as gripping or lifting. Ironically, it rarely occurs in tennis players!
It is due to overuse of the “extensor muscles” used for gripping and extending the wrist which causes some irritation/inflammation of the small tendon where the muscle attaches to the elbow (see right image).
Tennis elbow usually begins gradually due to activities that place a large load on the elbow such as gripping (eg gym weights) or repetitive manual work such as gardening or process line work. Occasionally the injury can happen with a sudden incident.
How do we know if it’s tennis elbow?
An experienced physiotherapist or sports doctor can diagnose tennis elbow by a thorough clinical assessment. Tennis elbow presents as pain on the outside of the elbow, which can occasionally radiate down the forearm. Identifying the activity that has caused the overuse is very important in diagnosis and treatment.
Diagnostic tests include pushing your wrist or your 3rd finger up against resistance which produces the typical pain (see left image). Gentle pressure by the practitioner with their thumb on the tendon is also painful.
Other conditions that cause pain in the same area include elbow osteoarthritis (which is quite rare), muscle strain (which is uncommon but usually settles quickly), or referred pain from the neck. There are other tendon related problems that can occur around the elbow, but they present with a different pain location. Golfer’s elbow for example produces pain on the inside of the elbow.
How is tennis elbow treated?
Treatment for tennis elbow often includes:
Education around the activities that caused the overuse and developing some guidelines around how much pain to “allow” during and after such activities. A tennis elbow brace or tape can allow people to continue their sport/activities without aggravating the condition further
A key component is a graded strengthening program that can improve the strength and power in the elbow and desensitise the pain levels in the tendon. This then allows a graded return to full activities without pain
Our physiotherapists might review your case in collaboration with your treating doctor to discuss appropriate medications
Manual therapy performed by your physiotherapist can help to reduce pain and improve strength. Sometimes treatment of the neck can additionally assist with tennis elbow symptoms
With the right treatment tennis elbow generally improves over 2-3 months, although full recovery can take longer. If recovery is slow or stalled, other treatment options include:
“Cortisone” injection. This can provide a short term benefit, but in the longer term (3 months or greater) the pain often returns
PRP (platelet rich plasma) injections. PRP involves separating out components from a patient’s blood sample and injecting this into the tendon. However, research shows that PRP is no more effective than a placebo (eg saline) injection. Other injection type therapies (eg prolotherapy) also do not have convincing evidence of effectiveness
Ultimately, tennis elbow is a common injury that generally responds well to physiotherapy. However obtaining the correct diagnosis and treatment is important. A consultation with our experienced physiotherapists is the best approach to getting you back to the activities you love doing as quickly as possible.
References
Coombes, B. K., Bisset, L., & Vicenzino, B. (2015). Management of lateral elbow tendinopathy: one size does not fit all. Journal of orthopaedic and sports physical therapy, 45(11), 938-949.
Coombes, B. K., Bisset, L., & Vicenzino, B. (2009). A new integrative model of lateral epicondylalgia. British journal of sports medicine, 43(4), 252-258.
Branson, R., Naidu, K., du Toit, C., Rotstein, A. H., Kiss, R., McMillan, D., & Vicenzino, B. (2017). Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow. Journal of science and medicine in sport, 20(6), 528-533.
Coombes, B. K., Bisset, L., & Vicenzino, B. (2012). Elbow flexor and extensor muscle weakness in lateral epicondylalgia. British journal of sports medicine, 46(6), 449-453.
Coombes, B. K., Bisset, L., & Vicenzino, B. (2015). Cold hyperalgesia associated with poorer prognosis in lateral epicondylalgia: a 1-year prognostic study of physical and psychological factors. The Clinical journal of pain, 31(1), 30-35.
de Vos, R. J., Windt, J., & Weir, A. (2014). Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. British journal of sports medicine, 48(12), 952-956.
Keijsers, R., de Vos, R. J., Kuijer, P. P. F., van den Bekerom, M. P., van der Woude, H. J., & Eygendaal, D. (2019). Tennis elbow. Shoulder and elbow, 11(5), 384-392.
Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare in Boronia. Aidan's post-graduate qualifications in Sports Medicine enable him to educate the patient regarding the nature of their diagnosis, as well as empower them with the best methods to return to their normal level of function as soon as possible.