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What is tennis elbow?

Tennis elbow or lateral epicondalgia is a painful condition affecting the tendons that attached to a bony prominence on the outer side of the elbow. The tendons are of muscles which move our wrists to lift our hands such as over a keyboard, help us grip objects and help us to turn our forearm such as to twist a door key. Therefore, it is these movements that are commonly painful with this condition.

The pain is caused by a degenerative process within the tendon. This can cause the tendon to become weak and intolerant to loads when it is in use. Along with pain with activity, it is painful to touch the bony prominence of the elbow where the tendons attach and there is often stiffness in the forearm, which is most notable after periods of rest.

It is important to have an assessment from a physiotherapist or other medical professional to ensure that the symptoms you are experiencing are indeed caused by these tendons. There are many other potential conditions that can masquarade as tennis elbow.

Causes:

Most commonly, tennis elbow is an over use injury. It can be related to work or hobbies that have repetitive activities that put strain through these tendons such as gripping, pulling and twisting activities. It is common with people who garden or paint, with mechanics, hairdressers and tennis players. Typically symptoms will develop slowly over time. However, if there has been a sudden increase in activity such as starting a new sport or hobby there can be a rapid onset.

The other main cause is trauma. Any direct impact to the body prominence where the tendons attach can cause irritation to the tendon and an acute tendinopathy with similar symptoms. In this case, symptoms are more likely to respond to rest alone, depending on the severity of the trauma.

Treatment:

Rest and activity modification are essential as this is most commonly a condition where the tendon has been overloaded with repetitive use. It is essential to reduce the activities that are aggravating the symptoms, so the area can rest and can have a chance to recover. This can be difficult if there are tasks that are part of your job that you cannot stop doing, you may need to alter the way the task is done.

Physiotherapy includes a range of treatments to help reduce the pain and improve the tolerance of the tendons to load. Massage, stretches, mobility and acupuncture can be effective short term but must be used in conjunction with a strengthening programme for long term relief. The tendon needs to be stronger to cope with the demand placed on it. Your physiotherapist will be able to guide you through a progressive rehabilitation programme of exercises that you can use to reduce your pain and make the tendon stronger. Physiotherapy is the gold standard treatment, and will be helpful for up to 90% of patients. The treatment process is not a quick fix and a reasonable period of physiotherapy would be 3-4 months of regular treatment and strengthening.

Braces and supports can be very effective to reduce the pain day to day. They are especially helpful if you are unable to limit the pain aggravating activities. An Epiclasp is a type of brace that is commonly used and can be very effective for a lot of people. However, using a brace is not as effective as rest.

Other treatments:

In the minority of cases, if rest and appropriate physiotherapy has been ineffective, other options might need to be considered. These are not first choice treatments as these are invasive with inherent risks and their success rates can be low, these should only considered when pain has persisted at high levels affecting daily activities and has not responded to a reasonable period of physiotherapy. Additional treatments can include: various injections, extracorporeal shock wave or surgery.

If you still have some unanswered questions or want to talk to a physio about any specific concerns that you may have, please get in touch with the Flawless Physio team here.

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Very knowledgeable physio Team! Was in London on a business meeting and ended up visiting James for some urgent treatment on my lower back. Delighted with the service. James put me at ease straight away. His treatment was paramount in getting me through what was a hectic weekend. Could not recommend enough. Will definitely be back when in London again!
Funky Inflatable Co.
Funky Inflatable Co.
17:29 11 Sep 18
Went to "Flawless Physio" two weeks ago for back pain that I'd been carrying for months. Three sessions later, it's all gone! The staff was very pleasant, professional and gave me a series of simple exercises to do at home. I definitely recommend them. I'll be back, hopefully not too soon ;)
Charles Muzard
Charles Muzard
13:04 24 Sep 18
I was recommended to see James by my consultant following surgery to my ankle. He was extremely professional and knowledgable. He motivated me throughout the process and I have now returned to long distance running thanks to his help. I would recommend his services to anyone
David Burns
David Burns
19:32 08 Sep 18
Awesome team. I ended up having to seek out treatment when my back went into spasm (on going problem) whilst down visiting friends. I saw James and he was very professional and through with his treatment. More importantly he gave me a better understanding about what was going on and how to manage my injury in the future. Highly recommended!
James Tatham
James Tatham
08:03 20 Sep 18
I received treatment from Vicky for a very stiff and painful neck, possibly brought on by tension. I felt confident that my therapist was knowledgeable. The service was very friendly and professional and I felt good progress from the first session already. Vicky recommended some exercises and explained how to do them with very clear diagrams and instructions. I would highly recommend Vicky
Tiziana Guffanti
Tiziana Guffanti
17:23 29 Aug 18
I would highly recommend Flawless Physio. Excellent knowledge/treatment and also brilliant customer care - following up and giving advice. Tailored rehab to suit the type and level of sport as well as lifestyle. My wife & I have been treated by both James & Victoria and they have both been great. Will continue to use for any future injury & rehab.
Joe Gomes
Joe Gomes
19:11 30 Mar 19
I saw Victoria for my dodgy shoulder, and she was brilliant. Very professional And knowledgeable, she really took time to explain what was going on and to treat it. She followed up with me to check I was getting on well with the exercises. She is also really accommodating with timings for appointments. I couldn't recommend more highly, thank you Victoria!
Fiona Hall
Fiona Hall
08:35 27 Mar 19
First class. Had 4 or 5 appointments with Victoria that were always late in the evening, although you wouldn't know it. She took her time, whether that be on soft tissue work, explaining how to do an exercise, or the purpose behind it. A genuine person that wants to help and she clearly knows her stuff.
Jamie Moles
Jamie Moles
21:14 20 Jan 19
Went to flawless physio and vic was great! Training for a marathon and she was very understanding and helpful. Living in the Twickenham area so was in great location! Her specialist knowledge in knee injuries was able to get me back running in two weeks 🏃🏼‍♀️
Ruth Herlihy
Ruth Herlihy
23:44 25 Jan 19
I injured my leg (ITB) training for the Berlin Marathon and then made it far worse it by trying to run it. Victoria has been essential in my recovery, helping me understand how to strengthen the right muscle groups and get back to running. I have been very impressed by the depth of knowledge and insight. This weekend I will run the Cancer Research 10km. Thank you!
Paul Carpenter
Paul Carpenter
17:02 28 Jan 19
Really impressed with the service provided at Flawless Physio. Vicky was knowledgeable, professional and her invaluable treatment and advice got me to the start of this year’s marathon when I’d had to stop running with 8weeks to go. Without the advice and care I received at Flawless Physio, at best I’d have limped my way round the course and at worst, not been able to take part at all. Definitely recommend!
Katy Gomes
Katy Gomes
11:03 30 May 19
James helped resolve a hamstring injury that had troubled me for the best part of a year. I'll certainly use Flawless Physio for any future issues. Highly recommended.
Sandeep C
Sandeep C
18:02 30 Apr 19