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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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