Tennis elbow is a very common complaint, affecting a wide range of individuals, not just tennis players. It typically results from overuse or repetitive strain on the forearm muscles and tendons around the elbow joint. This condition can cause significant pain and discomfort, impacting daily activities, sporting performance and reducing quality of life. Proper diagnosis and treatment are essential for effective management and recovery.
What is Tennis Elbow?
Tennis elbow, sometimes referred to as lateral epicondylitis, is a condition primarily related to microtears and inflammation in the tendons that attach to the lateral epicondyle, the bony prominence on the outer part of the elbow. This injury occurs when when repetitive motions, whether on the tennis court, in a demanding profession, or even in daily household tasks, subject the tendons to increasing loads (typically over days, weeks or months) without sufficient time for them to heal and adapt.
Symptoms and Warning Signs
Tennis elbow may manifest as a gradual onset of discomfort and pain on the outer side of the elbow. Most will initially dismiss it as a minor inconvenience, but ignoring the warning signs can lead to further aggravation and prolonged healing times. In advanced stages, even simple tasks like gripping a racket or even lifting a water bottle can become excruciatingly painful.
The most common symptoms include:
Pain and Tenderness: The most common symptom of tennis elbow is pain and tenderness on the outer side of the elbow. The discomfort may gradually worsen over time and are particularly noticeable when performing activities that involve gripping, lifting, or twisting motions.
Weakness in the Arm: As tennis elbow progresses, you may experience a weakening of your grip strength. Simple tasks like shaking hands, opening a jar, or even holding a racket may become challenging and painful.
Pain Radiation: In some cases, the pain from tennis elbow can radiate down the forearm towards the wrist. This radiation of pain is a common symptom of the condition.
Stiffness and Limited Range of Motion: Tennis elbow may lead to stiffness in the elbow joint, resulting in restricted movement. You may find it challenging to fully extend or flex your arm without discomfort.
Pain with Rest: Often in the acute stages, individuals with tennis elbow can experience discomfort even when their arm is at rest.
Common Triggers and Contributing Factors Leading to Tennis Elbow
Understanding the triggers of tennis elbow is essential to prevent its occurrence or recurrence. Two primary factors that contribute to this nagging injury are:
Repetitive Movements
One of the most common triggers of tennis elbow is the repetitive engagement and overuse of forearm muscles and tendons. Athletes who participate in sports that demand frequent and forceful gripping, such as tennis, squash, or racquetball, face a higher risk of developing this condition. Furthermore, individuals in occupations that involve repetitive hand and wrist motions, such as painters, carpenters, and office workers who spend prolonged hours typing, are also susceptible to tennis elbow. These repeated actions place excessive strain on the tendons connecting to the lateral epicondyle of the elbow.
Improper Equipment and Technique
Closely linked to the overuse of forearm muscles and tendons, the use of incorrect sports equipment or flawed techniques during play can exacerbate the demand on these structures, ultimately increasing the risk of injury. For example, using a tennis racket with an improperly sized grip or worn-out strings can force players to grip the racket more tightly, putting added stress on the forearm tendons. Similarly, in activities like weightlifting, incorrect lifting form can strain the elbow tendons unnecessarily. Awareness of proper equipment fit and technique is essential in preventing such injuries.
Interestingly, some risk factors for developing tendon pain are unrelated to your specific sport or activity. While we won't factors in this article, it's important to be aware of them as they can contribute to your risk of developing tendon-related issues. Here are some points to keep in mind:
Age: Advancing age increases the risk of tendon-related problems. As we get older, the tendons tend to become less flexible and more prone to injury.
Certain Medications: Some medications, such as statins used to lower cholesterol levels, have been associated with an increased risk of tendon issues. It's essential to discuss potential side effects of medications with your healthcare provider.
Smoking: Smoking has been linked to impaired blood flow and reduced collagen production, which can affect the health and healing capacity of tendons. Smokers may be at a higher risk of developing tendon problems.
While these factors may not be directly related to your chosen sport or activity, they can play a role in your susceptibility to tendon pain and injuries.
Reducing Your Risk of Developing Tennis ElbowEquipment and Technique
To reduce your risk of developing tennis elbow, consider the following tips:
Appropriate sports training load or workload progression: Whether you're an athlete or engage in repetitive tasks at work, it's crucial to progressively increase your workload. Gradual increments allow your muscles and tendons to adapt to increased demands over time, reducing the risk of overuse injuries like tennis elbow. Consult with a sports physiotherapist and/or coach create a suitable training plan that balances intensity and recovery.
Proper Equipment Selection: Choose sports equipment, such as rackets, with appropriate string tension, grip size, and shock absorption features. Seek expert advice if needed to ensure your equipment is tailored to your specific needs and playing style.
Technique Analysis: Consult a coach or sports expert to analyse and improve your technique, ensuring that you're using efficient and ergonomic movements. Correcting posture, grip, and movement patterns can significantly reduce the stress on your elbow tendons during activities.
Warm-up: Always engage in thorough warm-up exercises before sports to prepare and protect your muscles and tendons. Warming up increases tendon elasticity which can reduce your risk of injury.
By addressing these common triggers, you can reduce the risk of developing tennis elbow.
Treating Tennis Elbow
How long will It take?
The duration of recovery from tennis elbow can vary significantly from person to person and depends on several factors, including the severity of the condition, individual health, adherence to treatment and rehabilitation, and lifestyle factors. We see a very broad range of recovery times, from 12 weeks to 12 months or longer. This makes giving advice on timeframes difficult.
Relative Rest and Ice Applications:
Relative rest is an important component of the healing process for tennis elbow. Giving your forearm muscles and tendons time to recuperate is crucial in preventing further irritation. Relative rest means limiting or avoiding engaging in activities that aggravate your symptoms, especially those involving repetitive gripping and lifting but continuing with your usual daily activities as best as possible.
An important factor to note with this advice is how long your symptoms have been present for. If you are battling with your first ever occurrence of tennis elbow and your symptoms have started within the last 2-3 weeks, complete rest from aggravating activities together with a targeted rehabilitation plan is recommended (if possible) to stop any progression of symptoms and reduce your risk of developing persistent symptoms which tennis elbow is known for. If, however you have had multiple occurrences of tennis elbow, or your current flair up has lasted for longer than 4 weeks, a slightly more proactive approach may be taken which includes continuation of your usual activities but at a lower intensity/volume and starting an appropriate, physiotherapy guided exercise rehab plan.
Alongside rest, the use of ice packs can be an effective means of pain relief. While it may only offer temporary relief, applying an ice-pack to the affected area for 10 minutes at a time, multiple times a day, can help alleviate discomfort.
Rehabilitation Exercises
Elbow extensor loading exercises play a pivotal role in the rehabilitation process for conditions like tennis elbow. As previously discussed, the initial step often involves relative rest to allow the affected tendons to heal and reduce inflammation. However, once that initial phase is established, the introduction of specific isolated exercises becomes crucial. These exercises are strategically designed to target the affected common extensor tendons in a controlled and progressive manner. By targeting these tendons with precision, we can diminish their sensitivity to pain and enhance their capacity to tolerate the stresses associated with various activities. In essence, elbow extensor loading exercises are instrumental in not only alleviating discomfort but also in building resilience, ultimately aiding individuals in returning to their favourite sports or daily routines with confidence and reduced risk of recurrence.
When this step is overlooked, the underlying weakness and vulnerability of the affected tendons aren't adequately addressed which increases the risk of recurrent pain and discomfort on returning to activity, even after a period of relative rest. It highlights the significance of a comprehensive rehabilitation approach that not only manages acute symptoms but also fortifies the affected structures. By integrating these exercises into the recovery plan, individuals can better equip themselves to face the demands of their chosen activities and reduce the likelihood of tennis elbow symptoms resurfacing.
The Wrist Extension Exercise
For those beginning their rehabilitation journey for tennis elbow, the isometric wrist extension exercise serves as an excellent foundational step. This exercise involves gently pressing down on the affected-side wrist to activate the wrist extensor muscles without any joint movement. This subjects the common extensor origin to controlled load which helps to initiate the recovery process of pain desensitisation and improving extensor tendon health. This should then be progressed appropriately under the guidance of a sports physiotherapist.
Press down until you feel some discomfort in your elbow and hold for 5 rounds of 20-30 seconds with a 30 second rest between each effort. You should feel no more than 2-3/10 pain during or after.
What about treatments like massage, dry needling, compression, taping and cupping?
While treatments like massage, cupping, taping and dry needling can offer temporary relief from the discomfort associated with tennis elbow, it's essential to recognise their limitations. Most of these modalities primarily focus on symptom management by promoting blood circulation, reducing muscle tension, or addressing trigger points. However, they often do not directly address the underlying deficiencies in tendon strength and resilience. Consequently, their benefits are often short-lived, and without concurrent targeted rehabilitation exercises, the risk of symptom recurrence remains high. Therefore, these treatments are best used as adjuncts to comprehensive rehabilitation programs, complementing the efforts to alleviate pain but not serving as standalone solutions for long-term recovery. The core of tennis elbow rehabilitation remains in tailored exercise programs that systematically strengthen and condition the affected tendons, fostering lasting recovery and injury prevention.
How about medical Interventions like Cortisone injections or Platelet Rich Plasma (PRP) Injections?
Cortisone injections have long been used to provide relief for conditions like tennis elbow due to their potent anti-inflammatory properties. They can swiftly reduce pain and inflammation, offering welcome respite for those experiencing discomfort. However, it's crucial to consider the long-term effectiveness of cortisone injections. Research and clinical studies have shown that while these injections can be highly effective in the short term, their benefits tend to diminish over time. In fact, when assessing the outcomes in the long term, patients who have received cortisone injections often fare no better than those who haven't. This suggests that while cortisone injections can provide immediate relief, they don’t address the underlying causes of the condition, potentially masking symptoms without promoting true healing or preventing recurrence. Consequently, a more comprehensive approach, including targeted rehabilitation exercises, is often necessary for sustained improvement and lasting relief from tennis elbow.
PRP injections have more recently come into the spotlight, gaining attention as a potential treatment for tennis elbow and other musculoskeletal conditions. This innovative therapy involves using a patient's own blood to create a concentrated plasma rich in growth factors, which is then injected into the affected area. Some individuals have reported positive outcomes, making PRP injections an intriguing option for those seeking alternatives to traditional treatments. It's important to know at this stage that this treatment is often costly and ongoing research into its effectiveness suggests its effects may be no greater than a placebo. Waiting until further high quality research is conducted to confirm its efficacy and effectiveness is therefore advisable.
Shockwave: a promising new therapy
Shockwave therapy has emerged as a promising and innovative treatment option for various musculoskeletal conditions, including tennis elbow. This non-invasive procedure utilises high-energy soundwaves to stimulate the body's natural healing processes. One of its key advantages is its ability to address the root causes of the condition, rather than merely alleviating symptoms.
In the case of tennis elbow, shockwave therapy can effectively target the damaged tendons and stimulate blood flow, possibly helping to promote tissue regeneration. as well as desensitising the affected tendon leading to symptom relief. As a result, individuals often experience reduced pain and discomfort, which can significantly improve their quality of life.
The Tennis Elbow Journey
Overcoming tennis elbow requires timely and well-guided intervention. Early treatment is crucial for a quick resolution of symptoms and for preventing the condition from becoming chronic. In cases where the condition has already progressed to a chronic stage, expect a lengthier recovery; however, proper guidance on managing workloads and incorporating targeted rehabilitation exercises will allow the fastest possible road to symptom resolution.
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