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Tennis Elbow

The condition of Tennis elbow is somewhat misleading, because it does not exclusively affect tennis players. The true name for it is actually lateral epicondylitis, meaning the strain and ensuing inflammation of the tendon (and sometimes muscles) located in the outer aspect of the elbow. These muscles are called the wrist extensors, simply meaning the muscles used to extend the wrist and fingers (extend them upwards). The second function of these muscles is to stabilize the wrist while gripping firmly. Although the action of these muscles occur further down the arm, they originate from a common tendon that attaches to the lateral epicondyle (outer bony prominence of the elbow). When these muscles get overused or overloaded, small tears in the tendon (tendon strain) may result. This strain results in an inflammatory process, further increasing the pain and decreasing the function of the tendon and muscles involved. When there is no inflammation, and only degenerative changes exist within the tendon it is actually called a tendiosis or tendinopathy.

FACTORS

Activities that involve a lot of gripping or repetitive wrist extension will load the tendon. Some examples are racquet sports, work involving lifting, grocery store clerk. Overuse causes the tendon to fatigue, and eventually strain.

Additionally, increasing the load on the tendon alone can lead to this injury. For example, lifting a very heavy weight or gripping something firmly when it suddenly pulls away from you. The overload of the tendon can cause the strain immediately.

External or outside factors that may contribute to tennis elbow may be the equipment used or the surrounding environment. An example in the tennis player is using a racquet that vibrates too much. This causes the player to grip more tightly to stabilize the racquet. Ergonomics of the work station may also be to blame. Ergonomics refers to the physical set-up of the immediate environment and how well it eases the workload on the individual. The store clerk who needs to reach over a large counter to move items along demonstrates this. If the reach is less, other muscles in the arm can take some of the load, as opposed to working the wrist extensors alone.

PREVENTION

Prevention of tennis elbow can best be achieved through activity modification. Some tips to prevent the onset of this injury are:

• Grip less tightly. In tennis, especially when not hitting the ball. Also, changing hands when waiting for play to resume.
• Decrease the frequency and/or load on the tendon. This means reducing the number of times you perform the particular action or activity, as well as reducing the resistance involved.
• Watch for the outside factors, such as the equipment being used. In tennis this may include avoiding the use of a racquet that vibrates too much, has too large a grip, or has a small "sweet spot". (if you improve your stroke, you may not need a larger sweet spot). Some of these tips apply when operating machinery as well if it vibrates too much or has an awkward grip.
• Optimizing the ergonomics of the work station. This requires proper assessment so that relationships between the work/activity can be made to injury prevention. It may include re-arranging the components of the station and the use of some helpful devices (such as hand rests, paper holders, automated devices).
• Correcting any faulty biomechanics. This can be assessed by a physiotherapist. For example, if you have areas of weakness or stiffness, this may affect your movement and place undue stress on certain structures, leading to injury.

PHYSIOTHERAPY TREATMENT

Initially, as per the guidelines, apply ice (not directly to the skin, use a towel for seperation) to the affected area for 10-15 minutes. Rest and compression may also help to relieve the pain from the injury. Examination by a physiotherapist may help to determine the specific cause and biomechanics of the injury. This information is important so the appropriate structures and movement patterns can be targeted for therapy.

Gentle stretching may begin almost immediately, but care must be taken not to aggravate the injury by stretching to aggressively. Often, the best stretch for tennis elbow involves straightening the elbow (elbow extension) and bending the wrist downwards (wrist flexion).

Depending on the extent of the injury, your physiotherapist may decide to implement various treatment options, including both manual techniques and the appropriate physical modalities. Manual therapy may involve passive exercise, soft tissue manipulation or massage. In most cases, the modality used to deal with inflammation in the tendon is ultrasound, however other electrotherapy choices may be appropriate.

Once the initial healing phase has completed, muscle strengthening should begin to prevent reoccurrence of this injury. If this takes place too soon it will actually further the injury.

Lastly, your physiotherapist may discuss other options such as bracing or taping during the course of the injury, and should most definitely answer any questions you may have.

All of the previously mentioned prevention tips are equally as important when treating the injury. The only question is the degree to which one must change their activities, which depends on the nature and severity of the injury. Your physiotherapist will look at all aspects of the injury, beyond simply treating the symptoms. To achieve this the physiotherapist may employ a variety of treatment options. See the Rehabilitation section of the general Injury Care page to review these.

Your physician may prescribe some anti-inflammatory medication, as well as provide some other options for treatment.