As summer settles down and the long tennis season comes to an end, it is fitting that we take a closer look at the over-use condition named ‘Tennis Elbow.’ This loosely termed condition is actually more common in other gripping sports such as golf and baseball. It is also very common with housework such as hammering or gardening. Lateral epicondylalgia, as it is medically known, is due to over-gripping, lifting and moving of the hands and/or wrist.
What is it?
Lateral Epicondylalgia is primarily a condition caused by the degeneration of the common extensor tendon, which is found on the outside of the elbow. When the hand is used to grip or the wrist to lift an object, the wrist extensor muscles contract to support the wrist. Over time with extensive lifting, pulling or gripping it can weaken the tendon and cause irritation and soreness. The condition is essentially due to constant and forceful movements causing more trauma than the rate of healing is able to cope with.
How do I know if I have it?
Usually patients will feel some pain over the outer bony part of the elbow as well as pain with gripping and lifting. There will also usually be a past history of gripping sports or unaccustomed amounts of lifting at home or work. See your local Physiotherapist to confirm.
Lateral epicondylalgia largely affects people who are over the age of 40 and are generally active, or have increased their activity recently. It is particularly common in those who use a very tight gripping position in their chosen sports. Lateral epicondylalgia is more common in those who use a one handed backhand as that tends to place higher loads on the tendon. Studies also show that if you make contact with the ball closer to your body it can also increase your likelihood of pathology.
What treatment should I get?
The best practice for treatment of tennis elbow is to receive physiotherapy aided by a GP for pain relief if required. The Physiotherapist will assess the pain site, the movements affected and more than likely suggest a period of ‘active rest.’ This means that you will need to avoid the provocative actions until the pain settles, but keeping the arm moving in positions that are pain free. In more recent times, studies have found a link between neck pain and tennis elbow, which may also need to be assessed and treated.
Your physio may also use dry needling to relax and decrease muscle tension and elbow joint mobilisations to rapidly decrease pain levels. Once the pain has settled the clinician will generally start you on an exercise program to improve the strength of the tendon. These exercises should be progressed as required over the next few weeks.
What can I do about it?
Most importantly, listen to your Physiotherapist. Tennis elbow is a complicated condition that requires you to make some changes to your daily activity and your physio can guide you in the right direction.
- Decrease activity in the resting period
- Do prescribed exercises once you start to improve. Compliance with this will make a big difference to the rehabilitation period.
- Wearing a brace for the aggravating activities (as it can take load off the tendon.)
- Technique modification/correction: consider using an over-grip can reduce pain as it decreases grip forces. Consider changing your single-handed backhand to double-hand to lessen the load on the tendon. Changing the tension of the strings or the type of golf club or hockey stick to decrease vibration. String tension should be lowered about 5lbs and shock dampeners are also helpful. If you are looking at a new golf or hockey stick, graphite shafts tend to have less vibration and therefore send less shock into the elbow. If you are getting pain in the kitchen, it may be time to buy lighter equipment or get a hand with the cooking!
How long will it last?
The prognosis will largely depend on how long you have had the condition, the state of the tendon and your compliance with the exercise program. The longer you have had the condition, the longer it will take to heal the tendon and then strengthen. Usually treatment times range from 4 weeks to 6 months. The good news is that with the right treatment tendons will improve over time and you will be able to go back to doing everything you could before!