What is Tennis Elbow Exactly?
What is Tennis Elbow Exactly?
Chances are you’ve probably heard about Tennis Elbow, but what is it exactly? “Tennis Elbow” is a term for elbow pain on the lateral (outside) side of the elbow and is an overuse injury of the extensor tendons of the wrist. Even though it is called “tennis elbow,” tennis players only make up 5-10% of people who present with cases of this condition (1), and there are many different names for this condition. The current preferred term is “Tendinopathy of the lateral epicondyle,” and has also been known as “lateral tendinitis” or “lateral epicondylalgia/epicondylitis”, so you can see why “Tennis Elbow” is catchier!
The pain felt up near your elbow in tennis elbow is caused by overuse and irritation of the tendons of the muscles involved in wrist extension (2) (the movement you’d do if revving a motorcycle). Tendon overuse injuries are usually caused by a sudden increase in the amount of work that a muscle must do when compared to what is normal. For example, Achilles tendon overuse injury might occur if someone suddenly starts to run or jump more than they normally would. For tennis elbow, a common overuse scenario might be the onset of elbow pain after spending a weekend of DIY, using a screwdriver, or cleaning windows - any activity that requires repetitive use of the wrist, particularly if you hadn’t been using your wrist very much prior to the increase. Usually, there is actually more than one tendon that is affected in tennis elbow, but due to them having similar functions and attaching to a similar place on the elbow, it is not necessary to determine exactly which of these muscles is most affected in order to effectively treat tennis elbow.
Who is likely to get tennis elbow?
Tennis elbow is most prevalent in people between ages 30-50 years and it is equally common in both males and females. It is uncommon to obtain tennis elbow on both elbows and your dominant arm is most likely to develop tennis elbow (3). A systematic review found three risk factors for tennis elbow: 1) Handling tools heavier than 1kg, 2) handling loads heavier than 20kg at least 10 times a day, and 3) repetitive movements for more than 2 hours a day (4). Other factors to consider are things like changing tennis racquet or using a wet tennis ball (for tennis players), overtraining, sudden increase in use of wrist (e.g. painting a fence on the weekend), or a shoulder injury that could lead to increased use of the wrist.
What does tennis elbow feel like?
In the early stages it may be that you may feel some faint pain in the lateral elbow a couple of hours after the provoking activity, which may then progress to pain at the end of or immediately after the provoking activity. Continuing to perform the aggravating activity, you may start to get pain during the activity which intensifies after ceasing the activity, and finally can progress to constant elbow pain (5). You may also find it difficult to lift and grip objects due to either pain or weakness, and it may radiate down the forearm as far as the wrist or hand. It may be tender to touch over the muscles just below the elbow on the back of the forearm and you may find your range of motion in your wrist is also reduced.
How can physiotherapy help manage your tennis elbow?
Early management of tennis elbow is based on two principles: relieving pain (rest/avoiding aggravating activities) and controlling inflammation (anti-inflammatories, ice 3 times daily for 15 minutes). An elbow brace can be helpful also for reducing tension on the muscle attaching at the elbow.
Physiotherapy management of tennis elbow is aimed at reducing pain and improving the function of the elbow. Broadly speaking, the main physiotherapy management principles include:
- Education on pain management or modification of activities.
- Exercises to strengthen and stretch the muscles.
- Manual therapy or massage, involving hands-on treatment from the therapist aimed at improving the function of the muscles involved in tennis elbow. This may include joint mobilisations/manipulations aimed at improving movement of the elbow or wrist. Massage can also be a useful tool in helping to improve the function of aggravated muscles.
- Braces/splints/straps may be used, though evidence surrounding the use of some of these is unclear.
- Extracorporeal Shockwave therapy is a developing area of physiotherapy that involves the use of shockwaves to facilitate recovery of a tendon. It is administered by a physiotherapist over several treatment sessions and uses a specialised shockwave machine to impart mechanical energy to the affected muscles to promote healing.
- Dry needling of the involved muscles is a useful tool to help release tension or “trigger points” in the muscles that are irritable in tennis elbow.
If you are injured, get it touch with one of the Habit Rehabilitation Clinics today. No ACC referrals required from your GP. We can lodge your claim directly for you.
Jimmy Tie, Staff Physiotherapist
- Blanchette MA, Normand MC. Impairment assessment of lateral epicondylitis through electromyography and dynamometry. The Journal of the Canadian Chiropractic Association. 2011 Jun;55(2):96.
- Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Surg Am 1999; 81:259-278.
- D. M. Walz, J. S. Newman, G. P. Konin, and G. Ross, Epicondylitis: Pathogenesis, Imaging, and Treatment, RadioGraphics, January 1, 2010; 30(1): 167 - 184.
- Van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford). May 2009;48(5):528-36. A1http://rheumatology.oxfordjournals.org/content/48/5/528.full.pdf
- Warren, RF. Tennis elbow (epicondylitis): epidemiology and conservative treatment, in AAOS Symposium and Upper Extremity Injuries in Athletes, Pettrone, F.A., Ed. St. Louis: C.V. Mosby, 1986; 233-243.