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You don’t need to play tennis to have tennis elbow


Do you have an extremely painful elbow? Do you find it difficult to twist or grip something? Have you never played tennis but been told that your painful elbow is tennis elbow and that you need physio treatment? At Debbie Cameron Physiotherapy we can help you with your pain and recovery as well as help you understand your injury better. To make things clear from the start, no you don’t need to be a tennis player to have tennis elbow.


Tennis elbow is a common name for a condition known as Lateral Epicondylitis (Cutts, et al., 2020). It doesn’t have to be activity and lifestyle-limiting, with the correct management you can be back to doing what you enjoy without the serious pain and discomfort that comes with this condition. Physiotherapy is an effective and important part of this management. This short and informative blog will cover the condition, its risk factors, signs and symptoms, and what you can expect when you come for physiotherapy for your tennis elbow.


Tennis Elbow (Lateral Epicondylitis) is a tendinopathy-like overuse injury of the wrist extensor muscles in the forearm. These wrist extensor muscles all originate in the same point as the common extensor tendon - originating from the lateral bony side of the elbow, the lateral epicondyle (Walz et al., 2010). This overuse of the muscle combined with the repetitive contractile forces sustained by the muscles results in damage and structural changes occurring in the tendons - thus creating the pain and inflammation that occurs (Zwerver et al., 2019).


The condition varies and differs for each patient, however common signs and symptoms of the injury include the following (Ma & Wang, 2020).


  • Pain in the lateral region of the elbow that’s located more anteriorly and distal.

  • Pain that radiates up the upper portion of the upper limb as well as pain that · radiates down the forearm and into the wrist.

  • Pain that is activity related - specifically repetitive wrist extension or rotation of the forearm.

  • Tightness and stiffness in the wrist extensors.

  • Weakness in grip strength.

  • Difficulty carrying objects, more so with the elbow extended.



As mentioned you don’t have to be a tennis player to be diagnosed with the condition, in fact according to research approximately 5% of patients actually play tennis, anyone can actually suffer from this injury . However, there are several risk factors and contributors that leave you more at risk (Rasuli, 2022). Study have shown that the following is true about risk factors related to the condition.


  • You are most at risk between the ages of 35 and 50 but can get it at any age.

  • There are no differences in risk when it comes to gender.

  • The condition is work and hobby related - activities that include repetitive wrist extension, forearm rotation and gripping as well as one sided activity are considered as possible risks (Rasuli, 2022).

  • Sports examples include – tennis, squash, baseball, gym, swimming, arm wrestling.

  • Hobbies include – gardening, art, gaming, rock climbing.

  • Occupation examples - any computer related work, mechanics, carpenters, bakers, electricians and manual labourers.)

  • Biomechanics concerns including reduced muscle strength and extensibility specifically in the forearm and shoulder are identified as possible causes.


Tennis elbow is a condition that can be managed comfortably if done properly. Physiotherapy is an extremely important part of this management. Not only can a physio reduce your pain and inflammation (Ma & Wang, 2020), they will help modify your daily activities and give you a correct and suitable strengthening programme which together will help prevent further or re-injury. As mentioned, tennis elbow is essentially a tendinopathy or over-use type injury that ends up with structural changes in the tendon (Cutts, et al., 2020). The aim of physiotherapy will be to reduce the pain and inflammation that arises as well as to strengthen and load the tendons correctly through rehab and exercise therapy. Physiotherapy for tennis elbow can incorporate a variety of modalities that all help toward achieving this goal (Yelland et al., 2019). This includes:


  • Soft tissue mobilisation of the related musculature-for pain relief and increased mobility.

  • Manual therapy – which aids in pain relief and improving joint mobility.

  • Dry needling.

  • Exercise therapy – To correctly load and stretch the necessary muscles.

  • Patient Education - Biomechanics and Ergonomic corrections and advice

  • Electro therapy – Ultrasound, interferential current or TENS can be used to aid in pain relief, muscle extensibility and muscle stimulation.

  • Taping – To help support and offload the area if needed.


To recap tennis elbow or Lateral Epicondylitis is an overuse tendinopathy like injury affecting the wrist extensor muscles and lateral epicondyle of the elbow. Tennis elbow is different for everyone; however, the condition is often work or activity related and a result of tendon overloading. If assessed correctly and treated specifically tennis elbow will be well managed by a physiotherapist. If you are struggling with tennis elbow, this is something that Debbie Cameron Physiotherapy can help you understand and manage correctly.


To book an appointment contact Michelle on 031 765 8898 or book online by clicking on https://www.debbiecameronphysio.co.za/online-booking.


References

Cutts, S. et al. (2020) “Tennis elbow: A clinical review article,” Journal of Orthopaedics, 17, pp. 203–207. Available at: https://doi.org/10.1016/j.jor.2019.08.005.

Ma, K.-L. and Wang, H.-Q. (2020) “Management of lateral epicondylitis: A narrative literature review,” Pain Research and Management, 2020, pp. 1–9. Available at: https://doi.org/10.1155/2020/6965381.

Rasuli, B. (2022) “Lateral Epicondylitis - Tennis Elbow,” Radiopaedia.org [Preprint]. Available at: https://doi.org/10.53347/rid-98132.

Walz, D.M. et al. (2010) “Epicondylitis: Pathogenesis, imaging, and treatment,” RadioGraphics, 30(1), pp. 167–184. Available at: https://doi.org/10.1148/rg.301095078.

Yelland, M. et al. (2019) “Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: A single-blinded randomised clinical trial,” BMC Musculoskeletal Disorders, 20(1). Available at: https://doi.org/10.1186/s12891-019-2905-5.

Zwerver, J. et al. (2019) “Icon 2019—International Scientific Tendinopathy Symposium: Building an iconic tendon tower—launching a new era in clinical tendinopathy research,” British Journal of Sports Medicine, 54(8), pp. 442–443. Available at: https://doi.org/10.1136/bjsports-2019-101214.

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