Tennis Elbow

In today’s blog I will be talking all things tennis elbow management. If you haven’t had a chance to read Nick’s blog on tendon injuries, I’d highly encourage you to do so now before going further as Nick’s blog details everything you need to know about tennis elbow and other tendon injuries. Check out that blog HERE.

Briefly speaking about tennis elbow, pain is located on the outside of the elbow at the bony prominence (lateral epicondyle). The extensor muscles of the forearm, which assist move the wrist and fingers often become overused and weak therefore irritating the tendon and therefore causing pain. Once considered inflammatory it was often called ‘tendonitis’, however we now know that this is no longer the case and therefore has moved away from the term ‘tendonitis’ to ‘tendinopathy.’ Treatment for tennis does gain effective results with physiotherapy. Often a treatment approach should be multimodal, and this can include but is not limited to education, exercise, tissue loading management and manual therapy.

Education regarding the condition is important. Informing the patient about the condition, prognosis, management strategies and self-management are all required to ensure the patient understands what is required of themselves and ways of resolving the condition with the hope of preventing the reoccurrence. Exercise therapy should be stressed as a key factor for improving the condition… I can tell you from experience this condition doesn’t get better by only massaging the area! Load management education is crucial for tennis elbow. The reason being, this condition is due to overuse i.e. loading of the tendon too quickly, therefore resulting in thickening of the extensor tendon. Repetitive movements especially with jobs that’s involve repetitive hand, wrist and elbow movements are more likely to develop tennis elbow, therefore trying to avoid activities that cause pain is important.

Exercise therapy is crucial for management of tennis elbow and is one of the treatment techniques which does get great results. Exercises should be completed in a staged manner and progressed to ensure the tendon is loaded gradually.

• Stage 1: consists of isometric loading. Essentially isometrics means a muscle contraction in which the length of the muscle does not change (i.e. statically holding a position). Isometrics are used because they have shown to provide an analgesic affect that can reduce the pain you feel by altering the nerve/nociceptive pathways to your brain. It is also a perfect way to modify the load to allow the tendon to heal. Resisted wrist extension for tennis elbow is a perfect place to start (as shown in the image) by pushing with one hand and resisting with the painful side often involves a 45 second hold x 5 reps up to 3x/day.
• Phase 2: involves isotonic loading – this means a muscle contraction in which the length of the muscle changes (for example repeated wrist extensions without holding the position). Isotonic involves two types of exercises which include concentric and eccentric. Concentric contractions occur whereby the muscle shortens, whereas eccentric occurs when the muscle lengthens and is often in movements that “lower” with gravity. Concentric and eccentric exercises are excellent for tennis elbow as they specifically load the affected tendon. A progressive loading program is required in order for the tendon to undergo positive adaptations so that it can tolerate the demands imposed on it. For example, the exercises below show concentric and eccentric exercises of wrist extension as well as supination and pronation respectively.

Importantly with tennis elbow, most of the muscles in the upper limb (from the shoulder to the fingers) are weak in patients with long-term term tennis elbow, therefore patients will often be prescribed exercises from their physiotherapist to improve general strengthening exercises for the upper limb as well as postural exercises, however these should not exacerbate elbow pain. Moreover, manual therapy such as massage and joint mobilizations can provide pain relief and reduce pain through improving range of motion, reliving tightness and assisting with tissue healing.

Remember one size does not fit all and therefore treatment of one person will differ from person to person and thus it is best to seek a physiotherapists opinion as to what treatment and exercise is suitable for you. It is important to be patient with tennis elbow as recovery can take up to 12 months.

Do you need help with your tennis elbow? We would love to get you back pain free and doing what you love.

Written by William Lewis