Tennis elbow, also known as lateral epicondylitis, is a common condition that affects the elbow joint. It is characterized by pain on the outside of the elbow, and it is typically caused by repetitive use, or overload, of the extensor forearm muscles. Although it is commonly associated with tennis players, tennis elbow can affect anyone who performs repetitive activities that strain the forearm muscles and tendons.

Causes

Tennis elbow is caused by the repetitive loading of the forearm muscles and the tendons that attach to the lateral epicondyle, a bony bump on the outer part of the elbow. This overloading can cause pain and inflammation in the common attachment area. Common activities that can cause tennis elbow include playing tennis, painting, typing, and using hand tools. It is also possible to develop tennis elbow as a result of a sudden injury, such as a fall or a blow to the elbow.

Symptoms

The main symptom of tennis elbow is pain and tenderness on the outer part of the elbow. This pain may be sharp or dull and may radiate down the forearm. The pain is usually worse when the forearm is used, especially with gripping activities, and it may be accompanied by weakness or stiffness in the elbow or wrist.

Commonly it is worse in the mornings with increased pain and stiffness and can take some time to warm up.

Treatments

There are several interventions that can help to treat tennis elbow. The most effective treatments will depend on the severity of the condition, the cause, and the individual’s lifestyle and preferences. Some of the most common interventions for tennis elbow include:

Rest and activity modification

In the first instance resting the affected arm and avoiding aggravating activities can make things more comfortable. Depending on the severity of the condition, this may involve limiting or modifying activities such as sports or work-related tasks. Simple task modifications can help you function, such as lifting with the palm facing upwards and to reduce the tightness of your grip while doing things.

Therapy

Clinicians in the first instance can assess your condition and provide a definite diagnosis, as well as identify potential causes. They can then help to develop a rehab program which will address all aspects of your condition.

Therapy may include a variety of techniques, such as manual therapy, stretching, and exercise. Manual therapy involves the therapist using their hands to manipulate the affected area, which can help to reduce pain and improve function. This may also include taping techniques and splinting. As part of your rehab program your therapist may require you

A therapist may also use other modalities, such as ultrasound and electrical stimulation, although the evidence for the effectiveness of these in tennis elbow is quite weak. There is more recent literature that suggests that Shockwave Therapy can be an effective modality in managing tricky, long standing tennis elbow problems.

A proper assessment of your condition can identify any underlying causes, and treatments to address them can be included in you rehab program. This may involve factors such as neck involvement, possible neural contributions, postural considerations and global upper limb kinetics and function.

Non-steroidal anti-inflammatory (NSAIDs) and painkillers

Over-the-counter pain relievers such as ibuprofen or panadol can help to reduce pain and inflammation in the affected area,  but should only used if acutely painful and not long term.

Bracing or splinting

A brace or splint can help to immobilize and unload the affected arm and reduce strain on the tendons and muscles, making your daily activities easier to do. Specific tennis elbow braces can be very effective in unloading the affected tendon making life way more comfortable. Check out all the options here, but the Supporta Tennis Elbow brace is a very popular option.

Topical Creams and Ointments

There are several topical creams and ointments that can be used to give you symptomatic relief of tennis elbow pain. These can be used in conjunction to an overall rehab program. There are large of options but the most popular are Perskindol and Biofreeze.

Steroid injections

In some cases, a steroid injection into the affected area can help to reduce inflammation and pain, however there is growing evidence that this may not be required for a successful outcome.

Ice and Compression

Icing the outside of the elbow can be a great way to reduce pain when the elbow becomes irritated and sore. Whether it be an ice pack or pack of frozen peas, ice can numb the area and make you more comfortable. Our favourite icing options are the Freeze Sleeve and the Cryo wrap.

Surgery

In very rare cases, surgery may be necessary to repair or remove damaged tissue in the affected area.

Prevention of Tennis Elbow

There are several steps that can be taken to prevent tennis elbow from occurring or reoccurring, including:

• Using proper technique and form during sports or other activities that involve the use of the forearm muscles and tendons.
• Warming up properly before engaging in physical activity and cooling down afterward.
• Gradually increasing the intensity, load and duration of new activities and to avoid overuse.
• Using proper equipment and tools, such as a tennis racket with a grip that is the right size and shape for the individual.

Summary

The most important part of rehab for tennis elbow is generally considered to be a combination of exercise and activity modification.

Exercise plays a crucial role in the treatment of tennis elbow, as it helps to improve the strength, flexibility, and endurance of the muscles and tendons in the affected area. A holistic approach to the entire upper limb kinetic chain including any neural sensitivities is also crucial. Several studies have shown that a combination of exercise and activity modification can be highly effective in treating tennis elbow. Eccentric exercise, in particular, which involves lengthening the muscle while it is under tension, has been shown to be an effective form of exercise for tennis elbow. As part of your rehab program you may need some tools. We have a large range of popular rehab tools, such as the Twist Bar, that you can check out here.

Reducing the upper limb load in in the initial stages of tennis elbow and then  progressing it back up in a controlled fashion is essential to a positive outcome. Complete, long term immobilization and rest of the upper limb will not help long term.

Overall, while there are several different interventions that may be used to treat tennis elbow, exercise and activity modification are generally considered to be the most important components of rehab. By working with a therapist or other healthcare professional, individuals can develop a personalized treatment plan that includes these and other interventions to effectively manage and treat their tennis elbow. The great new is that Tennis Elbow is manageable and curable, and research tells us will be a memory within 18-24 months.