Tennis elbow, also known as “lateral epicondylitis”, is a condition that affects 1-3% of the population and typically occurs between the ages of 35-45 years of age. Tennis elbow is an overuse injury caused by repetitive wrist extension and activities that require power grip. These types of movements result in the recurring contraction of extensor muscles in the forearm, most commonly the extensor carpi radialis brevis (ECRB) which connects to the bony prominence of our outer elbow known as the lateral epicondyle. In tennis elbow, microtears occur in the ECRB muscle at its connection point to the elbow which explains why pain is typically felt in this location. Additional symptoms include morning elbow stiffness, forearm pain, decreased wrist and grip strength and difficulty holding objects.
Playing tennis is just one of the potential causes of this injury, mainly due to continual use of the backhand stroke. However, don’t be fooled by the name – tennis elbow does not just affect people who play tennis. More often, it occurs due to repetitive work-related activities such as the use of tools in plumbing and car repairs, cutting and chopping food, computer mouse clicking, as well as a variety of other sports and hobbies that require repetitive wrist motion and grip strength.
Although resting from aggravating activities and use of anti-inflammatory medication is often the first step to recovery during the acute stage of tennis elbow, additional treatment is often required for further healing. Up to 20% of tennis elbow occurrences may persist beyond 1 year. This highlights the importance of early diagnosis and treatment in the prevention of chronic tennis elbow injuries. Physiotherapy treatment is focused on patient education, increasing forearm flexibility and gradual strength progression. Research indicates that graded eccentric strength training of the wrist extensors helps to reduce pain, increase muscle strength and improve return to activity in cases of chronic tennis elbow. Eccentric strengthening means that your muscle is lengthened as it contracts, for example slowly lowering a weight down with control. New research is now suggesting the combination of eccentric, concentric (contraction as the muscle shortens) and isometric (contraction without change in muscle length) strengthening for the most effective treatment of tennis elbow. Your physiotherapist will guide you on the most optimal exercise program for you.
Other treatment methods including corticosteroid injections, counter-force bracing, electro-acupuncture, mobilizations/manipulations and deep friction massage are supported by low to moderate levels of evidence for short-term pain relief in tennis elbow. If you are experiencing tennis elbow pain, it is important to get an assessment by your healthcare provider in order to determine the best treatment plan for you.
Written by: Vanessa Younes, MScPT