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What to do about "tennis elbow", how can physio help?

So, the name is very misleading.. I see a lot of people who have never touched a tennis racket suffering from “tennis elbow”. This is because the nature of the injury is due to repetition of movement, which stresses the outside (extensor) muscles of the forearm.

The medical name is lateral epicondyle tendinopathy or lateral epicondylalgia (we are stepping away from lateral epicondylitis as it has been shown that there is more often no inflammation present with this pathology). Pain generally located around the outside of the elbow, normally at the origin of the common extensor tendon; with symptoms including pain on gripping, (shaking hands, or turning a door handle), hitting a backhand in a request sport, pouring a jug of water or even simply typing.

This pain can be confused for a radial nerve entrapment or referred pain from the neck (cervical spine), which can present in similar ways. This makes diagnosis from a physiotherapist or a doctor important to make sure you are receiving the correct treatment. It is thought that “the pathology may be the result of overuse, underuse, or tensile, compressive, or shear forces, which leave the tendon in a debilitated state” (Coombes, Bisset & Vicenzino., 2008, p.253). It most commonly presents in men and women between the ages of 35-54 (Coombes, Bisset & Vicenzino., 2015). 

I most commonly see “tennis elbow” in clinic when a lifestyle factor has changed. For example a person who hasn’t played tennis is 2 months starts playing a few times a week, or someone who has been doing painting at home or has changed their keyboard at work. These new stresses challenge the muscles and tendons in a way which causes local injury, and the tendon’s physiology changes to compensate. Unfortunately it often takes tendons time to build resilience to the new activity and if overloaded too quickly injury will occur.   

Visiting a health care professional whether it be a Physio or Doctor will help to determine the natural and underlying causative factors. They will perform a number of tests to determine the cause of you pain and any other postural, joint or muscle dysfunctions, and count out other pathology.  They will then discuss your personal goals, which will then determine the intensity of your treatment. It is different is someone is wanting to hold a pen for 40 hours a week with no pain, to a person who is a plasterer or an athlete wanting to compete at a raquet sport.

This will then lead to some form of exercise programme to help you recover.  It has been proven that strengthening surrounding muscle groups is an important factor in recovery, and eccentric exercises for the muscles connected to the injured tendon help with tendon recovery in the short term and then a more comprehensive strength programme is often needed long term to stop the symptoms from returning. This is where working with a physio helps to guide you through this and help you understand and be able to manage any reoccurring injury long term. (Chen and Baker, 2019)

We normally do not advice cortisone injections, though they do show good results in the short term for pain relief, there is now good evidence that they make the tissue more susceptible to injury in the future, which symptoms often returning within a year and normally worse than the initial onset. (Olaussen et al, 2013)