Tennis elbow (more correctly known as lateral epicondylopathy) is a common condition that can present with pain on the outside of your elbow. Back in the day, it used to affect many tennis players (probably trying to copy Federer’s famous one hand backhand), but it actually affects more people who perform lots of repetitive gripping or forearm movements.
Typing-too-much-without-breaks-elbow, young-mother-trying-to-carry-too-many-shopping-bags-at-once-elbow, or I’m-trying-to-deadlift-too-heavy-too-quickly-with-inadequate-grip-strength-elbow are not as catchy, but probably more representative of what we see in clinic today though.
Do I have Tennis Elbow?
Lateral epicondylopathy usually presents with outside elbow pain that can spread into the upper arm or down to the forearm. The pain can begin suddenly or develop gradually over time. Other things people commonly notice are:
Weakness of the forearm
Greater difficulty with activities that require strength like opening jars, carrying grocery bags, opening taps, throwing balls, or hitting backhands in tennis.
Are there any tests that I can do to see if I have Tennis Elbow?
Lateral epicondylopathy is usually diagnosed based on a physical exam by your doctor or physiotherapist, and your description of pain. When more detail is needed, an ultrasound scan or MRI can also be used, but is not really necessary. Statistically if you have outside elbow pain, it is likely to be lateral epicondylopathy as it is the most common cause of outside elbow pain. A good health care professional will check to see if it is coming from your shoulder, neck, or nerves though.
How is Tennis Elbow treated (the best way)?
Managing lateral epicondylopathy depends on the stage of the condition.
In the early stages:
Pain relief: such as with Panadol (paracetamol) or Nurofen (ibuprofen). When taking medications it is best to speak to your GP or Pharmacist first.
Arm braces: a tennis elbow brace or strap can help reduce pressure on the injured tendon. You can use the brace or strap while working or playing sports and can be work for up to 6 weeks. These can be purchased from chemists or from a good physiotherapy clinic.
Flexibility exercises: forearm and wrist stretches can help in some situations (but not all). If the elbow pain worsens with the stretch, these should be discontinued.
Strengthening exercises: are the bread and butter of good treatment. These can be isometric (long hold) exercises, especially early on which help control the pain. As this gets easier and the pain subsides, these can be progressed to heavier weights and eccentric (slowly lowering) exercises.
In the later stages:
Activity Modifications: trying to identify what might have contributed to the injury and changing the way it is done. E.g. a wider grip on a hammer or tennis racket, carrying 1 shopping bag at a time not 3, or adding a wrist support onto a mouse/keyboard.
Whole arm strengthening: building up the strength of the hand, wrist, elbow, and shoulder following an injury helps ensure these were not contributing to the elbow being over-worked in the first place.
Appropriate load management: load management involves controlling the amount of work the body must do to help prevent injuries. This might include changing the amount of days exercising at the gym, decreasing the amount of weight of certain exercises, or by incorporating regular breaks/stretches into daily tasks.
A good health care professional will try figure out what made your elbow tick, and how you might respond to each of the treatments above.
How is Tennis Elbow treated (in a crap way)?
Tennis elbow can be managed pretty poorly by those who are still stuck in their old ways (the dinosaurs of the medical world). Best to run away from clinics that:
Rub the crap out of the tendon
Poke the tendon with needles
Tell you just to keep stretching it without anything else
Start zapping it with a TENS or Ultrasound machine
Wave their hands over it and yell foreign words
These do not get your elbow better.
How long will it take to get better?
Most people respond well to treatments as described above. You might have some pain during work or sports for up to 6-12 weeks, but this should slowly improve over this time. It’s common for people to get frustrated, but these things take time to get better.
What if my Tennis Elbow doesn’t get better?
For those that do not respond to treatment as expected, a cortisone injection might be used which can help with the pain. This should be used with caution as it can lead to weakening of the tendon placing it at greater risk of tearing in future.
Surgery is not usually needed unless symptoms have not improved after six or more months of treatment. A review by an orthopaedic surgeon or sports and exercise medicine physician can be considered at this time too, and they will want to know that all the above has been trialed first.
What should I do if I think I have Tennis Elbow?
Read this article again, and pick up the phone to make an appointment to see someone about it. At Milsons Point Physiotherapy, we have good physiotherapists who will be well versed in managing lateral epicondylopathy (without the crap).
To book an appointment, call us on 02 9023 9999 or book an appointment online now!