Tennis Elbow

Many people have heard of tennis elbow before, but do not realize that it can occur in people who don’t actually play tennis. Tennis elbow is medically referred to as lateral epicondylalgia, which describes pain on the outside aspect of the elbow joint. It has been reported that this injury has an annual incidence rate of 1-3% of the general population.

What is Tennis Elbow?

It is true that performing the backhand swing in tennis can strain the muscles and tendons of the elbow, but lateral epicondylalgia (LE) can also occur because of certain types of repetitive activities such as painting, picking up heavy objects, and using different hand tools. No matter the cause of tennis elbow, though, the common factor is overuse. All of the muscles that work to pull our wrist backwards are connected at the same area on the outside bump of the elbow. This bump is called our lateral epicondyle.

Any time that you bend your wrist backwards or grip something, this group of extensor muscles contract. Once these muscles contract, they pull on the tendon that connects the muscles to the bone (the lateral epicondyle), which can put too much strain on the tendon if the same activity is performed over and over again for a long period of time. Eventually if the strain persists long enough, the tendon can become weak and painful. Scar tissue can also begin to form in the area, causing the tendon to thicken.

The most common signs and symptoms of lateral epicondylalgia include:
• Pain and tenderness on the outside bump of the elbow, which may or may not spread down the forearm
• Tightness of the forearm muscles
• Increased pain when bending the wrist backward
• Increased pain when turning palm upward
• Increased pain when grasping items or carrying heavy object with straightened elbow
• Limited motion of the elbow

Diagnosis and Treatment Options for Tennis Elbow

It is important to contact your primary care physician or physical therapist if you think you have tennis elbow so they can help guide you to the best treatment plan. When determining whether or not you have tennis elbow, your doctor/ PT will first take a thorough medial and social history including questions about pain, regular work and recreational activities, past injuries, and activities that have become more difficult or avoided due to pain. A screen of other areas, such as the neck and shoulder, may also be conducted to make sure pain isn’t actually coming from those places. Finally, a physical exam will be done which will include elbow and grip strength tests, mobility testing, palpation of the area to check for tenderness, and special tests that help to rule in or rule out the diagnosis.

Over the years, treatments for LE have included NSAIDs, corticosteroid injections, botox injections, physical therapy, and even surgery. Recent studies have supported the combination of hands on physical therapy, exercise, and education over the use of NSAIDs and injections. These older ways of treating LE were believed to reduce any inflammation in the joint, however it has been found that the elbow joint isn’t actually inflamed when LE is present, even though it might feel like that to the patient.

Physical Therapy for Tennis Elbow

As previously mentioned, physical therapy for tennis elbow will include a combination of education, hands on manual therapy, and exercises. In the early stages of the injury, it is important to reduce the stress on the tendon. Your physical therapist can help with this by providing education on proper mechanics while working, prognosis, and education on activity modification. The physical therapist may also try some taping or bracing techniques to help decrease the stress. Modalities such as ice, electrical stimulation, and ultrasound may help initially to decrease pain.

The manual, or hands on, therapy that your PT can provide is intended to help with the impairments of the elbow, as well as at the shoulder and wrist, if present. This part of therapy can include deep tissue or friction massage, stretching of the muscles, and a technique that is called Movement with Mobilization (MWM), which helps with pain free gripping. Finally, a physical therapist will be able to implement an individualized exercise program that targets strengthening the muscles that perform extension of the wrist and that are involved with gripping. By improving the strength of the tendon and surrounding muscles, it helps to take the stress off the injured area. Other general stretching exercises may also be included.  To schedule an appointment call Total Performance Physical Therapy today!


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