Tennis Elbow (Lateral Epicondylitis) What is a Tennis elbow? Tennis elbow or lateral epicondylitis is a term that is used to describe pain on the outside of the elbow joint. It is caused by a strain to the tendons in the forearm. The tendons become irritated where they join the bony part on the outside of your elbow joint [2]. What are the symptoms? Tennis elbow commonly presents as pain on the outer side of the elbow. People often describe localised tenderness and pain with movement of the wrist as well as painful and weakened grip strength. People tend to find gripping, lifting and turning keys and door handles difficult and/or painful. Who gets Tennis elbow? Tennis elbow affects roughly 1-3% of the general population and is more likely to occur with smoking, obesity and repetitive or forceful activity which last at least 2 hours daily [1, 3]. The condition typically affects people between the ages of 35 64 [1, 3].
What causes Tennis elbow? The exact cause of Tennis elbow is unclear although evidence suggests that over-strain and repetitive use of the hand and wrist may cause tendon irritation and wear with possible irritation of the surrounding nerve endings [3]. What can I do? Research has suggested that conservative treatment is effective in most cases. Simple self-help treatments are probably all you ll need to clear up your tennis elbow. The first thing you can do to help is to adapt any movements that may be causing your symptoms. For example, lift objects with your palms facing upwards and elbows bent [2]. Other treatments include: Regular pain medication as advised by your local pharmacist or GP A tennis elbow support (which can be purchased from most pharmacies) can be fitted firmly on the forearm about 6 to 10 cm below the elbow joint. This may reduce the strain of the muscles on the tendon thus relieving pain. Cold compress or ice pack crushed ice wrapped in a damp towel can be applied locally to the painful area for 10 minutes, every two to three hours. Check your skin regularly, if the skin turns excessively red or white, remove immediately as this may indicate a burn Relative rest Resting from activities that aggravate the pain can allow the irritation of the tendon to settle. Reducing any repetitive gripping activities and lifting activities that are painful can help alleviate symptoms.
Exercises to stretch and strengthen the tendon can be helpful for relieving symptoms and are found in this leaflet. Exercises: Stretches: o Keeping your elbow straight gently make a fist and bend your wrist until you can feel a stretch in the top of your forearm. Hold this stretch for 10 seconds and repeat up to 3 times. Isometric Exercises: These are push and hold exercises. Your therapist may get you to do these to help with your pain. With you elbow bent to 90 degrees and your forearm rotated so that your thumb is facing up towards the ceiling. Place your good hand on top of the affected hand as in the picture. Try to lift your wrist up, whilst the other hand resists. This tenses the muscle without moving your wrist joint as in the picture below.
Aim for 5-10 holds. If this is pain free, you can progress the exercise by rotating your forearm to a palm down position. Once this becomes pain free you continue to progress towards a palm down position with the elbow fully straight as in the picture below. This will be at your therapist s discretion Strengthening exercises: o Hold a small weight or water bottle in your hand. Rest your forearm on a table or the arm of a chair with your hand and wrist hanging over the edge and your knuckles pointing to the ceiling. Slowly lower the wrist downwards pointing towards the floor. Return to the starting position by assisting with your other arm.
o Repeat this for 10-15 repetitions. This can be repeated another two to three times with a minute rest in between. This exercise is typically completed twice a day and is often completed every other day. A little discomfort with exercise is expected and a normal part of the exercise programme. o This exercise programme is typically completed for 6-12 weeks before improvement in pain may occur. If your pain does improve with this programme you are recommended to continue the exercise program for 6-12 months.
References 1) Assendelft WJJ, Hay EM, Adshead R & Bouter LM (1996) Corticosteroid injections for lateral epicondylitis: a systematic overview British Journal of General Practice 46: 209 216 2) Arthritis Research UK (2016) Tennis Elbow Online at: http://www.arthritisresearchuk.org/arthritis-information/conditions/ [Accessed on: 22 nd March 2016] 3) Coombes BK, Bisset L & Vicenzino B (2008) 'A new integrative model of lateral epicondylalgia' British Journal of Sports Medicine 43: 252 258