What is Tennis Elbow?
What is Tennis Elbow?
Tennis elbow is the common term used for pain experienced on the outside of the elbow resulting from pathology in the wrist extensor tendons. Our understanding of this condition has progressed over time which has resulted in changes of the medical language for describing this condition. It has been or may be referred to as lateral epicondylitis; lateral epicondylagia; wrist extensor tendinopathy or wrist extensor tendinitis.
Pain will be experienced local to the outside of the elbow and may refer into the forearm. Symptoms are provoked with activities that require contraction of the wrist extensor muscle group. These muscles are important contributors to stabilising the wrist during gripping. As a result, functional tasks such picking up object; shaking hands; turning door knobs and working with hand tools cause pain.
Symptoms may initially only present whilst you are stressing the area with the gripping task. However, as the condition deteriorates, inflammatory symptoms can present as pain that continues when the activity has finished and may be experienced as an aching or throbbing.
Tendons are the structures that attach the muscles to the bones. They are the final point of contact and must transmit the forces produced by often a large surface area of muscle or groups of muscles. The common extensor origin is the tendon most commonly affected in people with symptoms of tennis elbow.
What causes tennis elbow?
Tennis elbow is typically described as an overuse injury and is certainly not limited to tennis players. It may develop suddenly after new activities have been attempted that are above the capacity that the tendon is conditioned to cope with. Alternatively, symptoms may develop gradually through repetitive loading, where there is insufficient time for the tissue to recover from the task it has been doing before it is asked to work again. This leads to breakdown within the collagen fibres that form the structure of the tendon.
A skilled clinician will combine information gathered about the symptoms and the factors that have contributed to overload, along with the responses to provocation tests. Provocation tests stress the wrist and finger extensor muscles. Response to grip testing can also be used to reproduce symptoms and confirm the diagnosis.
Imaging such as ultrasound or MRI are not necessary for a diagnosis of tennis elbow, but may be useful in differential diagnosis if the individual is not responding to treatment as expected.
How can Physiotherapy help you?
Your Physiotherapist can confirm your diagnosis and make sure you are set on a path to recovery. Tendons are not the only cause of elbow pain. Nerve tissue local to the elbow or the neck can contribute the pain and reduced grip strength. The joints of the neck and shoulder also have the ability to cause pain at the elbow.
Once your Physiotherapist has confirmed that the tendon is the source of your symptoms, they will identify the mechanism of overloading and help modify those tasks. This is an important first step in reducing pain and allowing the tendon to prepare its recovery.
Your Physiotherapist is equipped with therapeutic techniques which reduce pain, promote recovery and ensure the tissues in the upper limb are working in a coordinated and efficient manner. This may include soft tissue techniques, like massage, mobilisations, dry needling and taping / bracing.
Rest rarely results in full resolution of this condition as it does not train / prepare the tendon to transfer the loads required for the activities you wish to return to. Failure to cope with transferring the loads will result in further breakdown within the tendon fibres and cause recurrence of the painful elbow symptoms. Your Physiotherapist will work with you to create a training program specific to the capacity your tendon has and what it needs to be able to do for your work, sport and family life.
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