Tennis elbow is so common. I am often asked by patients if I can show them a some tennis elbow exercises. The majority of the time I am treating for something completely different. However I often hear, “Can I ask you about this pain in my elbow?”. I would never diagnose without getting more information but, most likely, it is tennis elbow. So what’s up with all this tennis elbow? Do I see a lot of tennis players? Actually I do. But, as it turns out, you do not need to play tennis to get tennis elbow.
What is tennis elbow?
Tennis elbow is called lateral epicondylitis in the medical world. It is an overuse syndrome of the wrist extensors. The wrist extensors are a group of muscles that extend or bend the hand backward away from the palm. They are located on the back of the forearm and form a common tendon that attaches to an area called the lateral epicondyle. The lateral epicondyle is the outside area of the upper arm bone at the elbow joint.
The pain is felt near the lateral epicondyle where the wrist extensor tendon attaches. This is why it is also called lateral epicondylitis. The overuse is usually from a repetitive activity that puts a load through the elbow and wrist. For example, hitting a tennis ball over and over. See the video below for further explanation.
It is the common tendon that attaches the extensor muscles to the lateral epicondyle that is affected. This condition could be a tendinitis, which is an inflammation of the tendon. There is evidence that the pain is caused by micro tears in the tendon which would indicate a tendinitis. However, the condition is most likely a tendinosos which is caused by chronic overuse without appropriate time for rest and healing. As a result of the body’s failure to heal the area, there is a degeneration of collagen proteins. There is also an increase in risk of tears in the tendon. Tendinosos means that recovery just became more complicated and longer.
What are the symptoms of tennis elbow?
Tennis elbow does have certain symptoms associated with it. These include:
- Pain on the outside of the elbow
- Pain when twisting your arm – like when turning a doorknob or opening a jar
- Swelling and tenderness at the elbow
- Decreased ability to grip
- Stiffness and pain when straightening the elbow
The progression of tennis elbow
It is important to recognize when you are developing tennis elbow (or any tendon injury). The pain usually starts as very mild and is not felt until a of couple hours after activity. It will then progress to pain right after the activity. The next stage is pain during the activity. The final stage is constant pain that prevents you from performing the activity. The key is to recognize when you are in the first stage. It is much easier and faster to treat early on.
Who is susceptible to tennis elbow?
Tennis elbow is more common in people age 35-50. As I mentioned earlier, it is not just tennis players who suffer from it. It is anyone who performs repetitive activities that use the wrists and forearms. This includes many professions. Below is a list of some professions that are at risk of tennis elbow.
- Electricians
- Gardeners/landscapers
- Assembly line workers
- Painters
- Carpenters
- Plumbers
- Chefs/cooks
- Mechanics
Is this the same thing as golfer’s elbow?
The answer is no. Golfer’s elbow is a tendinopathy of the common tendon of the wrist flexor muscles. It causes pain on the inside of the elbow. It is not as common as tennis elbow. However, just like tennis elbow, you don’t need to play golf to get it.
How do I fix it?
This is the million dollar question. The real answer is to treat it before it gets really bad. Once tennis elbow sets in, it can be very difficult to get rid of. I often tell my patients, don’t let your pain become a thing. If you are noticing a pattern of pain, address it before it becomes something much bigger and harder to control. With that said, there are still ways to manage your elbow pain and help it heal.
- Physical therapy – This is my go-to with lateral epicondylitis. After all, I am a PT who believes in my profession. I find the best way to really jump start the healing process with tennis elbow is dry needling. In my experience it helps decrease the pain, swelling, and inflammation in the area. Other techniques that help include taping, soft tissue mobilization around the area, joint mobilizations, strengthening of wrist extensors and scapular stabilizers, and stretching wrist extensors and flexors. If your pain has not improved after a few weeks in physical therapy, then it is time to see an orthopedist.
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to treat tennis elbow. Basically stay away from the activities that are causing pain. This gives the tendons time to rest and heal. If you keep doing what is causing the injury, it is not going to get better.
- Ice – Ice is a natural anti-inflammatory and can help decrease the pain and swelling at the elbow. I would recommend using an ice pack several times per day if the pain is constant or preventing you from participating in an activity.
- Stretching – The wrist extensor muscles are probably very tight and painful from overuse.Stretching them will help increase their mobility. Stretching the flexor muscles will ensure better wrist movement. See the video below
- Strengthening
- Wrist extensors and flexors – It is important to strengthen the wrist extensor muscles and flexors so that they are able to handle repetitive loads without damage or inflammation to the tendon. I use resistance bands to add difficulty and improve strength. See the video below for strengthening exercises.
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- Scapular stabilizers – These are the muscles that stabilize the shoulder.They are attached to the scapula or shoulder blade and are located on your back. The shoulder is a bigger joint than the elbow and has much larger muscles supporting it. If the shoulder is weak, then the elbow will have to do more. Patients with tennis elbow typically have weak shoulder and scapular strength. See the video below for scapular strengthening exercises.
- Bracing – There is a type of elbow brace that is used for tennis elbow. It is designed to decrease the pull on the tendon. I have several patients that have used one and the general consensus is that it helps.
In review
- Tennis elbow is caused by chronic overuse of the wrist extensors without appropriate time for rest and healing
- It is an injury that occurs from an activity that places repetitive forces through the wrist and elbow.
- You do not need to play tennis to get it.
- Treat it as soon as you suspect it. It is difficult to get rid of once it really sets in.
- Physical therapy can help resolve it. If you have not seen any improvement after a few weeks in PT, then go see an orthopedist.
- Things that you can do to treat it include:
- Stop the activity that causes pain
- Ice it
- Strengthen the forearm and shoulder
- Stretch the wrist
- Consider a brace
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Lateral_Epicondylitis
https://www.statpearls.com/articlelibrary/viewarticle/29949/
https://www.choosept.com/guide/physical-therapy-guide-tennis-elbow-lateral-epicondylitis