Tips to Manage and Treat Tennis Elbow (Lateral Epicondylitis)

Prevention and Treatment of Tennis Elbow

Tennis elbow physiotherapy.

Article by Sydney sports physio, Chris El-Hayek.

Lateral epicondylitis (commonly known as ‘tennis elbow’) is a condition affecting the common extensor tendon that attaches to the outside of the elbow. This occurs at the origin of the extensor carpi radialis brevis (ECRB) as seen in the diagram below:

Tennis Elbow

This condition often occurs secondary to repetitive actions that stress this area, including gripping, wrist extension, carrying heavy loads repetitively (generally over 20kg), and wrist radial deviation. It is a painful condition and gets its name due to the similar repetitive actions in racquet sports, however interestingly enough, most that suffer from it tend to be from non sporting populations.

How and why does tennis elbow occur?

This is a common condition in primarily people over the age of 40 years old, and occurs equally in both men and women. Tennis elbow effects between 1-3% of the population in Australia. Only about 10% of tennis players make up the population of those who suffer from this condition.

Mechanism of a tennis elbow injury

As mentioned in the introduction, there are certain activities that can flare up the common extensor tendon at its attachment site. The repetitive actions tend to be a risk factor when they occur for 2 hours or longer daily. Some of these include the following;

  • repetitive radial deviation (think bring your wrist in towards your body with your thumb going towards you)
  • Repetitive wrist extension (think bring your knuckles up towards the roof)
  • Repetitive lifting of weights >20kg.

Intra substance tears, thickening, or granulation tend to occur at the tendon insertion at the outside of the elbow, which may be seen on imaging. It is also hypothesised that there are a lack of inflammatory cells in ECRB tendon specimens of those suffering with tennis elbow.

Tennis Elbow

Risk factors for tennis elbow

  • Repetitive (>2 hours daily) wrist extension, gripping, forearm supination
  • Repetitive lifting of weights >20kg
  • >40 years old
  • Smoking
  • Obesity

Severity and duration of tennis elbow

Depending on the severity, tennis elbow symptoms can last anywhere from 3-18 months.1 It tends to be a lingering condition which can cause ongoing pain, discomfort, and progressive loss of grip strength due to pain when carrying/lifting items.

Fortunately, Tennis elbow does have a favourable outcome, with up to 90% of sufferers having a full spontaneous recovery within 1-2 years.1 As mentioned above, this time frame is dependent on the severity of the condition.

Medical Imaging

Medical imaging is normally unnecessary, as a diagnosis of tennis elbow can be made with a thorough assessment from a physiotherapist. Referrals for Imaging are still commonly given from medical professionals however, with the most common modality being ultrasound. Referral may also be given to rule out any sinister pathology or red flags if detected on assessment.

An ultrasound is a quick and easy imaging modality that can show any changes at the common extensor tendon, and any tear that may be present.

(Magnetic Resonance Imaging) MRI is gold standard when it comes to giving a more clear detailed image. However, these can be quite costly, and most of the time it is not needed.

Tennis Elbow Magnetic Resonance Imaging

Management of tennis elbow

As mentioned above, tennis elbow has a favourable outcome with time. It is important throughout this period to manage around the symptoms with light activities to minimise loss of strength, and flexibility.

Other treatment modalities from a physiotherapist include tissue massage, mobilisations, and/or manipulations for pain relief. Taping the area may also help manage pain and function, and more commonly tennis elbow straps can be worn when doing activities to reduce symptoms.

Tennis elbow is normally managed conservatively, and it is uncommon that surgical intervention is needed, or even considered.

Corticosteroid injections are commonly given to people with tennis elbow to manage pain/inflammation, however research does suggest that this can actually lead to worse clinical outcomes after a 1 year follow up.2

Plasma Rich Protein (PRP) is a treatment that has become very popular in recent years. Essentially, your own blood platelets are injected into the injured area with the aim of accelerating healing/reducing pain. Research suggests PRP may improve pain and function within 12-26 weeks.3 There is still conflicting evidence however, and passive treatments like this should not be relied on given the favourable natural history of this condition.

Below, are examples of exercise that can be done to manage your pain, and maintain/improve your strength and function throughout your rehabilitation journey

Early Stage Tennis Elbow Rehabilitation Exercises

Ball squeezes (Complete 10 sets of 10 second holds, 1-2x a day)

Ball squeeze excercise for Tennis Elbow

 

Wrist Stretch (Hold stretch for 20 seconds, 3-6 sets daily)

Wrist Stretch for Tennis Elbow

Mid-Late Stage Tennis Elbow Rehabilitation Exercises

Once pain is being managed better, and function has started to improve, consider the following resistance exercises to build the strength and capacity of your forearm muscles/tendons:

Controlled Wrist Drop (Complete 2-3 sets of 5-10 reps, x3 a week)

Controlled Wrist Drop for Tennis Elbow

  • Carry light weight in hand to start (0.5-1.5kg and progress each week as it becomes easy)
  • Lower the weight for 3 seconds, and help the weight back up with your other hand so you don’t become too fatigued 

Resistance Band Twisters (Complete 2 sets of 15 reps, x3 a week):

Resistance-Band-Twisters-for-Tennis-Elbow

  • Keep your elbow tucked in while doing the exercise
  • Your starting position is the top photo. Slowly control yourself as you twist your forearm into the 2nd position spending approx 3 seconds.

How a physiotherapist can help in the treatment, management and prevention of tennis elbow

If you are suffering from elbow pain and aren’t sure what to do, or if you have tennis elbow or not, a physiotherapist can help! At Optimise, our detailed physiotherapy assessment, and comprehensive rehabilitation programs will cater for your goals and help you get back to doing what you love. Send us an email or call to make an appointment to see how we can help you.

Do you need assistance managing or treating a tennis elbow injury? 

Sports physiotherapist Chris El-Hayek has extensive expertise in offering physiotherapy services to athletes in a range of high-performance sports. He has been able to assess and treat multiple athletes with a wide range of sport related injuries.  He can successfully implement programs that will minimise injury rates and enhance your athletic qualities.

 

References

  1. Buchanan BK, Varacallo M. Tennis Elbow. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431092/
  2. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013 Feb 6;309(5):461-9. doi: 10.1001/jama.2013.129. PMID: 23385272.
  3. Houck DA, Kraeutler MJ, Thornton LB, McCarty EC, Bravman JT. Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-analyses. Orthop J Sports Med. 2019 Mar 14;7(3):2325967119831052. doi: 10.1177/2325967119831052. PMID: 30899764; PMCID: PMC6419259.