Tennis Elbow or Lateral Epicondylitis is a condition which occurs as a result of overuse of the elbow causing pain and inflammation on the lateral side of the elbow. This overuse can occur during certain activities such as playing tennis (hence the name "tennis elbow") or other occupational activities like painting, typing, vacuuming etc. Lateral epicondylitis is a common condition which affects the tendon of the Extensor Carpi Radialis Brevis muscle, about 2 cm below the lateral border of the elbow joint. Any injury to the tendon at the point of attachment to the bone also results in tennis elbow. Symptoms comprise of wrist weakness and tenderness to touch at the lateral bony prominence (lateral epicondyle). The common line of treatment for tennis elbow is plenty of rest and ice therapy. Other than this, wearing a brace offers support and helps in pain relief along with speeding up the healing process. NSAIDs, such as ibuprofen, help in relieving pain, inflammation and swelling. Patient should also enroll into a rehabilitation program in order to prevent recurrence of the injury.
Causes of Tennis Elbow or Lateral Epicondylitis
- Overuse of the elbow or prolonged strain due to daily activities or playing sports like tennis.
- If the backhand technique in tennis is poor, then also it may cause tennis elbow.
- If the racket grip is small or the strings are very tight, then it may increase the risk of this condition occurring.
- The use of heavy and wet balls also is one of the causes.
- Repetitive activities such as typing, painting, gardening, using a screwdriver etc.
Types of Onset of Tennis Elbow or Lateral Epicondylitis
- Sudden Onset: As the name itself suggests, this occurs with an isolated episode of exertion, such as a late back hand causing the wrist extensors to strain and leading to small tears in the tendon.
- Late Onset: This type of onset often occurs within 24-72 hours after intense or rigorous wrist extension, such as playing with a new racket.
Symptoms of Tennis Elbow or Lateral Epicondylitis
- Pain or tenderness to touch approximately 1-2 cm below the lateral epicondyle.
- Increasing pain in the elbow.
- The wrist grip is felt weak and the patient experiences difficulty doing daily, simple tasks such as opening the door, picking up a pencil, holding a coffee mug or shaking hands.
- Pain on the external region of the elbow upon extension of the hand at the wrist against resistance.
- Extension of fingers against resistance produces pain on the outer side of the elbow.
- Palpating the region below the lateral epicondyle also produces pain.
Treatment for Tennis Elbow or Lateral Epicondylitis
- Application of ice or cold therapy to the elbow is very beneficial in alleviating the pain and inflammation.
- Rest is very important for healing and patient should rest his/her arm as much as possible.
- Wearing a brace or support is highly recommended, as it offers protection to the elbow and keeps the elbow stabilized and promotes the healing process. Ideally, the brace should be worn just about 10 cm down the forearm and the affected area should be avoided.
- After the initial acute phase has passed, the athlete should enroll into a rehabilitation program for exercises for tennis elbow so that there is an improvement in his /her range of motion and flexibility.
- It is recommended that the athlete consult a sports injury specialist in order to exclude any nerve involvement/injury.
- NSAID's like naproxen, ibuprofen can be given for relief from pain, inflammation and swelling.
- Ultrasound or laser treatment can also be done to alleviate pain and inflammation. It also helps in promoting the healing process.
- The athlete can also get massage therapy, transverse friction techniques or myofascial release done for faster recovery.
- Acupuncture (alternative treatment) can also be given a try.
- If the doctor confirms any nerve involvement, then neural stretching exercises are recommended.
- If the NSAID's are not working, then steroid injections can be given for relief from pain and inflammation.
- The root cause of the tennis elbow should be addressed by using correct backhand technique, or using the correct racket size and using the right grip.
- Extracorporeal Shock Wave Therapy (ESWT) is another mode of treatment which can be done.
- If all the above conservative measures do not provide relief, then surgery is considered.
Prevention of Tennis Elbow or Lateral Epicondylitis
The athlete should concentrate on the right techniques while playing. Poor or weak technique such as a poor backhand tennis stroke is the common cause of tennis elbow. Athlete should ensure that his/her wrist is not flexed when hitting the ball. Also, the wrist should be kept steady so that the impact of a high speed ball throughout the arm is diffused and is not just focused on the lateral epicondyle of the elbow. The wrist should always be held straight and firm when the athlete is hitting the ball.
Recovery Time for Tennis Elbow or Lateral Epicondylitis
- There should be a gradual return to full training and fitness as pushing the rehab will result in worsening of the injury.
- If the athlete is not feeling any pain upon doing strengthening exercises, only then should he/she consider starting any racket work.
- The stretching and strengthening exercises of the elbow should be continued even after achieving complete healing. This will help in preventing a recurrent injury.
- According to a research, athletes/patients who did not receive the standard treatment for tennis elbow didn't seem to be worse for wear than those who did get the treatment and in fact the patients who did not receive any treatment, got better on their own over the time. According to this study, both PT and cortisone shots weren't helpful in providing long term benefits when used as treatment for tennis elbow. Patients who did not get any treatment at all for tennis elbow have seemed to fare better in the long run than the patients who got the cortisone shots with PT. However, the cortisone shots were helpful in giving short term benefits, such as relieving pain and inflammation which in turn allowed the patients a faster return to their daily activities of living. Physical therapy, on the other hand, didn't offer the faster or short-term benefits such as seen from cortisone shots. However, patients who had enrolled into physical therapy reported that their dependency on the cortisone injections and other OTC pain killers and NSAIDs had lessened, which in turn saved them from the side effects of these medications, such as problems with acidity and other gastrointestinal issues. So, physical therapy may not guarantee a long term relief in tennis elbow, but still can be considered as a good modality of treatment in providing some relief, without the side effects of the cortisone injections and other pain relieving medications and should not be ruled out completely.
Assessment and Diagnosis of Tennis Elbow or Lateral Epicondylitis
The doctor or a therapist will perform a physical assessment to diagnose the cause of injury and pain. Palpation of the surrounding area to the lateral epicondyle helps in assessing for other regions of pain, tenderness and muscle tension. Diagnosis can also be arrived at by performing resisted wrist extension, resisted middle finger extension etc. There are other tests which will help in finding out if there is any nerve involvement or damage. These tests are Mill's maneuver and neural tension tests.
Tennis Elbow Strengthening Exercises
It is advised that the athlete (patient) seek medical advice before attempting any exercises.
Isometric Wrist Extension:
- The athlete should place his/her arm such that the forearm and palm are facing downwards. Try to keep them supported.
- Next the wrist should be extended by pulling it backwards.
- The contraction which is produced should be held for 5 seconds.
- Rest and repeat the above step 10-15 times.
- Wrist joint movement should be avoided.
- Bring your fingertips together as if forming a beak shape.
- Place a rubber band over the fingers while keeping the fingertips together.
- Next, try to pull the fingers apart against the resistance of the band.
- This exercise should be repeated around 10-20 times.