Tennis Elbow (Lateral Epicondylitis)
Tennis elbow
Tennis elbow is a very common injury, and despite the name it is by no means limited to tennis players. The medical term is lateral epicondylitis. Tennis elbow is an overuse syndrome, meaning that the tendon of the forearm extensor muscles has become overloaded. These muscles run across the wrist joint and attach to the outside of the elbow (the lateral epicondyle). The muscles most often involved are the extensor carpi radialis brevis and the extensor carpi ulnaris.
Tennis elbow also falls under the umbrella term RSI (repetitive strain injury), which covers a range of specific tendon, nerve and muscle-related conditions of the neck and arm. More recently the term CANS has also come into use, since RSI does not clearly distinguish between the different conditions – but this terminology is still so new that RSI remains the most commonly used term.
Symptoms
With tennis elbow, pain is felt on the outside of the elbow, sometimes radiating to the forearm and wrist, and occasionally to the outside of the upper arm and shoulder. The pain occurs when the wrist and hand extensor muscles are engaged, for example when picking something up.
Tensing the wrist and hand extensor muscles against resistance is painful in people with tennis elbow.
The origin of the wrist and hand extensor muscles is attached to the outside of the elbow, and pressing on this spot is also painful. Because the pain often eases off again early on, people tend to keep using the arm as normal, which can lead to pain that also persists at night, even when the arm is not being used. In an advanced stage, tennis elbow can lead to loss of strength and coordination. Pain may also occur when stretching the wrist extensors (elbow straight, hand moved towards the palm side).
Causes
There are two main reasons why this tendon becomes overloaded. First, it can result from too heavy a load over a short or long period. Second, the tendon's load tolerance can be reduced, for example by poor blood supply, which itself can have many causes. With reduced load tolerance, even a normal load can amount to overload and cause complaints. When a tendon is overloaded, small tears appear in its connective tissue. Because tendon tissue is naturally poorly supplied with blood, it takes a long time to heal. The pain in the elbow tends to ease off slowly early on, so people keep using the elbow as normal, and it never fully recovers.
What you can do yourself
Avoid or reduce the activities that originally caused the complaint. The best way to prevent new flare-ups is to follow the advice of your doctor and physiotherapist. It is worth following this advice, because it helps you rebuild muscle strength and fitness, increasing the load tolerance of your musculoskeletal system over time – this is the only way to prevent future problems. Here too, prevention is better than cure. This means that athletes who use their forearms very intensively should train their arm muscles specifically, loading them symmetrically and evenly. Prolonged, one-sided training should be well balanced with exercises that relieve tension. Again, it comes down to the right balance between maximum effort and recovery. If you perform certain movements every day, whether at work or in your free time, in a way that leads to overload, the muscles involved get too little time to recover – and recovery is essential for staying in good shape!
If avoiding or reducing the triggering activity is not possible because of your work, an elbow brace may be used to relieve the elbow during that particular load.
Treatment by the physiotherapist
Treatment focuses first on relieving the affected muscles and improving local blood flow, possibly with ice therapy in the acute phase.
Physiotherapy treatment focuses on reducing pain, keeping the joints mobile and keeping the muscles at an optimal length. Improving muscle strength is also very important, as this makes the tissue more resilient, reducing the likelihood of tennis elbow developing again in future. Exercise therapy strengthens the weaker muscles, lengthens the shortened muscles, and restores the necessary balance between specific muscle groups. In addition, the physiotherapist can work to improve local blood flow using deep transverse friction massage, dry needling and, where appropriate, related techniques such as periosteal pecking. Kinesiology taping can also be very helpful in the acute phase.