What is Tennis Elbow?
Tennis elbow or lateral epicondylitis (tendonitis) is an overuse condition where the elbow becomes sore and tender. Pain occurs due to irritation of the tendons that join the forearm muscles on the outside of the elbow with most sufferers being middle-aged. This condition is attributed to over use whether that be through playing tennis, trade work or over use of the forearm through desk work.It affects between 1% and 3% of the population, that’s nearly half a million people in Australia alone! Historically Tennis elbow was considered an inflammatory condition, however as no inflammatory cells can be found within the bone-tendon junction upon histological examination it is usually referred to as tendon degeneration rather than tendinitis.
How do you know if you have it?
Tennis Elbow can present symptoms such as tenderness or Stiffness on the lateral (outside) of the elbow sometimes with a persistent ache. The muscles of the forearm can also feel sore and worsens when you grab or hold things. Now before you rush on to the steps how to fix your pain, these symptoms can be mimicked by other pathologies such as Arthritis, posterolateral rotatory instability (elbow instability) or even referred pain originating from the neck. These require specific variations from the treatment plan, so it is important you have an injury checked by a physio and receive the correct diagnosis before continuing.
If on the other hand, you have a confirmed case of tennis elbow here are a few steps to help you reduce the pain and repair the damaged tissue.
4 Steps to recovery
Step 1 – Reduce the pain
Ice the elbow
Ice or Cryotherapy can have a great response from the body when it is strained or injured. When soft tissue is damaged it can become inflamed, swollen or hot, an array of chemical and neurological changes happens in which the blood vessels dilate increasing the amount of oxygen, nutrients and white blood cells that enter the tissue. This process can stimulate nerve cells of the surrounding area generating a pain response.
Although inflammation is a necessary evil in that it is your bodies mechanism for fixing and restoring the tissue, it is usually hyperactive at the initial onset of injury causing excessive pain and stiffness. When ice is applied directly to the injured area, blood vessels will constrict the flow of blood and therefore inhibit the immune systems response. Although temporary, ice therapy can be a very useful, cost effective and non-chemical way of reducing pain and potentially speeding up the recovery process.
Strap the elbow to reduce joint stress
Strapping of the elbow works by compressing the muscles of the upper forearm and absorbing the forces which are transmitted through the soft tissue outside of the elbow. If strapped well or using a specific tennis elbow clasp, a change of angle at which the tendon works at the elbow will change the force which is applied to the tendon attachment allowing the injured area to recover over time.
Nonsteroidal anti-inflammatory’s (NSAIDs)
These can be split into either oral or topical (applied to skin) anti-inflammatory’s with topical creams or gels showing some evidence of efficacy. Oral NSAIDs such as ibuprofen has a different interaction with the body via the digestive system and therefore more consideration is required. These can be obtained either by your doctor or over the counter and can help manage pain provided correct dosages are adhered to.
Step 2 – Facilitation of tissue repair
Soft Tissue Massage & myofascial release
After the inflammation has reduced and injured tissues are beginning to repair, soft tissue massage can aid in muscle relaxation, increased blood circulation and lymph flow. These systems are integral to the delivery and excretion of nutrients and waste, increasing their function will not only speed up the healing time but also prevent the formation of scar tissue. Beyond this, massage has been shown to reduce joint inflammation and improve range of motion and flexibility.
Myofascial release is a form of soft tissue therapy like massage that you perform on yourself. Foam rollers and soft balls are commonly used to release muscle fascia but there are many different tools or everyday objects that could be used to identify tight muscle and treatment of trigger points. Many an evening I find myself leaning heavily into a protruding wall in my house trying to release tension in my lower trap muscles.
Step 3 – Restoration of the normal joint range of motion and function.
Gentle Joint Mobilisations
Joint Mobilisation techniques focus on attaining a normal range of pain-free joint motion, for example joint play or accessory movement which would be performed by another individual in order to assess ROM at the joint.
Joint Distraction is a type of mobility technique that we can incorporate into our stretching exercises in order to create more ‘space’ inside the joint complex. With regards to tennis elbow this would mean applying an elastic force to the ulna on the forearm within the cleft of the elbow, this pulling of the forearm away from the upper arm can provide space and reduce stresses within the joint. Be aware that is the muscles of the forearm are engaged through gripping or extending the fingers, tension will remain on the forearms potentially exacerbating the issue.
Step 4 – Restoration of normal muscle length, strength and movement patterns
- Fist Clenching
Hold a Foam roller or small ball or even a rolled-up towel in your hand, squeeze in your hand and hold for 10 seconds, release and repeat to fatigue on both arms if necessary.
- Forearm Supination
Supination is an external rotation exercise with the hand rotating the weight outward, turning the palm up, rotate the hand back the other direction until your palm is facing downward, repeat as required.
- Wrist extension
palm facing down, extend your wrist by curling it upwards towards the sky, you should feel the extensor muscles of the forearm engage. If this is too easy try adding a light weight.
- Wrist flexion
Similar to extension however with the palm facing up, flex your wrist by curling it towards the sky, slowly returning to the starting position.
Muscle Energy Techniques
Muscle Energy Techniques MET is a gentle manual therapy intervention targeting the soft tissues utilising gentle muscle contractions of the individual to relax and lengthen muscles and normalize joint motion. The affected muscle is gently stretched to its longest pain-free range. then performing a series of 3 to 5 submaximal muscle contractions of about 5 seconds each, similar to PNR stretching. This encourages the muscle to naturally relax and results in an improved range of motion.
Eccentric strengthening involves working the affected wrist extensor tendon and muscle while they are lengthening. For example, using the exercise named above Wrist Extension you would hold a weight with the palm facing down, the aim is to lift the weight extending the wrist quickly and then slowly in a controlled fashion lower the weight for around 5-10 seconds.
Tennis elbow is a potentially debilitating injury that is caused by over use/repetition of movements involving the forearm. This condition can be painful and limiting, however it can be improved through a range of measures including physical therapy, strapping, icing and anti inflammatory’s. If you suspect you might have tennis elbow it is essential to seek advice from a health professional as a starting point. If you have been diagnosed with this injury some of the tips above may help get you back on track sooner! For more tips on health, well being and exercise we encourage you to have a look at our Functional For Life Blog. If you are looking for fitness and health advice in general we would love to hear from you! We hope you have found some value in this blog and happy training!
Damian and the Functional For Life Team