After watching what was an entertaining Aussie Open this year I found myself reflecting on what can be a very debilitating condition. Ironically, we are seeing less and less tennis elbow in tennis over the years due to increased awareness, better technique, and improved racquet technology. It is not uncommon to see this condition occur in other sports like golf and weight lifting where repetitive gripping activities are required.

Clinically we see many people present with tennis elbow resulting from repetitive strain both from office workers and manual occupations like gardeners and tradesmen.

What is Tennis elbow?

Tennis elbow is an umbrella term used to describe a few conditions that cause pain around the lateral (outside) of the elbow. Pain occurs due to excessive strain through the tendon which attaches the muscles on top of the forearm to the elbow. The technical name for it is common extensor tendinopathy but may be alternately described as lateral epicondylitis or tendonitis, although recent research suggests the condition is more of a degeneration of the tendon rather than inflammation. It is often the result of many years of accumulated load and is more common in people over the age of 35.

Signs and Symptoms

Typically the tennis elbow patient will describe pain when carrying out resisted wrist/finger extension or gripping tasks. Pain may also be present when stretching the forearm muscles. There will be tenderness directly over the lateral elbow bone, and there may be trigger points in the forearm muscles. Some sufferers may show signs of nerve irritation and present with neck/shoulder stiffness and pain. Generally, most elbow movements will be pain free, despite that being the location of pain. I also tend to see these types of overuse injuries when there is a dramatic change in loading. Examples of this include starting a new sport/job, an increase in work hours or duties, performing the bi-annual yard clean up, and sporting tournaments requiring an increase in games over a short period.

Treatment

• Ice/cold therapy in initial phase

• Soft tissue release

• Dry needling of surrounding musculature

• Mobilisations of neck, shoulder and elbow joints as needed

• Taping/ bracing to offload the affected tendon

• Gentle graded strengthening of the forearm muscles

• Postural retraining and strengthening of shoulder stabilisers

• Nerve gliding if warranted

Identifying signs of overuse and addressing any causes or underlying issues early is essential in achieving the best outcome in a short time frame. If left untreated the degenerative changes occurring at the tendon can become advanced which can then require further medical input like injections or even surgery. If you work in an occupation requiring repetitive wrist movement or gripping it would be worth touching base with a physiotherapist to assess for any warning signs and to implement a simple tailored injury prevention routine.