Tennis elbow? But I don’t play tennis!

Tennis elbow, or to give it it’s medical title, lateral epicondylitis, is by far the most common cause of elbow pain.  It is commonly seen in athletes who use racquets, but 95% of people who have tennis elbow don’t play tennis (1).   So why would you get tennis elbow?  Why is it so sore? And what can you do to get rid of it?

What is it?

Tennis elbow is a degenerative condition mainly concerning the muscle extensor carpi radialis brevis (ECRB).  It was previously thought that the pain produced was due to inflammation but later researchers proved that it was due to a breakdown of the tendon of ERCB leading to an increase of pain communicating nerves in the tendon making it very painful (2).

Who is likely to get it?

The most common predictor for tennis elbow is repeated extension of the wrist against resistance, activities such as typing without a wrist support, bricklaying or even sewing or knitting can produce it (and of course racquet sports).  The peak age of sufferers is between 40 and 50 but can affect any age group (2).  There is also a strong association with shoulder rotator cuff tears (3) (see our article on shoulder pain), and with stiffness in the upper back and neck (2).

How would I know if I had it?

Most people experience a gradual onset of pain that is intermittent at first then gradually becomes present more of the time.  The pain is usually around the outside of the elbow although you may feel some stiffness along the top of the forearm too.  It can often be linked to an increase in a specific repetitive activity or a new type of activity (onset of tennis season, DIY etc).  It can often be worse in the morning and can be aggravated by simple movements such as picking up the kettle or carrying a briefcase (3).

Will it get better?

Yes, although how long it takes may depend on how severe the problem is.  If it is simply a reaction to a heavy weekend in the garden or doing a bit too much with the screwdriver then the pain may subside in a few days or up to a week.  However if you have been feeling the pain for quite a while, if the onset was severe (one very sore movement), or if it is linked to a shoulder or neck problem then it may become chronic and take up to three months to resolve (with effective treatment)  (1, 3).

What kind of treatment works?

There is no single treatment that is proven to be successful in all cases, often you may have to try several different types of treatment to get resolution of the problem, however, nearly all cases get resolved (3).

The first thing to do is to modify the activities that are aggravating the pain, such as getting wrist support for computer work or  taking regular breaks from the activity.  If the pain is aggravated by lifting objects it is possible to reduce the aggravation by lifting with the palm facing upwards, this reduces the strain on the ERCB. (4).

Manual therapy such as soft tissue massage, myofascial release and prescriptive exercise are all recommended (4), and has been shown to be more beneficial in the long term (over 12 weeks) than corticosteroid injections (4,5).

(if you do play tennis and this seems to be the main time when you get pain, try getting into position for your shot earlier to reduce the need for forearm power, change to a two handed backhand technique, or get a larger grip/larger head size racquet), (3).

What is our experience as osteopaths?

Many people ignore the onset of tennis elbow, this can mean it can become chronic and hard to shift, it is always much easier to resolve if assessed, diagnosed and a treatment plan put in place early.  Many people will not associate the onset with a history of upper back, neck and shoulder problems, but many cases fail to resolve unless biomechanical restrictions in these areas are resolved.

You can find a fact sheet and a basic stretch and exercise guide to help with the care of tennis elbow on our resources page.

Do you want to know what is causing your pain and if we can help?  Why not take advantage of our new patient assessment introductory offer to get you started towards a tailor made recovery plan for only £19.

Are you in a lot of pain and want to get better as soon as possible?  If so then why not book in for a new patient consultation, with treatment on the day, for £72.

References

1. Magee, D. Zachazewski, J. and Quillen, W., 2009. Pathology and Intervention in Musculoskeletal Rehabilitation, Missouri, Elselvier.
2. Brukner, P, Khan, K.  2005.  Clinical Sports Medicine (3^rd Ed).  Sydney, McGraw Hill.
3. Carnes, M, & Vizniak, N. (2011). Conditions Manual.  Professional Health Systems, Canada.
4. NICE, 2015.  Tennis Elbow, Scenario; Management.  Available at; http://cks.nice.org.uk/tennis-elbow#!scenario
5. Smidt et al, 2002.  Corticosteroid injections, a physiotherapy, or a wait and see policy for lateral epicondylitis, a randomised controlled trial.  Lancet; 359, pp657-662