Platinum Physiotherapy

Tennis elbow - "Lateral Epicondylitis"

Tennis elbow, as many of you will have experienced or seen, is an extremely painful condition affecting the outer part of the elbow (when the palm is facing upwards). It literally means "inflammation of the lateral epicondyle", which is the bony protuberance at the outside of the elbow.

The cause of tennis elbow can be sudden (acute) or chronic, however, inevitably the tendon of the forearm extensor muscles is involved, as it is this that attaches to the area of pain. These are the muscles we use to lift objects such as bags, tools and of course the good old tennis racquet, hence the name!

The backhand in racquet sports is played using these muscles, therefore tennis, squash and badminton are very common causes of the overuse type of tennis elbow. But do not underestimate other activities such as painting, typing and many other day-to-day activities; in my experience, these far outweigh the racquet sports causes!

Correct diagnosis of tennis elbow is absolutely essential, and I commonly come across misdiagnosed elbow conditions that have been labelled "tennis elbow" just because of where the pain seems to come from. Other causes of elbow pain may be related to the neck, shoulder and other elbow conditions, so please have your pain assessed to avoid aggravating the symptoms.

After the correct diagnosis, the most effective treatment includes:

Ice: This will ensure the inflamed area can settle down to allow the extensor muscles to stretch and strengthen without aggravating the pain.

Deep tissue massage: In my opinion, this is the most important part of the treatment, loosening of the "belly" of the tight extensor muscles causes the tendon to pull less on the bone, therefore decreasing the symptoms.

Stretching/strengthening programme: Each patient will receive a personalised program to ensure that the extensor muscles stay supple through stretching, and also strengthening if indicated (not always required and in fact sometimes people may be "too strong"!).

Education: Identification of the aggravating activity is the most important key at the outset, as this will decrease the chances of recurrence. This may be related to sports, work, DIY activities and many other hobbies/chores. Modification of the aggravating activity is essential during the treatment, and this can be then increased again when the symptoms have settled.

You will note I have not commented on other "traditional" ways of tennis elbow treatment, including cortisone injections and tennis elbow braces. The reason is that the research behind the injection for long-term relief is poor, in fact, many people find the pain is worse after the effect of the steroids has worn off.

Regarding the brace, again this can be used for short-term relief however without the treatment of the cause (i.e. tendon tightness/weakness/inflammation), the long-term prognosis will not be as good.