Tennis Elbow

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Elbow Pain

Elbow pain may be due to a number of factors – one of the most common is lateral elbow pain which is experienced on the outside of the elbow or forearm and is commonly referred to or diagnosed as Tennis elbow. This is described below.

Tennis Elbow

Elbow pain which is located on the outside of the elbow (when the palms are facing forward) is commonly due to injury known as “Tennis Elbow”.
Despite its name, it is commonly found in non sporting people such as manual workers and people who do repetitive movements involving a lot of wrist extension (bending back) e.g. carrying a carrytot, or in activities which involve small or repetitive movements of the shoulder joint, or static postures of the neck and upper back.
It usually presents in one of four common sites – where the tendon attaches to bone, in the tendon, where the tendon attaches to the muscle or in the belly of the muscle.

Why does it happen?

There can be a number of causes for pain at this site.
Overuse of the wrist extensor tendon is the most common and it can result in inflammation where the tendon attaches to the bone or degeneration of the tendon along its length.
The pain can be made worse by tightness in the muscle in the forearm or tension in the neck or upper back.
In some cases there is no injury to the actual forearm muscles and all the pain is referred from the shoulder, upper back or neck area, or there may be a combination of both.

Predisposing Factors

Poor posture
Changes in, or poor training or work techniques.
Stress
Repetitive or sustained upper limb (especially wrist or outward rotation of the shoulder) movements.
Neck and upper back pain.
Myofascial Trigger Point Pain referral

All are factors which may cause / exacerbate lateral elbow pain. There may be symptoms at the elbow joint as well as these predisposing factors.

Neck and Upper Back Involvement

Elbow Pain can be severely influenced by the neck and upper back in a number of ways.
If a person has had a neck or upper back problem in the past, or at the same time as their elbow pain useful treatments include physiotherapy technique such as:

Soft tissue therapy
Deep massage
Electrotherapy
Myofascial trigger point release
Deep Dry Needling
Stretching and strengthening exercises
Pain Relief
Acupuncture

If a combination of the above doesn’t work, a costicosteroid injection may be considered.

Assessing the Injury

In order for treatment to be successful, a very thorough examination is required. This should include looking at the onset of injury, activities and lifestyle of the patient.
A detailed physical examination of the elbow, wrist and shoulder as well as a thorough examination of the neck and thoracic spine, bearing in mind previous episodes of neck and back pain.

Can tennis Elbow be treated?

No single treatment has been proven to be totally effective in the treatment of this condition. It is best treated by a combination of different treatments. The principles of treatment will involve:

Controlling pain and inflammation using physiotherapy techniques and non steroidal anti-inflamatories
Encouraging healing using deep transverse friction therapy and electrotherapy
Restoring flexibility and strength and eliminating the predisposing factors previously mentioned.

In the early stages before you have managed to contact your chartered physiotherapist use ice. 20 minutes at a time is more effective than prolonged period