Tennis Elbow


Tennis elbow (lateral epicondylitis) is the term used to describe inflammation or a series of small tears of the muscles which extend (bend back) the wrist and fingers.

Symptoms of tennis elbow may include:
  • Local tenderness on the outside of your elbow;
  • Pain radiating from the outside of the elbow into the forearm and wrist;
  • Pain when extending the wrist;
  • Pain and / or weakness in the grip during certain activities, such as holding a racket or turning a tap;
  • Pain at rest, particularly in the morning on waking or resting after activity;
  • Pain increasing over time.

Predisposing factors:
  1. Overuse of the arm, particularly repetitive movements such as playing tennis, using a mouse and
  2. Muscle imbalance and / or weakness
  3. When tennis related, incorrect technique or equipment

Treatment

Management of tennis elbow usually requires a combination of self management and physiotherapy intervention to resolve inflammation and correct biomechanical factors which predispose to the condition.

1. Rest
Continuing to perform aggravating factors with pain will exacerbate the condition. It is very important to avoid all activities which produce pain. Once the pain has settled, return to sport should be gradual with a slow increase in both frequency and intensity of play.

2. Ice
Regular ice application throughout the day as well as after aggravating injuries is very important particularly in the early stages.

3. Anti-inflammatory medication

If you are able to tolerate them, over the counter anti-inflammatory medication may be recommended.

4. Physiotherapy
Physiotherapy combining elbow manipulation and exercise has been shown to have greater benefit to no management in the first six weeks and to corticosteroid injections after six weeks.1
Initially the physiotherapist will work to reduce the inflammation in the muscle through massage, ultrasound and mobilisations;
As pain settles, a program of stretches (to maintain mobility and minimize scar tissue formation) and strength exercises (to prevent reoccurrence) can begin.

5. Brace / Taping
A brace worn around the forearm may be prescribed to reduce the pull on the inflamed tendon and allow inflammation to settle. Initially the brace is worn full time and later worn part-time during aggravating activities;
Alternatively, your physiotherapist may tape your forearm to reduce pressure on the tendon.

The tennis player
The two possible aggravating factors for tennis elbow are the stroke and the racquet.
Stroke – backhand and overhead smashing are more likely to cause pain. Lessons to revise technique to prevent reoccurrence may be necessary on return to sport.
Racquet – factors such as grip size (too large or small), racquet weight (too heavy) and string tension (too tight) may need to be assessed as causal factors.

1. Extensor / flexor muscle stretch

extensor stretch / flexor stretch

2. Eccentric extensor strength
  • assisted wrist extension - with weight in affected hand, use other hand to assist lifting weight up, then release to let affected hand control the movement down




3. Concentric extensor strength
  • unassisted wrist extension – as above, but use affected hand to lift weight up and lower slowly

4. Medial Glide Elbow (Mulligan)
  • Standing with upper arm against wall so elbow is level with door opening
  • Holding grip object in hand, push the forearm laterally and hold
  • Perform 10 pain-free grips