Tennis Elbow - Myth or Fact
Tennis elbow is a painful and debilitating musculoskeletal condition that impacts substantially on society and extensively challenges the healthcare industry. It is characterised by pain around the lateral elbow which often radiates towards the forearm, reduced forearm extensor muscle strength, pain on resisted wrist extension and reduced grip strength. The structure most commonly affected is the origin of the tendon of the extensor carpi radialis brevis which is why it is commonly referred to as an Extensor Tendinopathy. The mechanism of injury is associated with overloading.
“You can only get tennis elbow from playing tennis”
Myth - Only 5 to 10% of the patients who present with tennis elbow practice this sport. It often occurs in repetitive upper extremity activities such as computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration. Despite the name, you will also commonly see this condition in other sports such as squash, badminton, baseball, swimming and field throwing events. People with repetitive one-sided movements in their jobs such as electricians, carpenters, gardeners and those with desk-bound jobs commonly present with this condition. It may occur due to a single incidence of over-exposure of the wrist extensors such as using a screwdriver over a weekend or spending excessive time on the computer with poor ergonomics.
“Tennis elbow is not the only cause of lateral elbow pain”
Fact – Lateral elbow pain can also be caused by referred pain from the cervical spine or upper thoracic spine or radiohumeral bursitis, along with other conditions.
“Tennis elbow is an inflammatory problem”
Myth - Pain around the lateral elbow is known by a variety of names including ‘‘tennis elbow’’ and ‘‘lateral epicondylitis’’. The use of the term epicondylitis was questioned over time, as numerous studies have failed to show inflammatory cells in the affected tissue and any medical term which ends with “itis” generally refers to an inflammatory condition.
Tennis elbow however has been described in more recent literature as a degenerative process that is associated with overuse of the wrist extensor muscles which in turn causes collagen disarray in the tissue.
“All tennis players get tennis elbow”
Myth - Only a very small number of tennis players suffer from the condition. On the occasions that it does affect tennis players, it can often be associated with using a new racquet, new grip, playing excessively against the wind or when hitting late, thus overusing the extensor muscles as the bodyweight is not correctly transferred. A backhand is more likely to cause the symptoms of tennis elbow.
“Physiotherapy can help to treat tennis elbow”
Fact - No single treatment has been proven to be totally effective in the treatment of this condition. Therefore, integrating a combined approach that includes ergonomics into physiotherapy treatment is essential in the management of this condition.
The best approach is an in-depth assessment of the wrist, elbow, forearm, thoracic spine and cervical spine to assume the correct mechanism of injury. When the diagnosis and reason for onset is established, a combination of various treatments such as soft tissue techniques, dry needling, manipulation, mobilisation and concentric/eccentric strengthening exercises are essential in the management of this condition. However, the key to the resolution of this condition is not the treatment applied but the management of the aggravating factors and the management of how and when the treatment is applied.
Tendinopathies are particularly difficult to manage and can often be problematic for years. Make an appointment to see one of our team of physiotherapists who will not only treat your overuse injury but will manage your condition and get you back to activity fitter and stronger than before the condition began.