Lateral Epicondylitis (Tennis Elbow)
Updated: Feb 27, 2019
Hi Everyone, in this week’s blog we will be discussing pain that effects the outside of the elbow, known as lateral epicondylitis, or more commonly referred to as tennis elbow.
Tennis elbow is the most common overuse injury in the elbow and forearm. It is characterised by pain on the outside of the elbow on the bony landmark of the outer forearm (lateral epicondyle).
The main structure(s) involved are:
1. The extensor muscles of the wrist:
a. Extensor carpi radialis longus
b. Extensor carpi radialis brevis (main muscle involved)
c. Extensor digitorum longus
d. Extensor carpi ulnaris
2. The common extensor tendon – which attaches all of these muscles to the lateral epicondyle.
3. The lateral epicondyle itself.
The extensor muscles originate at the lateral epicondyle of the humerus and insert into various places of the hand and wrist, providing us with the ability to extend our wrist and fingers.
Contractile overloads that chronically stress the tendon near the attachment on the humerus are the primary cause of lateral epicondylitis.
It is often caused by repetitive upper extremity activities such as computer use, heavy lifting, forceful forearm pronation and supination (twisting) such as screw driving, turning doorknobs and activities that are exposed to repetitive vibration (power tools).
Performing these repetitive activities, particularly when the hand is not held in a neutral position and instead has a tilt into flexion or ulnar deviation, places an immediate stretch load on the tendon. As we continue to engage in the activity the tendon is gradually pulled away from its bony insertion resulting in micro tears which causes inflammation, pain and restriction in function.
The main aggravating factors for lateral epicondylitis have been identified as:
· Handling tools heavier than 1 kg
· Handling loads heavier than 20 kg at least 10 times per day
· Repetitive movements for more than 2 hours per day.
Other risk factors include overuse, repetitive movements, training errors, misalignments, flexibility problems, aging, poor circulation, strength deficits and muscle imbalance.
Treatment and recovery times are generally determined by the presenting severity of the condition, which can be identified by stages, correlating with the following symptoms:
1. Faint pain, hours after the provoking activity.
2. Pain at the end of or immediately after the provoking activity.
3. Pain during the provoking activity, which intensifies after ceasing that activity.
4. Constant pain, which prohibits any activity.
Lateral epicondylitis can be treated, very effectively, by conservative Physiotherapy, Chiropractic, and Remedial Massage treatment plans.
A well rounded treatment plan consists, initially, of pain control, inflammation management and scar tissue mobilisation – this always correlates with a period of rest from the aggravating activity. This is followed by restoring normal biomechanics to the elbow and particularly addressing the position of the radial head, before improving length and flexibility of the extensor muscle group.
The final step in any treatment plan is to strengthen the muscle group to minimise the chance of reoccurrence. This is achieved by progressing through a series of isometric, concentric and finishing with eccentric exercises, before resuming normal activities.
The reason that lateral epidondylitis can be so debilitating, is because it affects the tendon of the muscles that allow us to move our hands. Because we use our hands all the time once the inflammation is there it can be difficult to rest enough to control it. With this in mind preventing the onset of inflammation is a much better option than trying to manage it.
So here are 5 things we can do to help minimise the risk of the injury occurring in the first place:
1. Stretch the extensors before and after activity. Hold each stretch for 15 seconds and repeat x 2 with the elbow straight and bent.
2. Avoid using the scroll button on your mouse and make sure you change hands regularly
3. If you are prone to sore elbows then engage in self release massage to the extensor muscles
4. Avoid activities that require repetitive movements of the wrist. If you can’t avoid these (i.e. painters, carpenters, using power tools) then wear a counter force brace.
5. Maintain good strength in the elbows by regularly performing resisted wrist extension exercises. Use a light weight (1-2kg) or theraband (green or blue) and perform 3 sets of 10 repetitions.
So that’s a brief overview of how lateral epicondylitis or tennis elbow occurs and how to avoid it. If you have questions or comments feel free to e-mail us at firstname.lastname@example.org and we will happily answer them for you.
If you think you may still be suffering from tennis elbow want relief now, then call us on (08) 9486 8653 and we will arrange an appointment for you.