Tennis elbow aka lateral epicondylalgia is a condition usually related to the overuse of the muscles and tendons which attach at the outer elbow.
With more people interacting with PCs and laptops to communicate during the COVID-19 restrictions, here at the clinic, we have seen a significant increase in tennis elbow cases.
The condition causes pain and sensitivity at the outer elbow and often along the back of the forearm. Gripping, lifting and carrying as well as working on a keyboard is often weak and painful.
To heal and recover, a period of 'offloading' is required to allow the tissues to settle. During this period, you should generally avoid activities which cause pain. These include activities which use the wrist and hand such as lifting, carrying, holding objects, as well as sports such as tennis, golf, cycling and spinning.
Also, be careful to avoid prolonged use of a keyboard or tablet which will strain and aggravate the affected muscles and tendons. Take regular breaks, before any soreness develops. It helps to assume a good posture with the head and neck aligned, shoulders relaxed, and forearms supported when working at a desk.
A typical course of physiotherapy for this condition is 6-8 sessions over an approximately two month period, depending on how long the condition has been present. Unfortunately, when treating a true case of tennis elbow, there is no quick fix. Progress may feel slow at first, but usually, after around four sessions, pain symptoms and function are noticeably improved.
Physiotherapy techniques may include therapeutic exercise, manual therapy, electrotherapy and electroacupuncture aka electrical dry needling.
We often prescribe a gentle pain-free grip squeeze of a hand weight, initially in a supported position for up to 1 minute and repeating three times. This simple exercise performed once a day can assist with easing pain and starting to improve the muscle and tendons' ability to cope with everyday use again.
Once the pain has started to ease, a more progressed series of exercises must be done each day to strengthen and improve the 'load tolerance' of the muscles and tendon. These exercises will allow greater use of the wrist and hand during higher intensity and repetitive activity and sports. If these exercises are not prescribed, the likelihood of relapse is higher.
Steroid injections are generally not used nowadays due to the high risk of relapse and weakening of the tendon. However, sometimes a consultant may offer a steroid or other injections in the unlikely event you are not responding to physiotherapy.
Due to greater clinical research focussed on the treatment of tennis elbow, we can offer the best available evidence-based physiotherapy treatment. However, patience is required, there is no quick fix, and it is essential to complete the full course of treatment to prevent the condition returning after a few months.
In good health,
Simon Coghlan MSc, BSc Physio, DipMedAc
Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. Journal of physiotherapy. 2015 Oct 1;61(4):174-81.
Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. Jama. 2013 Feb 6;309(5):461-9.
Vicenzino B, Cleland JA, Bisset L. Joint manipulation in the management of lateral epicondylalgia: a clinical commentary. Journal of Manual & Manipulative Therapy. 2007 Jan 1;15(1):50-6.
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