Comprehensive Guide to Tennis Elbow and Its Treatment

Our elbow joint, adorned with the scientific logo in anatomy as the humeroular joint, is an undeniably hardworking part of the body that participates in innumerable daily activities we take for granted. It assists everyone, from adults of all ages to workers like carpenters, painters engrossed in their paintings, plumbers, butchers, and even those who engage in racquet sports, where the hand and the racquets form a dynamic team. This crucial joint contributes to complex movements, lending its strength and flexibility to everything from lifting a gallon of milk out of the fridge to propelling a tennis racket using our nimble fingers. Any object with significant weight can rely on these intricate bones and tissue of this joint for effective movement.

Studies of the lateral epicondyle, a resilient part of the elbow, show the intriguing way our elbow functions, quite like a hinge that allows us to move objects with finesse and technique. Given its constant usage and the inevitable wear and tear it withstands, it’s no surprise that it can lead to health conditions like tendinitis. This joint, an integral part of the larger skeletal system, when its health is compromised, impacts total bone health. Its complex structure, made up of several small bones, often becomes susceptible to various injuries, strains, and tears, particularly as the stiffness of age sets in.

The population of patients with such conditions often requires doctors to carry out services such as tests, including EMG and MRI scans (magnetic resonance imaging). These allow visualization of nerves, tissues, and blood flow. Additional techniques like x-ray can also be used to see beneath the skin surface. Such conditions can cause significant difficulty in our daily lives as it impacts our skin and blood flow, resulting in a bump in the journey of our health and well-being, something we often notice only when the pain sets in.

Common ailments like lateral epicondylitis, also known as tennis elbow, frequently cause elbow pain in adults. Protecting your health and well-being might involve consulting with a doctor who can run necessary tests, suggest interventions like steroid injections, or discuss other therapeutic procedures. Techniques include electromyography, MRI scans, enhanced by the use of state-of-the-art technology, and NSAIDS to manage the inflammation. Prescription drugs like ibuprofen can sometimes alleviate the discomfort in the short term, but to fully understand the root cause of the problem, a patient needs a proper diagnosis.

What is Tennis Elbow?

Given the overuse of forearm muscles in our daily tasks, lateral epicondylitis is often a repetitive strain injury caused by gradual damage from activities involving the nerves in our arms, and wrist motions. A common task that may cause strain is using the mouse too much. Extensive medical evidence indicates many treatment options, which range from cortisone shots, bracing the affected area, heat therapy, to a recently popular method, shock wave therapy. The choice of procedure depends on the severity of the swelling in the affected area.

Activities that could cause Lateral epicondylitis:

• office work (clicking a mouse or typing)
• hammering or drilling
• playing tennis or other racket sports

What muscles are involved?

The muscles involved include the proximal tendons of the extensor carpi radialis (ECR) and extensor digitorum (ED). Studies have shown that the ECR, in particular, comes under extreme stress during activities that require the use of the wrist and hands. Such strain, equally common amongst athletes or anyone handling heavy equipment, often results from using inappropriate tools or gripping other objects, like a doorknob, in an awkward position.

This can disrupt the normal functioning of the muscles and nerves, leading to muscle fibre tears that result in common tennis elbow symptoms such as arm pain and weakness.

Who is susceptible to Tennis Elbow?

Approximately 40% of the adult population will experience Tennis elbow symptoms during their lifetime. These symptoms might manifest as weakness in the affected arm, hindering simple tasks like gripping objects. It is more often found in women, those with office jobs, or work that demands the repetitive use of the elbow and fingers. Possible risk factors are closely tied with certain daily routines, with additional considerations for individuals with arthritis in the area.

Other risk factors Include:
• history of neck pain
• concurrent rotator cuff problem
• smoking

Is Tennis Elbow a tendonitis?

The answer is NO.

A tendonitis diagnosis usually involves having an EMG test and MRI scans, which typically means there is an acute inflammatory process ongoing within the tendon or where the tendon attaches to the bone. However, tennis elbow is not due to inflammation but to a Tendinopathy. This suggests that the pain results from a longstanding problem with the tendons’ internal structure, often accompanied by a decrease in grip strength, making the affected area tender to the touch.

Tendonitis vs. Tendinopathy, why does it matter?

Understanding the nature of the condition matters for treatment. While tendonitis is an inflammatory process that typically responds well to medicines like Advil, ice packs, and rest, Tendinopathies issues, like Tennis elbow, require a different approach. Tendinopathies respond well to controlled strain on the tendon from exercise. Physical therapists often recommend strengthening exercises to address weakness and improve grip strength for example.

Meanwhile, at Move Empower Concierge Physical Therapy, we pride ourselves on providing treatments that are evidenced by research and proven effective. Our team of skilled therapists employ a range of techniques to treat tennis elbow symptoms including manual therapy, dry needling, and therapeutic exercise.

How can we treat Tennis Elbow?

Tennis Elbow has been shown to benefit from a specific type of therapeutic exercise: eccentric exercise training, which is highly effective. This rubber bar, called a FlexBar, can be wound up to create resistance for an eccentric wrist extension that promotes healing of the tendon.

This researched-backed exercise protocol has been shown to be highly effective in reducing pain and increasing strength of the muscle tendon complex affected by tennis elbow.
• Dry Needling
• Therapeutic Exercise
• Manual Therapy
• Ultrasound
• Laser
• Elbow braces
• Taping

If you don’t have a FlexBar, no problem. Simply use a small dumbbell with a weight that you can carry for around ~15 repetitions, placing the emphasis on the eccentric (lengthening) part of the exercise. Just remember to ensure your arms are well-braced and remember the importance of flexibility in these exercises.

See the video below for more details on these exercises.