Tennis elbow is a term used to describe irritation of the extensor muscles of the forearm that help move your wrist; these muscles attach to the lateral epicondyle of the radius bone at the elbow1. Therefore, the term lateral epicondylitis is another term for this injury. Tennis elbow is common in activities where quick repetitive extension of the wrist is required, including tennis. However, it is also one of the most common workplace injuries2. The most commonly painful tendon of the extensor group is the extensor carpi radialis brevis, followed by the extensor carpi radialis brevis1,2. A few different mechanisms are responsible for contributing to the onset of tennis elbow. Firstly, local tendon pathology due to repetitive microtears leads to muscle and tendon physiology and structural integrity changes. Secondly, there are changed in the central nervous system where the muscles release more chemicals related to pain sensation1,2. Finally, the motor system is also impaired, which decreases the strength and fine movements of the wrist. Each of these three factors can affect a patient differently in their injury. 1,2
What Can Cause Tennis Elbow
Tennis elbow is related to hammering, typing, racquet sports, and playing an instrument. The age of onset is usually 30-50, with both men and women affected equally.2 It is also related to other injuries such as rotator cuff tears, carpal tunnel syndrome and DeQuervain’s Disease.1 Often patients will find the most tender point to be 1-2 cm below the lateral elbow. This pain can be a dull ache and maybe develop into constant pain. Pain may even radiate down towards the fingers.1 This pain will be related to the movement of the wrist but most significantly with resisted wrist extension. The grip may also be painful and weak. Patients often report stiffness of the wrist in the morning as well. Unfortunately, tennis elbow is most likely to affect the dominant hand of the patient.1,2
The first line of treatment for tennis elbow is bracing using an epicondylar counterforce brace. This helps to reduce tension in the extensor muscles. With the brace, we also want to ensure activity that requires excessive wrist extension or grip is reduced as much as possible (activity modification and rest).3
Common modalities used for tennis elbow include ice, heat, TENS, IFC, Ultrasound, Iontophoresis, acupuncture and sometimes shockwave therapy. In regards to ice, we recommend the elasto-gel wrap placed over the outside of the elbow (lateral epicondylitis) for approximately 20 - 30 minutes. Being repeated every few hours if possible. TENS over the area can also help decrease pain, increase blood flow and speed up the healing process. We often put the TENS and the elasto-gel wrap for 20 minutes. 3,4
An exercise program is very important in the recovery from Tennis elbow. We often start with stretching and range of motion. This helps to regain range and bring blood flow back to the tissues to promote healing - Tennis Elbow - Stretching and Range of Motion Exercises. We then progress to isometric exercises, without movement of the tissues. We start this as the pain starts to reduce. We focus on holding wrist extension and supination with a light load for 30-90 seconds as tolerated - Tennis Elbow - Isometric Strengthening Exercises.3,4
A study was done in Clinical Rehabilitation in 2014 by Cullinane F. et al1 looking into the effectiveness of eccentric exercises for the treatment of lateral epicondylitis (tennis elbow)5. They did a systematic review of 12 studies that looked into this and concluded that eccentric exercises as part of a multimodal therapy program were effective in improving outcomes in patients with lateral epicondylitis.
Finally, we add eccentric (slow lowering) exercises for the extensors and supinators of the wrist. Muscles can handle a greater load eccentrically and help to strengthen and stretch tissues - Tennis Elbow - Eccentric Strengthening Exercises.3,4
About These Exercises
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- Vaquero-Picado, A., Barco, R., & Antuña, S. A. (2016). Lateral epicondylitis of the elbow. EFORT open reviews, 1(11), 391-397.
- Buchanan, B. K., & Varacallo, M. (2019). Tennis Elbow (Lateral Epicondylitis). In StatPearls [Internet]. StatPearls Publishing.
- Coombes, B. K., Bisset, L., & Vicenzino, B. (2015). Management of lateral elbow tendinopathy: one size does not fit all. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 938-949.
- Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of physiotherapy, 61(4), 174-181.
- Frances L Cullinane, Mark G Boocock, Fiona C Trevelyan. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review, Clinical Rehabilitation January 2014 28(1):3