Tennis Elbow Explained: Frustrating Pain

Tennis elbow, also known as lateral epicondylitis, is a condition characterized by pain and tenderness on the outside (lateral side) of the elbow. It is a type of tendinopathy that affects the tendons attached to the lateral epicondyle of the elbow, which is a bony bump on the outside of the elbow where the tendons of the forearm muscles attach.

Lateral Epicondylitis

Lateral Epicondylitis, also known as “Tennis Elbow” and more recently proposed to be termed Lateral Elbow Tendinopathy (LET), is the most prevalent form of overuse injury affecting the elbow joint. The revised terminology highlights its classification as a tendinopathy, primarily affecting the extensor muscles of the forearm. These muscles originate from the lateral epicondylar region of the distal humerus, frequently involving the attachment site of the extensor carpi radialis brevis muscle. For more information on the elbow check out our Anatomical Guide.

Causes

Tennis elbow is caused by overuse and strain of the forearm muscles that extend the wrist and fingers. Despite its name, the condition is not limited to tennis players and can affect anyone who performs repetitive gripping activities, especially if they involve the use of the thumb and first two fingers. Common activities that can lead to tennis elbow include playing racquet sports, typing, painting, using tools, and knitting.

Conversely, this type of pain has been linked to certain straight-arm injuries where extended or excessive straightening of the elbow can lead to discomfort. This is often seen in activities requiring forceful pushing motions, such as in football, or through straight-arm locks in grappling sports.

Symptoms

The primary symptom of tennis elbow is pain and tenderness on the outside of the elbow, which can also radiate into the forearm and wrist. Other symptoms may include:

• Difficulty and pain when trying to grasp objects, especially with the arm stretched out
• Weakness in the forearm.
• Painful grip while performing activities such as shaking hands, turning a doorknob, or holding a cup.

Diagnosis

Diagnosis of tennis elbow typically involves a medical history review and a physical examination. Your doctor may apply pressure to the affected area or ask you to move your elbow, wrist, and fingers in various ways to assess pain and stiffness. In some cases, imaging tests like X-rays, MRIs, or ultrasounds may be used to rule out other conditions.

Treatment

Treatment for tennis elbow aims to relieve pain and restore the affected arm’s function. Options include:

• Rest and Ice: While there is always a time and place to incorporate the RICE system, this is generally applied only for the first 24 hours of irritation. Avoiding activities that exacerbate the condition and applying ice to reduce inflammation.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and swelling. Although this will be effective for training without pain, IT DOES NOT provide a long-term solution and can possibly make it much worse if overused.
• Physical Therapy: Exercises to strengthen and stretch the forearm muscles can be beneficial.
• Braces or Straps: Wearing a brace or strap around the forearm can reduce stress on the injured tendons.
• Surgery: In cases where symptoms persist for more than 6 to 12 months despite conservative treatment, surgical intervention may be considered.

Prevention

Preventing tennis elbow involves taking steps to avoid overuse of the forearm muscles, such as:

• Using proper technique and equipment when engaging in sports or work-related activities.
• Strengthening and stretching the muscles of the forearm.
• Taking frequent breaks during activities that involve repetitive arm movements.

Prognosis

With appropriate treatment, most people recover from tennis elbow. However, the condition can be persistent and may require a combination of therapies to resolve completely. It’s important to follow through with prescribed treatments and to gradually return to strenuous activities to prevent recurrence.

Physio Considerations

Finding Isometrics for the elbow

Similar to many athletes, I have frequently experienced this discomfort throughout a year of intense training. Consequently, after engaging in numerous discussions regarding this matter, I have discovered a solution that generally proves effective for me. It is crucial to acknowledge that tennis elbow and other elbow-related injuries are often mistakenly categorized as mere elbow pain. Therefore, these solutions are not universally applicable. Personally, I have found that performing isometric exercises for approximately 45 seconds to a minute, specifically at a 90-degree angle overhead or at the point of maximum pain, while occasionally providing support with my other hand, if necessary, has been beneficial.

I aim to avoid sharp pain while remaining within the range and load that elicits the most discomfort. Throughout the 45-second duration, my arm may gradually weaken, prompting me to supplement with my other arm as required, ensuring that I never release the weight but maintain maximum tension. Subsequently, the most crucial step involves using my other arm to fully extend my elbow from the 90-degree position to nearly hyperextension, if possible. If executed correctly, this technique significantly alleviates the pain.

Isometric Considerations for the elbow

Frequently, the way it has been described to me is comparable to squeezing out the accumulated fluid in the inflamed tendon and strengthening the weaker systems, resulting in a significant reduction in pain. Even performing a small set of 90-degree isometric exercises against a wall, extending all the way to hyperextension for 45 seconds to a minute during a mid-gym session, can have remarkable benefits for this condition. I would suggest repeating this routine as frequently as possible, particularly if the pain is severe.

In some cases, it may be beneficial to perform these exercises 5-7 times throughout the day. However, it is important to allow your elbow sufficient time to naturally heal, as excessive training of these exercises can have adverse effects. Fully extending the arm is crucial, as failing to do so or yielding to the pain often exacerbates the discomfort, in my experience. Following this routine, I would simply resume regular triceps and elbow training, as well as any other activities, and perform the isometric exercises whenever necessary.