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Lateral Epicondylitis – Busting some myths on what is previously understood about the Tennis Elbow and what can be done for it.

It was previously believed to be solely an inflammatory condition, lateral epicondylitis, or what is commonly known as Tennis Elbow, has been shown instead to be a degenerative condition, and is caused by repetitive strain or overuse of the forearm muscles.

Tennis Elbow develops with the tight band of tendons of the forearm muscle repeatedly rubbing over the bony prominence at the elbow (lateral epicondyle) during bending and straightening of the elbow. Overtime leading to micro tearing of the tendon, and subsequently inflammation and pain.

Imagine a tight rope repeatedly being rubbed over a rock, snapping back and forth; overtime, the fibers fray and eventually fail. The mechanism that is just described is similar to most degenerative tendon processes, including that of the Tennis Elbow.

Why does this tendon degeneration happen?

In order to do simple daily activities such as carrying a handbag or opening a jar of peanut butter, our forearm muscles need to work. Similarly, any task that requires force to be generated through the elbow to the hand would demand certain amount of force to be generated from the forearm muscles.

Therefore, people whose job or sport requires gripping coupled with movement through the elbow, like tennis, would be at risk of developing this condition. However, contrary to popular belief, tennis elbows not only afflict tennis players but also in sportsmen such as cricketers and weightlifters where there are similar physical demands.

For others who are more sedentary, it can be as simple as a weekend of spring-cleaning, where you are repeatedly carrying boxes and moving furniture back and forth, when pain in the elbow hits you. Simply, any excessive exertion that the forearm muscles are not used to, can put one at risk of developing this condition regardless the duration of exertion.

What are the signs and symptoms of Tennis Elbow?

All degenerative overuse tendon conditions go through similar phases. It typically begins with inflammation from the initial irritation of the tendon and overtime progresses to degenerative changes occurring and the eventual failure of the tendon, depending on how well it is managed in the early stages.

The accompanying signs and symptoms of the Tennis Elbow can be described in two phases: the early stage and the progressive stage.

Early phase:

  • Dull ache in the elbow at rest or with minimal movement
  • Night pain or resting pain- a distinctive characteristic of an inflammation taking place
  • Sharp pain with exertion of their arm such as carrying a hand bag or hitting a ball with a racquet

Progressive phase:

  • Worsening pain around the elbow with no position of relief
  • Sharp pain with simple low-load day to day tasks such as turning the doorknob or shaking hands
  • Weakness in the arm (holding chopsticks may seem impossible and uncomfortable)

How can physiotherapists help?

In the early phase of Tennis Elbow is often referred to as the inflammatory phase, pain is managed primarily with rest and medication. Movements involving repetitive movements around the elbow should be avoided to allow inflammation to settle down. Electro-modalities such as ultrasound and regularly icing can also be used to speed up the healing process. Athletes who are heavily involved in sports requiring use of their elbow and wrist such as tennis players or cricketers will have to rest completely for a couple of weeks.

At this stage, it is also necessary for tight muscles in the forearm to be released to help offload the tension on the tendon, reducing the tautness around the bony prominence. Taping techniques can facilitate further reduction of the irritation around the elbow.

As the condition gradually progresses, exercises to strengthen the tendon should be done to prevent recurrence of this condition. A physiotherapist would be able to ascertain when it is appropriate for you to start on these exercises without potential flare-ups of the inflammatory response. The ultimate goal is to have pain-free movements, and for return to sport and occupation as quickly as possible.

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