Physiotherapist holding patients wrist because of Elbow Pain

What is Tennis Elbow?

Tennis elbow (lateral elbow tendinopathy) is a common overuse injury of the elbow. It refers to pain in the tendons of the muscles in the forearm that extend the wrist, rather than being an injury of the elbow joint itself. When using the muscles, the tendons undergo microtrauma, meaning they need time to heal and become stronger. An overuse injury means that use of the muscles in everyday activities (lifting, tennis, carpenters, computer use etc.) exceeds the amount of load that the tendons can handle and does not give them sufficient time to heal. This leads to pain as the tendons continue to be used without time to heal.

Physiotherapists are experts in guiding you through Tennis Elbow Pain. 

Based on your body condition, they analyze, review, and prescribe treatment plans that are suited to you so that you achieve a fast and effective recovery.

Conditions that may relate to Tennis Elbow

Tennis elbow is commonly found in combination with neck problems. This may be related to the nerves which arise from the neck and travel down the arm. Irritation of these nerves may lead to people experiencing pain around the elbow and is common in desk workers who have prolonged/poor postures.

Weaknesses around the shoulder are also commonly found in people with tennis elbow. Normally these muscles are much stronger and larger than those found at the elbow. However, some people adopt movement patterns that use the smaller muscles around the elbow instead of the stronger shoulder and back muscles, eventually leading to pain due to overuse of the muscles in the forearm and elbow.


Common symptoms / signs

  • Pain with loaded wrist extension or repetitive movements

        Eg. gripping, painting, typing, chopping, tennis

  • Pain and stiffness in the morning which eases as you begin to move but worsens throughout the day as movement accumulates.
  • Pain with palpation of the lateral elbow.
  • Pain may also be felt down the forearm, but rarely into the hand and fingers


What causes Tennis Elbow?

In the context of overuse, this may be seen in racquet sports, carpenters, keyboard use and chefs (repetitive chopping) and can be influenced by factors such as technique or grip sizes being too small. The continuation of these tasks (eg. tasks required for work every day) will mean continued use of painful tendons without allowing adequate healing. As explained above, these tasks lead to microtrauma in the tendons, which if not allowed time to heal, causes pain as aggravating tasks are continued.


How is Tennis Elbow Treated?

Tennis elbow is treated with relative rest from aggravating tasks, with exercises and education. Tendons should not undergo complete rest as this will lead to weakening, so movement should be progressively re-introduced without causing excessive pain. This is typically done through simple exercises at the wrist and elbow, starting with static (isometric) exercises. 

Exercises can then progress to be more dynamic movements using the whole arm, using a variety of equipment such as dumbells, resistance bands and flexbars. Therefore, exercises also target muscles around the shoulder with the aim of offloading the smaller muscles around the elbow. 

The overall aim of these strengthening exercises is to increase the load tolerance of the tendons at the elbow such that everyday tasks to not exceed the tendons capacity for loading. Other treatments include the use of compression braces (eg. to wear during tennis games). Corticosteroid injections have previously been used in tennis elbow but we now know that they can have detrimental long-term effects on the tendon, so should be very carefully considered before use.


Risk factors of Tennis Elbow

  • Involvement of manual labour in work (chefs, painters, carpenters, athletes in racquet sports).
  • Poor gripping technique or stroke technique (eg. tennis)
  • Prolonged use of corticosteroid medications
  • Smoking history
  • Other upper limb injuries such as rotator cuff tendinopathy, De Quervain’s, carpal tunnel syndrome.
  • Age (commonly found in people aged 30-50


Other possible causes

The other common cause of this condition is due to trauma at the elbow, such as bumping the elbow heavily (compression injury). This causes localised damaged to the tendons, which if not allowed to heal, can become ‘tennis elbow’ as the tendons continue to be used in everyday tasks.





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