Lateral epicondylitis, commonly call tennis elbow is a very common condition. 40% of people will experience is in their lifetime. In my opinion, it mind as well be called rock climbers elbow as it is very common for these athletes. Rock-climbing required a lot of grip strength, which involved the tennis elbow muscle. Overuse is therefore quiet common, especially in athlete with a bit more “life experience” (from 35 to 54 years old). We will go over the anatomy, diagnosis, and treatment of this condition including physiotherapy

 

Anatomy

 

Tennis elbow is a tendinopathy (problems to a tendon) that can involve a couple muscles

 

·      The Extensor carpal radialis brevis (most common)

·      The extensor carpal radialis longus.

·      extensor digitorum,

·      extensor carpi radialis longus 

·      extensor carpi ulnaris

Signs and symptoms

·      Lateral elbow pain

·      Pain on palpation at the lateral epicondyle

·      Pain with gripping: opening jar, pressing a bottle of shampoo, holding a mug of coffee

·      Pain may radiate down forearm as far as the wrist and hand

Diagnosis

 

The elbow is usually the body part that will suffer whenever something is wrong somewhere else. Therefore, a thorough upper body scan should be performed in order to find the cause of the pain. In other word, an tennis elbow is fairly easy to diagnose, but the actual cause is a bit harder to find.

 

Clinical history will be a major key to diagnose tennis elbow. Your physio will look for signs of overtraining or overuse. He/She will ask about your pain pattern, aggravators, easier, location and intensity of pain. The therapist will also ask question about your ergonomic set up at work

 

The physio will then assess your range of motion and strength of your whole upper body as tennis elbow is link with postural problems, shoulder and neck weakness, and upper back stiffness. The radial nerve mobility and conduction will also be assessed.

 

A few tests can be performed to confirm the diagnosis.

·      Pain on palpation of the lateral epicondyle.

·      Pain resisted extension of the wrist, index finger, or middle finger.

·      Pain with gripping

Imaging studies, such as ultrasound (US) and magnetic resonance imaging, have high sensitivity but lower specificity in detecting LE.

Treatments

 

Protect:

This is most likely the most difficult step, but also the most important one. Tennis elbow is a tendinopathy, and like every tendinopathy, loading will be very important. The goal would be to follow the tendon loading principals. The thing is, it is very easy to go over the limit when you are suffering from a tennis elbow, as daily life activity is sometimes too much… You will have to try to find a way to drastically decrease the load on these tendons. Not easy since your need your hands to live your like normally.

Education and advice will be given on:

• tendinopathy principals
• load management
• tools and workstation
• self-management

Exercises:

·      General guidelines recommend application of gradually increasing resistance, focusing on the extensor muscles of the wrist. Some studies favor eccentric over concentric exercise, while others indicate no differences between concentric or combined concentric/eccentric programs

 

Manual therapy:

Your physio will be able to perform a few elbow joint glide to hopefully decrease your pain temporarily. 

·      The ulnar-humeral lateral and radial head

·      Mulligan mobilization with movement

 

Other:

In terms of pain control, ice can sometimes help.

An elbow brace is sometimes helpful in reducing symptoms temporarily, but won’t be enough alone

Acupuncture could also help!! 

 

Mobility strength and proprioception return to sport:

We will combine the 4 sections in this article. The treatment will really depend on the cause of the tennis elbow. That cause is different for every patient. But your physio will usually work on shoulders, scapula, neck, and upper back.

For rock climber, upper back stiffness is quite often a cause of elbow pain. Shoulder external rotation as well can be one as well (see video).  The treatment will then vary from people to people but will usually include manual therapy, exercises and education

 

 

Other treatment

If conservative treatment fails to improve symptoms after 12 weeks, corticosteroid injection could be considered to temporarily improve symptoms in order for the patient to participate in physiotherapy with less pain.

 

Prognosis

Prognosis is not the greatest for tennis elbow that condition is not dangerous at all… but it could take 6 months to 2 years before symptoms are completely resolves.

What to do next: 

If you suspect you have a tennis elbow, the next step is to seek help from a physiotherapist. A trained professional can assess your condition, identify underlying causes, and create a personalized treatment plan to help you recover. Physiotherapy is key to managing pain, restoring function, and preventing future injuries. If you're in luck and live in Kanata, Ontario, you can visit us at Kinoveo Physiotherapy Clinic, where our experienced team is ready to help you get back to your activities pain-free.

 

Disclaimer

The health and medical information on this site is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatments. Consult your health care professional before making any decisions to your health. Call 911 in case of a medical emergency. If you have any concerns or questions about your health, you should always consult with a physician or another health-care professional.

 

The research

 

Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy, 61(4), 174–181. https://doi.org/10.1016/j.jphys.2015.07.015

Coombes, B. K., Bisset, L., & Vicenzino, B. (2009). A new integrative model of lateral epicondylalgia. British Journal of Sports Medicine, 43(4), 252–258. https://doi.org/10.1136/bjsm.2008.052738

Coombes, B. K., Bisset, L., & Vicenzino, B. (2015). Management of lateral elbow tendinopathy: One size does not fit all. Journal of Orthopaedic and Sports Physical Therapy, 45(11), 938–949. https://doi.org/10.2519/jospt.2015.5841

Raman, J., MacDermid, J. C., & Grewal, R. (2012). Effectiveness of different methods of resistance exercises in lateral epicondylosis - A systematic review. Journal of Hand Therapy, 25(1), 5–26. https://doi.org/10.1016/j.jht.2011.09.001

Stasinopoulos, D., Stasinopoulos, I., Pantelis, M., & Stasinopoulou, K. (2010). Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy. British Journal of Sports Medicine, 44(8), 579–583. https://doi.org/10.1136/bjsm.2008.049759