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Sep 18,2019

Tennis Elbow everything you need to know – Part 1

I have recently had a lot of clients coming in to the clinic with Tennis Elbow so I thought I would share some tips on how to manage it. Have a look at the following video I created to learn everything you need to know.

By the way, Tennis Elbow can also be called Lateral Elbow Tendinopathy or Lateral Epicondylitis. They are different names for the same thing, with only some minor technical differences if you want to be really picky, but either way we treat them the same.

Tennis Elbow is typically felt as a pain, tenderness or even a burning sensation over the Lateral Epicondyle of the elbow.  As you can see, there are a number of muscles which attach into the tendon. Tennis Elbow is a chronic overuse injury to the common extensor tendon of the forearm.

Often you will notice a gradual worsening of symptoms with repetitive activities over a long period of time or there will be a sudden worsening of mild symptoms as a result of some repetitive movements.

Things that aggravate Tennis Elbow are repetitive extension of the wrist. Activities that may make it worse are : gardening, painting, carpentry, racquet sports and even using the computer mouse. Most people get Tennis Elbow from repetitive work tasks, not actually playing tennis.

Fortunately symptoms will generally improve with rest!

If you have been suffering from Tennis Elbow for a while you may notice that your grip and forearm strength will weaken and it may start to affect the shoulder as well if it goes on long enough.

So how do you manage it?

In the short term you want to manage the pain. Things that can be helpful include: ice, analgesics, antiinflammatories, dry needling, cross friction massage, activity modification, relative rest and exercise.

Ice:

Apply ice over the painful area in order to numb the pain. Three repetitions of ten minutes on, then ten minutes off will normally be effective. Do not place ice directly on the skin as this can cause burns, always wrap the ice in a cloth before it is applied to the skin.

Analgesics:

Taking analgesics (pain killers) may be important in the short term to reduce the pain levels to a manageable level. This will allow you to start performing your strengthening exercises sooner.

Anti-Inflammatories:

Nonsteroidal antiinflammatory medications (NSAIDs) and local corticosteroid injections have been commonly prescribed for this condition. However research suggests little or no inflammation is present in these conditions. Therefore these types of medications will generally not provide any benefit in the long term. They may provide some pain relief in the short term hence they may still be provide some small benefit.

Dry needling:

Dry needling can be helpful to reduce pain and increase blood supply to the area to improve tissue healing. Make sure the needling is being performed by a suitably qualified therapist.

Cross Friction Massage:

If you are getting some passive treatment from a therapist they will normally perform some cross friction massage. This technique helps reduce pain and breaks up any scar tissue around the tendon. You can perform this technique easily enough on yourself,  have a look at our video for a demonstration

Activity Modification:

Overuse or simply too much of certain activities is the main risk factor in causing tendinopathies to occur. Some people are predisposed because of biomechanics (e.g. strength, etc) or systemic factors (e.g. age, menopause, elevated cholesterol, etc). Predisposed people may develop tendon pain with even subtle changes in their activity. Therefore activity modification is important in order to help manage the loading placed on the tendon and manage the pain. By managing the work load on the wrist you can help bring the symptoms under control. An example could be when using a specific tool has caused the tennis elbow to flare up on your dominant arm, then changing the activity so that both arms are used alternately helps reduce the workload on the dominant arm.

Relative Rest:

Reducing the work load on the wrist will help better manage the symptoms. Taking rest breaks where needed during the activity which has caused the tennis elbow will help reduce the loading on the tendon. Note that  tendinopathy does not improve with rest. Relative rest is useful as it can help settle the pain, but returning to activity is often painful again because rest does nothing to increase the tolerance of the tendon to load.

Exercise

Exercise is currently the most evidence based treatment for tendinopathy and needs to be part of the longer term solution, see the second video in the series. Ultimately you need to strengthen the tendon to make it thicker, stronger and more elastic. I will go into more detail about this in the next post and the second video in the series.

Take me to Part 2,  Exercise to overcome Tennis Elbow 

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