What Is Tennis Elbow?
The ironic fact about tennis elbow, or it's more formal name “lateral epicondylitis”, is that folks do not need to play tennis to get the condition. A tennis elbow arm injury can happen to anyone who repeatedly uses their hand and wrist for heavy gripping, be it for their job, sport, or daily activity.
Tennis elbow is brought about by overuse and strain of the extensor muscles of the forearm and wrist. It is a painful condition and the area of pain can range anywhere from the top of your wrist, up your forearm and into outside part of your elbow. Tennis elbow is brought about usually by gripping and twisting activities as the extensor muscles control for these motions. The pain aggravated even more by daily activities that mimic the injurious activity, which is why even maneuvering a steering while driving can cause pain after the injury.
Typical mechanisms of injury include prolonged use of the wrist and hand, such as when typing on a computer or operating machinery with levers, and of course playing tennis. The condition occurs more frequently in men, than in women and affects folks between the ages of 30 and 50.
Symptoms of tennis elbow can either occur suddenly or they can occur gradually. Sudden onset of tennis elbow is usually a result of excessive use of the hand and wrist during an activity that requires a high amount of force. This usually happens in quick and heavy lifting, twisting and pulling activities. In such a case the extensor fibers are strained and injured, and pain can ensue very quickly.
Signs and Symptoms of Tennis Elbow
Symptoms that come on gradually are more common and they develop over weeks or months as a result of repeated overuse of the wrist and hand during forceful activities. Common mechanisms of injury involve repetitive activities like the continuous lifting of bags or pulling of levers.
Symptoms of tennis elbow may feel like:
- Radiating pain into the forearm and wrist
- Difficulty and/or pain with common everyday tasks, like turning pouring liquids from a bottle, or holding a coffee cup, lifting (even light) objects, opening a jar, gripping a knife or fork during meals
- Difficulty with gripping objects
- Increased pain when you use your wrist and hand for lifting objects, opening a jar, or gripping something tightly, such as a knife and fork
- Stiffness in the elbow
- Forearm weakness, weakness in gripping
How Is Tennis Elbow Diagnosed?
Because of the radiating nature of tennis elbow, and its usual concurrence with pain on other parts of the arm and shoulder, your physical therapist will evaluate your elbow and affected joints. There are special manual tests that they can perform to test the specific muscle and tendon involved to confirm tennis elbow. Muscle strength of the entire arm should be tested to clear involvement or concurrent impairments of the shoulder and neck. An X-Ray or and MRI is rarely needed to confirm tennis elbow.
Tennis Elbow and Physical Therapy
For the first few hours and days after the onset of your injury, the following tips may help you in alleviating your pain and soreness:
- Modifying your activity level and resting the arm from any twisting or gripping activities so that the muscles and tendons have time to rest and heal.
- Cold therapy for 10-15 min at the area of pain, as needed./li>
- Use of elastic support or forearm brace to help reduce the pressure on painful muscles and tendons.
Your physical therapist may choose to recommend a brace or a support for you to offload the muscles while you are in the healing phase. Personally, here at Stride Strong, we prefer patients use the Band-It brace because it gives an effective amount of pressure.
If the injury and pain is severe, your physical therapist may refer you out to an orthopedic doctor or sports medicine doctor for further diagnostics or medication. In some rare cases, cortisone injection and surgery may be indicated.
It is important to be treated by a physical therapist as soon as possible after you injury. If your tennis elbow is left untreated, the tendonitis may become chronic and the condition may last months, if not years of disability. Focusing on relieving the pain and achiness is not enough for treating tennis elbow - you must be guided to correct the muscle weakness and bad biomechanics habits that have led you to have tennis elbow in the first place.
Tennis Elbow Plan Of Care:
The first step in treating tennis elbow is to reduce pain and inflammation in the muscle and tendon. Manual therapy and deep tissue muscle work administered by your physical therapist, ice and heat treatments will help loosen up and calm down muscles that have spasmed since your injury. ASTYM, a treatment technique that we can do here at Stride Strong Physical Therapy has been very effective in the treatment of tennis elbow.
Your physical therapist will also show your exercises and stretches to do in the clinic and at home to help the muscle both strengthen and stretch so the muscle tissues can improve in their tensile function. Passive stretches and movement in the beginning of treatment can help improve range of motion of the wrist and elbow. As pain diminishes, resistive exercise using bands and weights will help you regain your forearm strength and grip strength. The amount of weight will be need to be carefully progressed to avoid re-aggravation of the extensor tendon.
Oftentimes tennis elbow indicates an overcompensation and overloading of the wrist and forearm muscles due to weak shoulders and weak postural control muscles. Take, for example, the movement of hitting a bat. If the batter’s back muscles and shoulder muscles are weak, this may cause him/her to overgrip the bat for stability and strength, thereby overloading the forearm extensor muscles. Another non-sports example is the act of lifting grocery bags - if your shoulder blade and trunk muscles are weak, you will tend to overcompensate and lift from the wrist then the larger joints.
Therefore, one large aspect of PT is to regain stability and strength in larger and proximal muscles so the distal muscles down the arm are not overused. In the case of grocery bag lifting, contracting muscles around your shoulder blade and trunk while performing the lift will give the necessary support and stable base for your arm muscles. This will cause less stress on the injured forearm muscles and allow you to slowly return to sports and activities and avoid re-injury
Returning to Sports and Activities
Your physical therapist will likely modify your activities at work and home and in sports. While you are healing they will make recommendations on how to improve and modify your workstation, or use of tools so as to prevent re-aggravation and re-injury. Resting and stretching breaks are also important when performing frequent repetitive hand and arm movements. The goal is to gradually and healthily return to your sports and work/home activities in the ergonomic and cognizant manner when the tissues have completely healed. Your physical therapist can guide you through this transition.
It is also important to note, too, that returning to full activities may pre-position you for tennis elbow re-injury. If the tendon has not had enough time, care, and rest to heal your muscle strength is likely not fully restored. Your physical therapist will determine when you are ready to return to full activity by completing simulation drills, muscle and range tests.
Can Tennis Elbow be Prevented?
Yes - you can help prevent the occurrence of tennis elbow by keeping proximal muscles and joints - shoulder, shoulder blades, back and core - strong and healthy with regular conditioning and resistance training workouts. Using proper equipment that is well designed for the activity also helps overuse of the wrist.