Probably the most common elbow complaint is the ‘tennis elbow’, known among physiotherapist aslateral epicondylosis, and is often one of the most resistant injuries to treat. This article will help to shed some light on the cause of the injury, what makes tennis elbow more difficult to treat and common treatments that provide successful outcomes. It will also highlight the need for longer term rehabiltation and strengthening solutions. The injury is common both as a sports injury and from normal life and from work.
Tennis elbow is an injury that gradually sneaks up on most patients who are often puzzled as to what has caused the pain in their elbow. Repetitive use of your arm is the primary cause of this injury and can occur at work, home or with sporting activities. Thus the injury is considered an overuse injury. The main complaint patients present with is pain on the outer part of the elbow, and is especially painful when gripping objects or twisting their hand (taking a lid of a jar).
Though the injury occurs by overusing the muscles in your arm, the changes occur in the tendons that originate from your elbow joint. In a healthy arm the tendon fibres run parallel to each other, however with repetition of wrist extension, supination and pronation the tendon suffer large quantities of microtrauma causing the tendon fibres to become disorientated. It’s for this reason that movement and lifting become painful, often a sharp pain. A common misconception is the notion that tennis elbow is an inflammatory condition, however this is untrue. While the use of medication can help to ease the pain, the underlying condition will not change (along with the cause of the injury). Commonly used medical relief comes in the forms of injections specifically corticosteroid, saline and blood. The concept of these injections is to help relieve inflammation along with encourage tendon cell repair. However strong evidence has contradicted these methods of treatment though are continued to been seen regularly by physiotherapist and often with poor outcomes. While there is a chance they can provide relief from the pain, this almost provides a false sense of security for patients as the condition can return as the contributing factors haven’t been corrected.
The frustration for both the patient and the physiotherapist is the inconsistency of the tennis elbow rehabilitation. This is largely dependent on many factors including the length of the injury, associated changes that have occurred, and external factors.
Associated conditions linked to tennis elbow are an important factor in the outcome of their rehabilitation. Tennis elbow can often be a result of other factors, and without addressing these, the rehabilitation can become extremely slow or even cause the injury to resurface in the future. Neck stiffness/pain, wrist stiffness/pain and upper limb nerve involvement are commonly associated with tennis elbow.
As mentioned the injury occurs from an overuse, so continuing to perform activities that cause pain will continue to aggravate the condition. This is the common battle as physiotherapist we fight against with tennis elbow. Avoiding certain aggravating activities at times can be difficult but avoiding the avoidable activities is the highly important.
Considering the factors mentioned above, treatment of the tennis elbow is a holistic approach and there is no secret remedy. Physiotherapy focuses on manually addressing the area, so mobilising the elbow and wrist and releasing soft tissue around the area. Specialised Mulligan technique can be useful though doesn’t work for every patient. Addressing biomechanical factors that include shoulder position, posture and correcting the activities that contributed to the onset of the injury. Specific taping techniques can be useful for de-loading the affected muscles while encouraging improved functionality. Advice is critical in the tennis elbow rehabilitation. As mentioned earlier the patient needs to avoid activities that are going to create pain that will only hinder their recovery. Finally a structured self-management plan is needed that includes structured strengthening program and addressing postural deficiencies. Specifically the program starts with isometric strengthening (contracting the muscle without moving). This is then progressed into eccentric strengthening (contracting the muscle while it is lengthening). Eccentric loading of the muscles allows remodelling of the tendon fibres to occur, back to a parallel fibre position.
A successful recovery from lateral epicondylosis is highly achievable. Affecting the outcome is largely dependent of the patient’s diligence to their rehabilitation and trusting the physiotherapy guided rehabilitation program as outlined.
This information is provided to counteract the wealth of misleading information available and to empower you to take control of you elbow pain and live with it actively. The physio team at Coastal Physiotherapy & Sports Injury Clinic can assess you and put into place a proactice program to get you back on track.