Tennis Elbow – Who, What, Where, Why?

The infamous case of ‘tennis elbow’ affects approximately 1-3% of the general population and is most common in professions that require repetitive, forceful twisting movements. Pain is often felt on the outside of the elbow joint when gripping and twisting objects, most commonly trying to use a screwdriver, and can be very tender to the touch.

Previous research believed that tennis elbow was attributed to chronic inflammation of the wrist extensors and by repeatedly stressing the extensors (through manual work or sporting activity such as tennis or basketball) micro trauma to the muscle bulk can lead to a maladaptive healing response. However, studies by Nirschl & Pettrone and Kraushaar & Nirschl in the 1990’s found that the extensor tendons showed signs of a degenerative rather than inflammatory process. This subsequently led to a surge in research which challenged our understanding of the pathology and, in 2005, Waugh introduced a new term to describe the condition; lateral epicondylalgia. Although this may seem like a daunting new description, this simply means pain associated with the outside of the elbow. This new term was introduced as an umbrella term for the condition; as research suggested the involvement of the wrist extensors, elbow biomechanics and muscular firing patterns, the radial nerve, local changes in bony congruency and the excitation of pain mechanisms in the brain due to neural and chemical stimulation. A study by Alfredson, Ljung, Thorsen & Lorentzon in 2000 found an increased presence of glutamate at the lateral elbow in ‘tennis elbow’ patients. Glutamate is an excitatory neuro transmitter; this means that it relays pain sensation to the brain. Therefore, an increase in this substance leads to an increase in pain felt within the region.

These emergent findings have now begun to challenge the conventional treatment of non-steroidal anti-inflammatory drugs, ultrasound and corticosteroid injections. An interesting study by Bisset and colleagues in 2006 compared physiotherapy, wait and see and corticosteroid injections as treatment for tennis elbow over a 52 week period. They found that the steroid injections had a superior pain relieving effect in the first 6 weeks; however 47 out of the 65 participants had recurring pain thereafter. They concluded that a physiotherapy program was superior to the wait and see approach in the short term and the steroid injections in the long term. As well as physiotherapy and steroid injection, other common treatment modalities include acupuncture, extracorporeal shock wave therapy (using sound waves), laser therapy and manipulative cervical spine techniques. A review paper by Bisset, Paungmali, Vicenzino, & Beller (2005) found that the use of laser and extracorporeal shock wave therapy in treating ‘tennis elbow’ is not beneficial and manipulative cervical spine and physical therapy show promising results.

For initial, short term relief of symptoms I recommend soft tissue massage to the area, gentle stretching of the forearm as well as the use of something called a counter force brace. These braces sit across the forearm extensors and may artificially produce a second, broader muscle origin; thereby reducing forces at the muscular attachment across the lateral elbow. Because ‘tennis elbow’ is multipathological in cause (meaning more than one factor can be responsible for the condition) symptoms may resolve over time, need further investigation or a physical therapy program.

If you have any questions or concerns regarding possible ‘tennis elbow’ injury then please feel free to contact your nearest Allsports Therapy Clinic. We would be happy to help you resolve any issues!

Thank you for reading.

Luke at Allsports Therapy

#4Athletes4Everyone

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