Tennis elbow (aka lateral epicondylitis)

Tennis elbow

What is tennis elbow?

Tennis elbow is an odd name to give to a problem which affects mostly people who do not play tennis! It is also called lateral epicondylitis or lateral epicondalgia.

The pain from tennis elbow is felt on the outer side of the elbow and the back of the forearm. Sometimes the pain radiates to the wrist or the back of the hand.

How common is it and who gets it?

Tennis elbow affects about 1-3% of people and is more common in manual workers (7%). It also includes those using a keyboard or mouse for many hours per day. This is because tennis elbow is a mainly a problem or repetitive movements and of overuse.

Tennis elbow affects men and women equally. It is most common in the 42-54 age group.

What are the symptoms?

Pain over the outside of elbow.

Pain worse with hand gripping or twisting.

A weak grip if the problem is severe.

Stiffness and pain when trying to straighten the elbow.

What causes tennis elbow?

We used to think that tennis elbow was due to inflammation. However, we now know that it is mostly to chronic changes that occur over months or years in the tendons and muscles around the elbow. It is due to overuse.

Inflammation might still play a part in the early stages of the problem but is not present by the time tennis elbow becomes painful.

How long does it take to get better?

Typically, tennis elbow takes a number of months to get better. That is because it takes many months or even years of doing an activity for it to develop.

How to treat tennis elbow

1. Relative rest

Tennis elbow is an overuse disorder. In most cases, it is due to something that you do regularly, either as part of your work or a hobby.

The activities that caused the problem should be identified and then stopped if possible, or modified. This will be difficult, of course, if it is related to your work. However, tennis elbow is unlikely to get better if you do not stop or modify the activity that caused it to begin with.

Examples of modifications include taking regular breaks during work, using the other hand, using a lighter grip or getting help with certain tasks. If you use a keyboard, then consider using speech recognition software to give your hands some rest.

Modify the way you lift objects

A: This is the correct way to lift an object with your palms facing upwards. This allows you to use your big biceps muscles to do the lifting and avoid strain around the elbow.

B: In this diagram, the hands are held so that the palms are facing each other. You are still using the biceps a little but are now straining the smaller muscles around your elbows.

C: Now the palms are facing downwards and all the strain is being taken by the smaller muscles around the elbow. This is the worst possible position for tennis elbow.

Modify the way you use a keyboard and mouse

Incorrect position: The wrist is angled upwards or to the side. This puts the small muscles around the elbow under strain for long periods of time. This can cause tennis elbow or wrist pain. Sometimes it is called RSI or a Repetitive Strain Injury.

Correct Position: The wrist is not angled either upwards or sideways. This prevents strain of the muscles and tendons around the elbow. You can achieve this position more easily by getting a rest for your wrists when using a keyboard and mouse.

2. Take simple painkillers

Simple pain-relieving medicines can give you symptomatic relief. Examples include paracetamol and ibuprofen. These can commonly be bought over the counter.

Of course, the medicines give temporary relief and do not treat the underlying cause of the problem.

3. Do regular stretching exercises

You can stretch the correct muscles and tendons affected by tennis elbow by holding your elbow straight and then flexing the wrist using your other hand. In the second diagram above, notice how the hand is also rotated inwards at the same time to get a better stretch.

Then you will need to stretch in the opposite direction and hold the wrist in extension using the other hand.

All stretches should be held for about 30 seconds and repeated 10 times. They should also be passive. This means that it is the other hand that is holding the tennis elbow arm in stretch. Applying ice for 10-15 minutes to make the area feel numb before stretching also adds to pain relief.

4. Eccentric exercise

Eccentric exercises are one of the few proven therapies for tendon pain as there is in tennis elbow.

See the video below for an eccentric exercise for tennis elbow:

This exercise involves holding a 1-3kg weight in the affected hand whilst the forearm is supported. The weight is then lowered slowly over 4-5 seconds using a wrist movement. At the bottom of the movement, you then use the other hand to lift the weight to its starting position. This is to avoid straining the affected muscles and tendons. You then lower the weight again slowly over 4-5 seconds.

This movement effectively stretches the muscles and tendons under strain from the weight held in the hand.

5. Tennis elbow massage

This is a great way to treat tennis elbow using massage balls or just a tennis ball will work just as well.

The idea is to massage the muscles involved in tennis elbow and put some pressure particularly on the areas that you find tender. This type of massage would be good to do before doing the stretching exercises described above.

6. Use a tennis elbow brace

A tennis elbow brace is worn around the forearm and not over the elbow itself. It also gives temporary relief of pain whilst it is worn and can be useful whilst at work.

It works most likely by putting pressure on ‘trigger points’ in the affected muscles. This is a little like acupressure.

7. Wear a wrist splint

A wrist splint consists of a material which overlaps your wrist joint and contains a metal insert which stops the wrist from moving. Unlike a tennis elbow brace, a wrist splint is difficult to wear at work. The best time to wear it is after work and at bedtime.

It works by allowing the muscles and tendons around your elbow to rest and allow healing to take place.

8. What about a steroid injection for tennis elbow?

Steroid injections are the treatment most used by doctors to treat tennis elbow. Studies show that they do give short-term relief for up to a few months.

However, evidence suggests that the problem ends up lasting much longer in people who have had injections after the initial period of relief.

Steroid injections do not treat the underlying cause. They were initially used because we thought that the problem was due to inflammation. However, we now know that this is not the case.

Summary

Tennis elbow is an overuse problem. The most important first treatment is relative rest or modification of the movements causing it.

Active treatment works best in the form of massage and stretching, plus eccentric exercises.

Passive treatment in the form of a tennis elbow brace or wrist splint works less well. These should only be used as an addition to the exercises and not relied on to work by themselves.

Steroid injections may be useful for some people for short-term relief.