Tennis Elbow: (But I’ve never played Tennis!)
Tennis Elbow, despite the name, isn’t just reserved for the Ash Bartys and Lleyton Hewitts of the world. It’s other names include lateral elbow tendinopathy which simply translates to “problem with the tendon on the outer side of the elbow” OR lateral epicondylitis – which translates to “inflammation at the little bony bit on the side of the elbow”.
Whichever name you choose to refer to it, we know three things:
1. It hurts
2. It limits activity
3. It is usually a chronic or long-term issue
In my many years as a physiotherapist, I can probably only think of one tennis player that I’ve treated who developed this injury. Mostly it will affect people like:
· Plasterers
· Painters
· Paddlers i.e., kayak/canoe/rowing
· Gym goers
So what is Tennis Elbow?
The lateral elbow contains some important ligament, nerve and tendon structures. We have a group of extensor muscles that help extend our fingers, hand and help with gripping. These muscles share a single tendon that attaches to the side of the elbow – The common extensor tendon. Tennis Elbow is an injury characterized by pain where this tendon attaches to the bone, or pain at the tendon itself.
People with tennis elbow will often complain of pain when lifting heavy objects, performing repetitive lifting, or gripping activities. The reason that the Bartys and Hewitts are unlikely to complain of such an injury, is because of our body’s amazing ability to adapt to load. People who hold racquets and hit tennis balls regularly and from a young age are likely to have thicker tendons, bones and stronger muscles in this region than those of you and I. This means that the capacity of these structures to withstand load Is very high. That’s not to say that Ash or Lleyton couldn’t develop it, but it would just be unlikely.
What causes Tennis Elbow?
Usually, Tennis elbow is triggered by overuse. This could include a sudden increase in upper body exercise, lifting heavier weights than usual, sudden increase or change in workload and in some cases, will develop when returning to work or exercise after a period of rest e.g. sport off-season, returning to sport after an injury or an extended holiday from work. In some rare cases, certain medications and health conditions can contribute to the risk of developing this condition.
From an anatomical standpoint, overuse/overload will cause micro-damage in the tendon, and if this continues, your body cannot regenerate and rebuild fast enough to keep up, leading to tissue breakdown. Once this happens, the tendon will become weaker, and even easier to damage.
So if I rest, it will get better?
NO! Our tendons thrive from regular stress and load. This is what keeps them strong and able to withstand our day-to-day life. If you rest completely. It’s likely that your tendon will get weaker, and therefore more likely to be overloaded. That said, you can’t continue doing exactly the same thing that caused it in the first place.
The key is balance, which can be difficult to find. We must figure out how much your tendon can be loaded without triggering unhelpful pain or further damage. This might mean you have to modify your work or exercise and means you will need to do some strengthening for it. The balance is – stress the tendon enough that it gets stronger without damaging it, and don’t underload it so much that it becomes weaker.
How long will it take to get better?
Unfortunately, months, and in some cases, years. This is because for some people it is very difficult to rest the affected structures due to work and financial pressures, or sporting commitments and exercise goals. The other reason is that the recovery capacity of tendons is VERY slow.
What should you do then?
Firstly, speak to a physiotherapist – I know a good one, he’s the author of this blog and his booking button is at the top of this page (wink, wink). Get the injury assessed and rule out any serious pathology (like a tendon rupture) or any issues that may be arising from your neck as is sometimes the case.
I’ll try to help you figure out if there are any specific triggers to your pain – like a specific work or exercise activity and try to think of some creative ways to get around it.
Sometimes manual therapies like massage, needling, taping can be helpful for relieving pain, but they aren’t proven in any way to stimulate healing or recovery. They make you feel better (short term) but they won’t GET you better. If that’s all your current physio or therapist is doing, it’s time to find a new one.
Things that will GET you better include:
Modifying, reducing or if needed, resting from aggravating activities
Perform exercises (not exclusively elbow exercises) that improve the capacity of the tendon
As your elbow tolerates more, increase the load and exercise to suit the demands of your work or sport
Stick to the plan, patience and consistency are a must!
If you’d like more info, shoot me an email, or if you’d like an appointment you can book online or by calling PhysioPM.
