The medical term for tennis elbow is lateral epicondylitis. It is a condition which affects the outside of the elbow bone (the lateral epicondyle).
Tennis elbow is not simply an "inflammation" of the tendons around the joint. The problem is thought to be more of a degenerative process as a result of repetitive use. The symptoms may be the result of an incomplete healing response in an area that does not have good blood flow and therefore has difficulty accessing nutrition and oxygen necessary for healing. This leads to degeneration of the tendon causing small tears.
It has been referred to as tennis elbow since the year 1883, when Major used it in his paper 'Lawn-tennis elbow'. Despite the name 'tennis elbow' only approximately 5% of the people afflicted with this injury are actually tennis players. Each year, in the UK, approximately five in 1,000 adults are affected by tennis elbow. The condition occurs mostly in those who are between 30 and 50 years of age.
Symptoms
The main symptom is pain and tenderness on the outside of the elbow and often in the muscles on top of the forearm. Symptoms usually develop gradually, although can be of acute onset, caused by a direct blow to the elbow for example. The pain is often aggravated by simple daily activities such as shaking hands or opening a door.
Tennis related Factors
The main tennis-related factors thought to be either the cause of tennis elbow, or at least having a negative impact once a player already has symptoms are:
- A small grip width
- Poor backhand technique
- A racket which is too heavy
- Snapping and turning the wrist wrist while serving with full power
Research published in The American Journal of Sports Medicine however showed that a grip that is either too big or too small for the player's hand is not a factor in whether or not a player may develop tennis elbow. They concluded that grip size should be determined by a players individual level of comfort.
It would appear therefore that improper technique is the biggest cause of tennis elbow, which reinforces the recommendation that players with elbow pain work more on their tennis swing mechanics and stroke instead of changing equipment
Treatment
Physiotherapy treatment of tennis elbow involves a thorough initial assessment. It is essential to determine the history of the onset of symptoms. i.e. was it caused by a direct knock to the elbow, a heavy day of gardening, or did it occur very gradually and for no obvious reason.
A physiotherapist will assess your neck, shoulder, thoracic spine, neural flexibility, grip strength, elbow mobility and a number of other factors when determining what structures need to be treated.
If you have had tennis elbow symptoms for any more than two to three weeks it is unlikely that the condition can be “cured” by treatment to the elbow area alone. Pain in the elbow usually causes people to change the way they perform activities, which can then affect structures such as the neck and shoulder.
Tennis elbow braces are often prescribed as part of the treatment process and are to be worn during aggravating activities.
Once the initial symptoms have settled, it is essential to start a graduated strengthening program, which will ultimately allow the muscles to cope with normal every day activites again, as well as sport.
If conservative treatment doesn’t completely solve the problem, it is not uncommon for a GP to refer people for either cortisone injections or even surgery. These however, should be seen very much as a last resort, and not contemplated until all of the other underlying issues have been sorted out.
Bluemonsta