Tennis Elbow / Common Extensor Tendinopathy

Tennis elbow or Lateral Epicondylitis is a common chronic condition of the extensor muscles of the forearm. It is characterised by pain in the region where the wrist extensor muscles originate (pulling the knuckles up) – the outside region of the elbow.

• Pain when palpating the lateral elbow soft tissue

• Radiating pain along the upper arm and down the outside of the forearm

• Reduced movement and wrist strength, specifically extension of the wrist and gripping

• Symptom irritation 24-48 hours following overload

• Morning stiffness and pain which improves with gentle movement

• Sudden increase in activity or changes in technique or equipment

The most common cause of this condition is chronic one-sided overload from a high volume of repeated contraction which stresses the tendon. Predisposing activities and occupations involving repeated wrist extension expose the elbow tendons to excessive strain which the body cannot adapt to, resulting in poor healing and pain. Despite being referred to as epicondylitis and ‘itis’ pertaining to inflammation, the current evidence suggests that this is only present in the very immediate stages of the condition.

Most patients seen with tennis elbow have manual jobs such as electricians, plumbers, gardeners and production operatives which involve repeated heavy lifting, tool use, gripping & pulling actions. Although it is commonly referred to as tennis elbow, the prevalence in tennis athletes is <5% and has been reported with other racket sports, swimming and throwing sports. The highest prevalence is those aged 35-50 with no significant differences between sexes.

At Pure Physiotherapy, your therapist will take a full history of your condition to identify relevant factors which may raise suspicion of lateral epicondylalgia. Your Physio will then perform a full physical examination to facilitate rapid and accurate diagnosis, ensuring that the most appropriate and effective treatment can be implemented. We will work with you to produce a set of goals tailored to what is important to you, that way treatment can be aimed towards achieving those aims. Regular re-assessment will track your progress and provide an opportunity for any treatment changes to take place with the intention of optimising recovery.

Your Physiotherapist will provide you with education and practical tips on how you can effectively manage your symptoms. Relative rest and activity modification strategies will be discussed so that a clear plan can be established to allow you to continue working, whilst reducing the mechanical overload. This may comprise of avoiding movements/actions that reproduce your pain or ways to lift heavy objects in a way that places less strain through the affected structures.

In many cases, work-related activities could exacerbate symptoms, and this is where you may be advised to liaise with your employer/Occupational Health department to discuss workplace alterations so that you are able to remain in work. Your Physio may also suggest pain relief such as paracetamol or may advise that you consult your GP or Pharmacist. Scientific evidence of moderate-quality demonstrates that topical non-steroidal anti-inflammatories (NSAIDs) may help relieve symptoms in the short term (4 weeks). If your symptoms are severe enough to considerably reduce your function, the use of a brace could be recommended however this is only suggested when combined with Physiotherapy treatment.

Based on your limitations and goals, you will be prescribed a personalised and progressive home exercise programme designed to gradually strengthen the soft tissues affected. Please find the patient resources section of our website where we have created a series of recommended exercise programmes for tennis elbow. We advise consulting with your Physiotherapist prior to trying any of these exercises.

In combination with strengthening exercises, your Physiotherapist may also recommend stretching and implement taping methods to offload the structures affected. Manual therapy techniques such as soft tissue massage and joint mobilisations are used to help reduce symptoms further.

Throughout the course of your treatment, you will be re-examined to check your progress and to ensure the treatment design is beneficial in producing restoring function and facilitating optimal recovery. As your progress through treatment, we provide ongoing advice, support and progressed exercises to help you achieve independent management and to prevent re-occurrence.

In the unlikely circumstance where your symptoms do not improve or you have a severe functional impairment, your Physiotherapist may request the opinion of an Orthopaedic specialist. This could involve imaging techniques such as ultrasound or MRI scans to assist with diagnosis and guide the treatment and management plan.

NHS information on Tennis Elbow – click here.

National Institute of Health and Care Excellence. (2017). Management of tennis elbow. Retrieved from https://cks.nice.org.uk/tennis-elbow [Accessed 1/7/2020].