Chiropractic

Tennis Elbow?! - But I don't even play tennis!

Post by
Alexandra Putica

Tennis Elbow?! - But I don't even play tennis!

One of the most common conditions of the elbow that we see in our clinic at Dural Health is lateral epicondylopathy. Many people know this as tennis elbow, but the technical term is lateral epicondylopathy as this more accurately describes the irritation to the forearm muscle tendons as they attach to the bony part of the arm called the lateral epicondyle. Less and less people are actually coming in saying they play tennis that caused it, and it is much more common for people to report a history of overusing their hands and forearms such as with repetitive gripping, carrying, or typing.

Lateral epicondylopathy is a condition where the extensor tendons connecting into the lateral epicondyle become irritated, often causing elbow pain.

What is actually going with tennis elbow?

If we look under a microscope at the tendons of the elbow in people with lateral epicondylopathy, we see strange changes to cells that makeup the tendons, with more blood vessels, and very disorganised collagen fibres (kind of like uncooked straight spaghetti compared to cooked messy curvy spaghetti). This often happens when the tendons are put under constant strain or compression, which starts to stress them out. Normally, we can recover if we use use our tendons (such as a day in the garden cutting some branches) as long as we rest it enough afterwards (often 3 days to fully recover). But when we stress these tendons and do it continuously without a good rest (cutting branches for 8 days in a row), then the tendons can become inflamed and begin to change.

When tendons become overused, the cells change inside from straight organised cells (uncooked spaghetti) to curvy disorganised cells (cooked wavy spaghetti).

What are the symptoms of Tennis Elbow?

Most people with lateral epicondylopathy will report pain on the outside of their elbow, which is worse with:

  • Gripping things: shaking hands, scissors, coffee cups, using power tools
  • Carrying things: shopping bags, saucepans, pouring kettles, weights at the gym
  • Twisting things: keys, door knobs, using screw drivers, wringing towels
  • Using the fingers for a long time: keyboard typing, using a mouse a lot, playing piano or guitar

How is Tennis Elbow diagnosed?

It is quite easy for your General Practitioner, Physiotherapist, or Chiropractor to figure out if you have lateral epicondylopathy with just a few questions and physical examination tests. This often involves Maudsley's test, where the practitioner pushes against your middle finger to try reproduce your elbow pain. When this is positive, it is quite likely you do have lateral epicondylopathy. Other things include testing your grip strength, shoulder strength, and feeling for tenderness over the bony part on the outside of your elbow (lateral epicondyle).

Other investigations such as ultrasound scans and MRI scans can also be used, as these can show any possible tears or signs of the radial nerve being irritated. Scans like these are not that necessary though, as they rarely change treatment if you have not had any yet.

How is Tennis Elbow treated?

The best management of Lateral epicondylopathy involves:

  • Advice and Education: about what the condition is, why it might have happened for each person, and the role that rest plays in tendon recovery.
  • Activity modification: where you get taught how to avoid things that strain the elbow. This might be lowering the keyboard height, carrying things with the palm up instead of palm down, or changing your exercises at the gym to something more elbow friendly.
  • Stretches: of the wrist, forearm, and shoulder muscles to address any tightness that might be placing tendons under greater strain.
  • Strengthening exercises: of the hand, forearm, elbow, and even shoulder muscles to help reduce overusing it. The stronger you are, the less likely the elbow will become overused with simple everyday tasks!
  • Elbow braces: special elbow counter-braces can be useful for some people to help reduce irritation on the lateral epicondyle where the tendons attach, by creating a new anchor point further down the arm.
  • Hands on treatment: where we help relax any tight muscles in the forearm, help joints move more freely, help the nerves glide nicely through the elbow, and even the shoulders, neck, and middle back.

What does a well designed treatment plan for Tennis Elbow look like?

At Dural Health, our Physiotherapists and Chiropractors will start by trying to understand how your condition developed. Identifying, reducing, or avoiding any activities that might be triggering the lateral epicondylopathy is important to giving it sufficient rest to recover. We find that people can just be unaware of what might be contributing to it and a simple change to the way they hold their wrist whilst gripping and and holding things can help reduce excessive strain on the elbow tendons.

We then usually measure your grip strength using a grip dynamometer which accurately tells us how strong your grip is. Weak grip strength can place you at higher risk of developing lateral epicondylopathy, and getting an accurate reading is ideal. We like to see a reading of 30kg or more for normal healthy adults, which is the same amount required to become a Police officer in Australia! We can also use other dynamometers to measure how strong your other arm muscles are (like your shoulder) to see if that weakness might have led to the elbow being overused.

Depending on what we find during the examination, we might also use some special treatment techniques like:

  • Mobilisations with movement to help restore how the elbow joints are moving. If you've got a stiff and sore neck or middle back, this can also impact the elbow, so we go ahead and get that moving again too.
  • Massage: to try relax any tight muscles through the forearm, elbow, and shoulder to reduce strain on the elbow tendons.
  • Nerve gliding movements really help too when people feel pins and needles or numbness down their arm from the radial nerve being irritated at the elbow.
  • Taping or bracing to help support the elbow when the pain is quite intense.

We then start testing out which exercises will help you best, and most of them will involve some resistance of the wrist going into extension to gently strain the tendons. Tendons need a small amount of strain to recover and work normally, but this can't be too much (or we overuse it and add to the problem!). Rest in between exercise sessions is crucial to allow it to recover, before we hit it again.

Exercise bands can be a nice way to start to build up the strength and endurance of the muscles and tendons in the elbow.

Eventually once the pain settles down, it is important we consider the whole arm as a team, so we start to build up some big muscles around the hand, shoulder, and even middle back. This is probably the most important part to make sure it doesn't come back!

Exercises that target the whole arm (hand grip, forearm, and shoulder) are great to build up strength and endurance to help stop tennis elbow from coming back!

How long does it take for Tennis Elbow to recover?

Most episodes of lateral epicondylopathy will recover within 6-12 months. With a good treatment plan to settle the pain, reducing any aggravating activities, and an exercise program to build back up the strength and endurance of the entire arm, people can experience only minimal discomfort as the elbow recovers in this time. With no treatment, the condition tends to frequently come and go over time. People will do less when their elbow hurts, which allows the tendon to recover, but then the tendon is still not fully rehabilitated which means it can take less and less to trigger the next episode.

At Dural Health, all our Physiotherapists and Chiropractors provide our patients with an ongoing program to keep their arm strong, because prevention really is the best way to reduce the risk of this issue from coming back.

If you live in the Dural, Glenhaven, Kenthurst, or Castle Hill area and feel like you might be experiencing tennis elbow or lateral epicondylopathy, make an appointment with one of our Physiotherapists, Chiropractors, or Exercise Physiologists at Dural Health by calling us on 02 8403 4200 or booking in online today!

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