Symptoms of tennis elbow:
- Pain or burning on the outer part of your elbow
- (especially tender over the bony bump on the outside of your elbow. This is where the tendon attaches onto the bone)
- Weak grip strength
- Pain that worsens with certain activities such as shaking hands, opening a jar, holding a racquet.
- Pain may radiate into the forearm.
Tennis elbow or lateral epicondylitis is pain that is felt on the outside of the elbow due to the irritation of the soft tissue connecting the forearm to the elbow.
Tennis elbow occurs when the tendons on the outside of your elbow are overloaded, often due to repetitive movements of the elbow, wrist and/or shoulder. This causes your tendon to produce proteins which in turn leads to pain. There has been shown to be an inflammatory component to this condition, but there is still research to be done.
Tennis elbow symptoms generally develop gradually. It usually appears as a mild pain which slowly gets worse over time. There is usually no specific injury that can be accounted for before the symptoms occur. Tennis elbow usually occurs in your dominant arm, but both arms can be affected.
The name “tennis elbow” can be misleading as it is not only tennis players that get this condition. It is often seen in people that repetitively overload the area, such as plumbers, painters, fishermen, carpenters, butchers, seamstresses.
Due to your tendon’s poor blood supply, tendons take longer to heal than other soft tissues. Generally, you are looking at nothing less than 3 months, but it could go on for up to a year.
Risk factors for tennis elbow:
- Following a rest period with overload of the area (too much too soon scenario)
- Systemic diseases such as diabetes, hypertension
- >30 years old
- Overweight (esp. BMI>28)
- Women are less likely to get tennis elbow than men, until they hit menopause. Oestrogen seems to have a protective function over tendons. When women hit menopause, oestrogen levels often drop – increasing chances of tendon pain
- Use of quinolone antibiotics e.g. ciprobay. These are closely linked to tendon rupture and tendinopathies (tendon pain).
- Other medication can also have an effect on tendons. (e.g. tamoxifen, statins, doxycycline)
The treatment of choice is non-surgical. Here are a with a few options. It is important to get an accurate diagnosis from a trained professional to rule out any other causes of your elbow pain.
Stop or reduce any aggravating activities
Tendons like to be loaded. It is important to find this optimal load. It is important that you don’t rest completely as this can often make it worse. Talk to your physiotherapist for more details on this.
Non-steroidal anti-inflammatory medication
As mentioned earlier there seems to be an inflammatory component to this condition, which is why oral anti-inflammatories seem to help. Research has shown that the use of Brufen is the anti-inflammatory of choice as it reduces or stops the tendon from producing protein which seems to be a leading pain contributor.
Use of a brace such as the one shown in the picture below is a vital element of managing tennis elbow. It assists to offload the tendon. The brace can be worn during the day, but should be removed at night.
Your physiotherapist will assist you with specific exercises proven to be effective in managing tennis elbow. Your physiotherapist will also assist you with soft tissue release to reduce the tension on the tendon and possibly assist you with elbow joint and nerve mobilisations if required.
Some people request a steroid injection into the site of the tennis elbow. This has been shown to reduce the strength of the tendon so it can be a risky procedure. It has also been shown that long term recovery is no better after having had a steroid injection.
A lot of research still needs to be done around shockwave treatment on tennis elbow. Shockwave has been shown to be effective in treating other tendon issues such as gluteal tendinopathy. The shockwave machine sends shockwaves to the area being treated. These waves create micro trauma which, in theory, then recruits a quicker healing response from the body.
Check your equipment
It is important to take all factors into account when treating a tennis elbow effectively. This may be the string tension on your tennis racket, grip size or the size of the head of the racket can all have an impact on the injury.
Platelet-rich plasma (PRP) injections
There is currently a lot of research being done on the effectiveness of PRP to speed up the healing process in tendon injuries. This is not currently funded by medical aid as there is very little evidence to show that it works. PRP is prepared from the patient’s own blood. It is put into a spinning machine where it separates components of the blood. A high concentration of platelets are extracted from the blood sample and re-injected back into the troublesome area. PRP is blood plasma containing concentrated platelets that your body can use to speed up the healing process. Some believe that these high concentrations of platelets can be important in the healing of tendon injuries.
Recovering from tennis elbow
As mentioned before, recovery can take anything from 3 months to a year depending on each individual case and how damaged the tendon is. People heal at different rates and there may be many different contributing factors.
It is important to remain patient throughout your recovery and don’t be tempted to do too much too soon.