Tennis Elbow

December 10, 2014 | By More

Tennis Elbow

By Specialist Chartered Physiotherapist – Eoin Ó Conaire

Do you get pain on the outside of your elbow with any of the following?

  • Lifting or pouring the kettleTennis elbow opening bottle
  • Opening jars or bottles
  • Turning a key in the lock
  • Grasping or gripping activities
  • Holding handlebars
  • Lifting weights

If so, you may have tennis elbow. Read on for all you need to know about this condition.

I have seen lots of tennis elbows recently – a condition that can be very painful but is usually very effectively treated with physiotherapy. Ironically it is usually activities other than tennis that bring on a flare-up. DIY (particularly using a hammer or screwdriver for extended periods), painting and gardening are common culprits. I also see lots of kayakers and it is certainly not unusual for paddlers to develop these problems – particularly in the control hand – the hand that grips the paddle.

What is tennis elbow and how can it be treated?

Tennis elbow is a condition involving the tendons on the outside of the elbow. It causes pain that is often aggravated by gripping and other arm activities such as opening jars, carrying and lifting. It develops when the tendon that joins the muscles of the forearm to the upper arm bone is strained by unaccustomed or repetitive arm activity.

Tennis elbow is a common complaint and affects approximately 1-3% of the general population but this can be as high as 15% in industries involving repetitive tasks.

New thinking – it’s not “tendinitis” or inflammation

For some time it was thought that the primary reason for the pain of tennis elbow and other tendon problems was inflammation. However, recent research has consistently shown that these painful tendons do not contain inflammatory cells. We therefore don’t use the term “tendinitis” anymore. It is now generally agreed that the problem is due to degeneration of the tendon.This causes characteristic changes in the tendon structure so that the tendon is less able to withstand normal activity. Healthy tendon tissue is made up of thousands of tiny fibres called collagen fibres. When we reach our 40s, the strongest type of collagen fibres (Type 1 collagen) begin to be replaced by Type 3 collagen fibres which are weaker and less robust. These changes to the tendon make it more vulnerable to small splits when we use the tendon – particularly if we do something new or unusual or at a higher intensity than the tendon is accustomed to. This also explains why almost all of the patients with tennis elbow that I see are in their 40s or 50s.

Breakthrough in the treatment of tendon problems

It may appear contradictory that a condition that appears to be caused by overuse may respond positively to exercise.

However a specific type of exercise called eccentric loading demonstrates excellent results. Two recent studies found that a combination of eccentric strengthening exercises and stretches were more effective in reducing pain and increasing function than treatment with laser, manipulations and other exercises. Eccentric strengthening exercises have also improved outcomes when given in addition to standard physiotherapy treatments.

Exercise programmes to treat tendon problems generally take 12 weeks to work but usually there is substantial improvement by 6 weeks. The key factor appears to be the progressive and graduated nature of the exercise where the tendon is reloaded in a manner that regenerates healthy tissue and does not aggravate the symptoms.

Should you have an injection?

In the past when tennis elbow was considered an inflammatory problem, it was often treated with injection of corticosteroid (cortisone). Recent research comparing injections with physiotherapy has shown that in the first 2 weeks, patients who underwent injection were better than those who underwent physiotherapy. However at 6 weeks and 12 weeks and 6 months later the physiotherapy group were better. I rarely recommend that patients with tennis elbow have a steroid injection unless other interventions to reduce pain have not helped. In fact there is good evidence that injecting steroid into the tendon actually has a detrimental effect on the microstructure of the tendon in the long term.

Individualised treatment

At Evidence-Based Therapy Centre, you will undergo a through assessment to diagnose the source of the elbow pain. As eccentric exercises have been shown to be most effective, these usually make up the core part of the treatment plan. However there are often other approaches that also help. For example many patients have pain and sensitivity of the radial nerve which runs through the same area. In these cases specific exercises help to reduce the nerve pain. Additionally sometimes severe pain initially prevents patients from carrying out the exercises effectively or to a sufficient level to improve the tendon structure. In these cases, a course of acupuncture is often very helpful in settling down the pain to allow progress with the exercises. There are also lots of other options for those of you who really don’t like needles!

Physiotherapy for shoulder dislocation, instability and hyper mobilityIf you have tennis elbow or any other tendon problems, call for an appointment with Chartered Physiotherapist Eoin Ó Conaire at Evidence-Based Therapy Centre today on 091 727777 or get in touch via the contact page

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