Tennis elbow or lateral epicondylitis is a painful condition of the lateral elbow often associated with overuse. Treatment and management of this condition varies enormously in part because the pathology is not always understood.
Historically this condition has been labeled as “tendonitis,” which means inflammation of the tendon. Tendon inflammation is rarely the cause of tendon pain. “Tendinosis” refers to micro-tears in the tendon and is associated with overuse of the tendon. In the majority of cases, lateral epicondylitis is better described as tendinosis and needs to be treated as an “overuse” condition rather than simply inflammation.
Overuse: Typically related to repetitive activity either with sport (think tennis, weightlifting or golf) or with occupation (referring to activities like keyboard entry, painting, plumbing, carpentry or cooking).
Age: Most common between ages 30-50, but if related to poor technique can come on at any stage of life.
Change In Activity: Frequently symptoms start after a change in type or frequency of activity; either sport, recreational or work-related. Typically, people may develop this condition if beginning a new activity with which they are unfamiliar or is new to them.
Symptoms: Normally begin slowly and gradually worsen over weeks or months. Pain or burning over the lateral elbow, sometimes extending down the forearm to the wrist. Loss of grip strength. The pain increased by forearm activities-such as shaking hands, holding a racquet, using a tool and gripping of objects.
Conservative treatment will be successful in greater than 90% of cases. Better outcomes are achieved when treatment is initiated earlier. Anti-inflammatory medication and/or a local steroid injection are useful in conjunction with physical therapy to assist in allowing a more progressive exercise program.
Relative Rest: A short period of rest from aggravating activities may be needed to initiate healing. Successful physical therapy involves re-introducing activity gradually once the patient is responding to the eccentric exercise program.
Ice: Patient education in the use of ice is important. Ice should be applied immediately after aggravating activities (sport, work, etc).
Manual Therapy: Soft-tissue release techniques are applied to prevent adhesions at the tendon attachment and to release tightness in the opposing muscle group (the flexors). Joint mobilization to the elbow has been found to improve grip strength, decrease pain and improve function. Physical therapists are trained in manual therapy to assist with the healing of tennis elbow.
Mark DeGarmo, PT, DPT
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