Symptoms and treatment of tennis elbow - Physiotherapy Helsinki

Tennis elbow – painful condition on the outer edge of the elbow

Lateral epicondylitis or lateral epicondylopathy is a familiar and unpleasant condition for many.

In colloquial terms, the issue known as tennis elbow, however, does not only affect those who play tennis or other racket sports, even though athletes in these sports may be prone to this condition.

Especially after the acute phase, lateral epicondylopathy, also known as pain in the outer elbow joint, likely best describes the problem, as in prolonged cases, in addition to inflammatory factors, there are also pathological changes in the tissues surrounding the joint. However, in this writing, I will use the term tennis elbow as it is the most familiar name for this condition for the majority.

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What causes tennis elbow?

Various risk factors have been identified in the development of the condition, especially heavy physical work and repetitive, unilateral movements that strain the forearm muscles expose individuals to the problem. Additionally, smoking, higher BMI, certain medications, and genetics have been recognized as risk factors.

The “culprits” are often suggested to be overloading of the wrist extensor muscles and finger extensor muscles, which creates stress at the attachment point of these muscles on the outer side of the humerus. The condition can strain the muscle and bone membrane, muscle tendons, and the surrounding tissues.

For athletes, rapid increases in training and/or playing load, or, for example, technical issues in tennis strokes, can predispose them to the condition. Furthermore, according to recent research, central sensitization, which is the heightened sensitivity of the central nervous system to pain, is a factor, especially in prolonged pain conditions. Communication between the patient and the professional is an essential part of treatment. Patients with tennis elbow often have underlying movement fear and catastrophizing, especially when the elbow is very painful.

How does tennis elbow manifest?

Individuals with tennis elbow often can pinpoint the exact location of pain. The pain is localized to the outer edge of the elbow, easily felt over a prominent bony knob. The area itself is often tender to touch. Pain may also radiate toward the forearm, fingers, and upward towards the upper arm. In such cases, it is important to consult with a specialist in musculoskeletal disorders, such as an orthopedic doctor or physiotherapist, as sometimes issues with cervical nerve roots can cause similar symptoms in the same areas.

Daily activities requiring grip strength, lifting or carrying objects, and wrist movements under load typically provoke the symptoms. Many patients report that even lifting a coffee cup can be painful.

Symptoms and the intensity of pain can vary greatly among individuals. In milder cases, the issue may resemble post-tennis-playing discomfort, but in more challenging cases, it can significantly hinder daily life and lead to extended periods of sick leave.

How can tennis elbow be treated?

At the core of the rehabilitation plan is communication between the patient and the physiotherapist, where the etiology of the condition, the typical progression of tennis elbow rehabilitation, what the patient can expect from treatment, and the expected duration of rehabilitation are discussed.

The plan often includes relative rest, depending on the situation, where clearly provocative activities are avoided or the load is reduced. As tennis elbow involves structural changes in the tendon, progressive strengthening of the tendon and musculature, as well as increasing tolerance, are key aspects of rehabilitation. Unfortunately, due to the structural changes in the tendon, the rehabilitation of the condition is relatively lengthy, and follow-up is often initially around 6-12 weeks. While the tendon is a malleable tissue, structural changes often take time and require a gradual increase in load! Additionally, the individuality of the patient and how they react to exercises must always be taken into account.

Some patients respond well to manual therapy when combined with active rehabilitation. For example, massage can be beneficial in pain management!

Moreover, there is some research evidence supporting stretching. Stretching of the forearm muscles can be performed several times a day, as long as the stretching itself does not provoke symptoms.

Local cortisone injections are not recommended based on current research. While injections may provide short-term benefits, they increase the risk of recurrence of the painful condition!