Probably the most common source of elbow pain we see at PHYSIO4ALL comes from the tendons that attach the extensor muscles of the forearm to the lateral elbow. This condition is sometimes known as ‘tennis elbow’ or ‘lateral epicondylitis’ but is more accurately termed ‘lateral epicondylalgia’.
Damage to these tendons causes pain around the outside of the elbow which may radiate into the forearm. In the acute stages there may be a constant dull ache in the area which is particularly bothersome at night, this is accompanied by sharper pain with certain movements. As the condition becomes more chronic, certain actions such as lifting heavy objects and using a computer mouse are painful.
In the initial stages, pain that is present at the start of an activity may ease with a few repetitions (warm up) and return again after cooling down. As the condition worsens pain will become increasingly more constant and intense and fail to ease with warm up.
Lateral Epicondylagia or Tennis Elbow can result from a single incident that overloads the tissue, or more commonly from repeated wrist loading or extension movements (bending the wrist up). The latter causes degeneration of the tendon which becomes progressively more significant and eventually results in pain. Overuse or repetitive strain injuries usually come about following an increase in the frequency of a movement or change in habits with respect to work or leisure activities.
Early management of lateral epicondylagia includes rest from aggravating activities, ice, deep tissue massage, acupuncture, myofascial cupping, sometimes pain medication and taping or bracing. Joint mobilization may be used to improve movement in the elbow joint, and stretches and soft tissue therapy will help break down scar tissue and rehabilitate the damaged tendon.
You will have to decrease, or if possible avoid activities that cause pain in order to reduce the stress on the damaged tendon. As my patients pain settles I will prescribe specific eccentric strengthening exercises designed to gently load the tendon in a controlled manner and increase the healing time.
The nature of tendon injuries are that they heal at a slower rate than other tissues, thus complete rehabilitation of degenerated tissue will take 6-12 weeks depending on severity. Return to pre-injury function needs to be progressed carefully and time periods will depend on condition severity and the nature of your sport or activities.
To eccentrically strengthen your wrist extensor tendon, rest your forearm on a table with your wrist hanging off the edge, and palm facing down. Extend your wrist back and take a light weight (less than 1.5kg) in your hand. Slowly lower your wrist down (take approximately 5 seconds). Now transfer the weight into the uninjured hand and lift your hand of the injured arm back up. Repeat the process 15 times, and do 3 sets.
This exercise can be viewed as a video at the following link: https://www.physio4all.com.au/lateral-epicondylagia-exercise/.
Another stretch for Lateral Epicondylagia can be viewed on the following link:
Our next blog will be on Medial Epicondylagia or Golfers Elbow.