WHAT IS TENNIS ELBOW?
Tennis Elbow (also known as Lateral Epicondylalgia) is pain associated with the outer aspect of the elbow, specifically over the bony prominence known as the lateral epicondyle. The lateral epicondyle is the anchor for the muscles that extend the wrist and fingers. It can begin as an acute injury or it can creep in slowly and without warning.
Tennis Elbow symptoms that have lasted more than six weeks will be considered to be sub-acute or chronic.
Typically the Tennis Elbow sufferer will experience pain when performing gripping tasks or resisted wrist/finger extension. Pain can also be present when the muscles are stretched. There will be tenderness directly over the bony epicondyle, and there may be trigger points in the wrist muscles. Some sufferers will also have neck stiffness and tenderness at C5/6, as well as signs of nerve irritation. All elbow movements are typically be pain-free, despite that being the area of pain.
Tennis Elbow is associated with degenerative changes in the muscle tissues located at the epicondyle. Although for a long time this was thought to be related to inflammation from overuse, this is now known to be incorrect. Testing of Chronic Tennis Elbow sufferers has shown no evidence of the chemicals normally associated with inflammation. Rather there is an increase in chemicals associated with pain transmission in the nerves. This is coupled with changes in the blood supply, and changes in the co-ordination of the muscles when using the hand and wrist. This results in decreased ability to perform normal functional activities by reducing reaction time and speed, and reducing strength.
PHYSIOTHERAPY AND TENNIS ELBOW
Tennis Elbow occurs commonly in the community. It is present in 40% of all tennis players (hence it’s name) and 15% of people working in repetitive manual trades. It can occur at any age. However, sufferers are generally between the ages of 35 and 50. Predictably, the side affected is usually associated with handedness, but it can occur in the non-dominant arm. Males and Females are affected equally. Untreated Tennis Elbows can last anywhere from 6 months to 2 years, and are prone to recurrence.
Physiotherapy aims to achieve three things
Reduction of pain
Increase in muscle length
Restoration of normal movement patterns
There are many ways to achieve these ends and, following a thorough assessment of your arm and neck, your physiotherapist will discuss the best strategy for you to use based on your level of symptoms and your lifestyle. Results are typically measured through patient feedback and measurement of pain-free grip strength. Treatments can include gentle manipulation of your neck and elbow, releases to the trigger points in the arm, supportive taping and, of course, home stretches and exercises. Electrotherapy modalities such as ultrasound may also be used.
WHAT CAN I EXPECT FROM TREATMENT?
Studies have shown physiotherapy to be the most effective way of managing Tennis Elbow when compared to injections or giving of advice alone.
When given a 6 week course of physiotherapy comprising of 8 treatment sessions, most patients show significant improvement after 3 weeks, increasing to a 60% or greater recovery after 6 weeks of treatment. This improvement is shown to continue to around a 90% improvement at 12 months, even without further treatment.
By comparison, provision of advice only resulted in a recovery of 60% or greater being delayed a further 6 weeks, to three months. Over longer periods of time, patients given good advice did recover, and by 6 months had achieved similar gains to the treatment groups. This was maintained over time and continued to improve.
Cortisone injections resulted in very good initial improvements with almost 80% reduction in symptoms after 3 to 6 weeks. BUT (and it’s a big one) patients who received cortisone injections only showed an increase in pain after 6 weeks, and by 3 months had fallen well below both the physio treatment groups AND the advice only groups in terms of their recovery. This deterioration was followed by delayed healing, resulting in the cortisone injected group having almost 30% more pain after 12 months than if they had followed advice alone.
For this reason we do not recommend cortisone injections as a stand-alone treatment for Tennis elbow. Physiotherapy should always be considered as a part of your management. IF you need more information or advice in managing your Tennis Elbow, book in with one of our experienced clinicians.