There are many different causes of tennis elbow, and we will explore some common patterns in this article. Tennis elbow can be a difficult and frustrating injury to recover from. However, Physiotherapy can help move you through the recovery process quicker. Read on to find out more!

What is Tennis Elbow (Lateral Epicondylitis/Epicondylalgia) 

Surprisingly only 5% of people with tennis elbow actually relate their injury to tennis! Tennis elbow, or lateral epicondylitis, is a condition where the tendons on the outside of the elbow (they attach to the lateral epicondyle, hence the name!) are chronically stressed and cause pain and weakness. Often people notice pain with gripping, bending the elbow, and resisted movements at the wrist with your palm facing down. 

Why Does This Happen? 

Not all cases are the same. Yes, the tissue is chronically overloaded, but why it’s overloaded may be completely different. Perhaps there is weakness in some of the shoulder girdle muscles. Maybe there is too much stiffness through the mid-back (thoracic spine) causing a loss of ability to turn their arm outwards and therefore they overuse their forearm muscles. The physiotherapist will work with you to peel back the layers and piece the puzzle together to figure out how to prevent this issue in the future.

Tissue Tolerance

All the tissues in our body have a certain level of tolerance. The level is likely different for each muscle, and the amount of tolerance you have can depend on a variety of different factors. Primarily, how much you challenge that muscle daily. Are you a computer worker that uses their forearms a lot? Are you an electrician that uses their arms and hands all day? Are you a parent that lifts your baby 1 hundred trillion times a day? This amount of work builds up your tolerance and strength within the muscles and tissues you use. 

Tendons can break down when the load that is placed through it is more than it’s tolerance. This breakdown can be one incident, where the force is so great it tears the tendon and creates an acute injury. Or, it can slowly happen overtime, with micro-traumas to the tendon. 

While healing your tissue tolerance is lower. This doesn’t mean you should stop using your arm completely, it simply means we need to find a balance of too much and too little. It is necessary to rebuild the tolerance of those tissues to resume normal activities. It is essential to managing the load/stress level, and progressively accumulating and building the tolerance level back and perhaps even stronger than prior to the injury.  If you want to learn more about tissue tolerance, read this article.

How Can Physiotherapy Help Tennis Elbow? 

The type of treatment depends a number of things: the stage of healing, the level of irritability, the findings from the assessment, the goals of the client, the type of treatment the client is open to or comfortable with. Often the following are used in clinic to help with Tennis Elbow: 

Manual Therapy 

• Hands on mobilization of joints that may be restricted 
• This can include working up the chain: shoulder, neck, mid back, etc. 

Soft Tissue Techniques: 

• Often with tennis elbow we need to work on the muscles of the forearm: wrist extensors (which continue as a common tendon to attach to the lateral epicondyle) 
• The other area that we commonly work on is the shoulder and neck. Loosening any of these muscles that are causing a restriction in movement and can relate to the overuse of the forearm muscles

Acupuncture 

• Some physiotherapists have additional training to be able to use acupuncture within their practice 
• If acupuncture is applicable, it is discussed with the client and determined if they are comfortable with this treatment modality, just like all the other modalities used in practice

Exercise 

• Through the assessment we identify where someone’s weaknesses are. Perhaps we need to strengthen the shoulder to provide a stable base for the arm to move. 
• As discussed earlier, we need to reload the wrist extensors through different exercises to rebuild the tolerance 

Taping 

• Athletic tape is used in a variety of different injuries and can be helpful in reducing pain giving a sense of support to the area 

Education 

• This piece is critical in all the conditions that we see as a Physiotherapist. Discussing posture, computer/work setup, how to off load the injured tissues, about the actual injury 
• This is another area of my job I really enjoy, connecting with the client and coaching them to understand their body and their movements through the day is very rewarding