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Tennis Elbow

What is it? 

Tennis elbow (lateral epicondylitis) is a condition that causes pain and tenderness around the outer elbow joint. It is called tennis elbow because it can be associated with repetitive forceful gripping activities such as encountered during racquet sports. It is also common amongst manual workers, although it can happen to anybody.

Usually, tennis elbow is caused by overloading the tendon that attaches your wrist muscles to your outer elbow joint. These muscles are the ones that cause your wrist to extend and twist, and fingers straighten. It is often aggravated by lifting, gripping and repetitive action of the wrist and hand.

Changes to the structure of the tendon cause pain to occur around the outer elbow joint, usually, close to where the tendon attaches to the bone, see picture below, discomfort can also be felt in the forearm.

The site of tennis elbow

Picture from Versus Arthritis shows a right elbow and the common site for tennis elbow.

    How to manage it?

    Tennis elbow is usually the result of overloading the tendon that attaches your wrist muscles to your outer elbow.

    It is a condition that most people can easily self-manage at home, with the right combination of:

    • Relative rest
    • Modify your activity – you may need to change the way you lift or carry things for a short period of time
    • Painkillers if necessary
    • Orthoses – A support or strap in the early stages of the injury
    • Ice or heat therapy
    • Exercise – stretches and strengthening
    • Steroid injections are no longer routinely offered for the treatment of tennis elbow as there have been studies to suggest they can make symptoms and outcomes worse in the long term.

    Simple painkillers

    Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

    Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Topical (applied directly on the affected body area) anti-inflammatories are recommended initially. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

    However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

    Up to date guidelines can be found on the NHS website:

    Ibuprofen 

    Paracetamol 

    Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days. 

    Support

    Using a splint to support your elbow may ease the strain when you’re doing certain activities that cause it to flare up. They’re available online or can often be purchased from a pharmacist.

    An epicondylitis clasp

    To the left is an example of a support – the picture is from Versus Arthritis. 

    The support or strap is placed on the forearm close to the elbow.

    This can reduce pain and improve function in the early days of the condition.

    Ice or heat therapy 

    Heat may be helpful in the form of a hot water bottle, wheat pack or hot shower. This can help to relax the muscles around your elbow and may allow exercises to be more effective.

    For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.

    • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
    • Check the skin regularly during and after the ice pack application
    • Stop if there is excessive pain, numbness or tingling
    • Do not put ice directly on to the skin as this may cause a burn.

    Exercises

    Following simple advice of rest and then gradual loading of the tendon, tennis elbow can make a full recovery. It may take time and you will need to follow a graded loading program.

    Wrist extensor stretch

    Start with your palm of your hand down towards the floor. With your opposite hand take hold of the back of your hand and fingers.  

    Bend the wrist towards the floor. Try to straighten your elbow fully. 

    You should feel a stretch on your forearm and elbow. This should not be painful.

     Hold the stretch for 30 secs and repeat little and often throughout the day.   

    Wrist flexor stretch

    Start with the palm of your hand facing up. With opposite hand, take hold of palm of your hand and fingers.

    Bend the wrist towards the floor. Try to straighten your elbow fully.

    You should feel a stretch on your forearm and elbow. This should not be painful.

    Hold the stretch for 30 secs and repeat little and often throughout the day.

     

    Eccentric strengthening exercises 

    Start with your arm supported on a table. Try to have to elbow straight. Hold on to a small weight (e.g. bottle of water) with your wrist extended and the back of your hand towards the ceiling. 

    Slowly lower the weight towards the floor.  

    Use your opposite hand to return to the starting position.  

    Repeat 15 times. Rest for 60 secs. Repeat x 3.

     

    Concentric strengthening exercises – perform this once the eccentric exercise is comfortable

    Start with your arm supported on a table or your knee. Hold on to a small weight (e.g. bottle of water) or resistance band. The back of your hand should be towards the ceiling.

    Raise you wrist up towards the ceiling as far as is goes then lower slowly, keeping your forearm supported.

    Repeat 10 times. Rest for 60 secs. Repeat x 3.

     

    Physiotherapy 

    If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing tennis elbow. Visit the patient self referral form to self-refer to a physiotherapist.

    How to prevent and manage future flare ups?

    As tennis elbow is often caused by overloading the tendon that connects your wrist muscles to the outer side of your elbow joint, the key to helping the condition is to take care when carrying out activities or sports that place pressure on the tendon with repetitive or forceful gripping.

    It takes time for your body to get used to a new activity and tendons take longer than muscles to adapt. So, it’s important to pace yourself and if in doubt, take advice from a physiotherapist.

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