This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow and these include extended time using the mouse or keyboard, carrying bags, painting, or using tools around the house or garden.
Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. The forearm muscles that bend the wrist back (the extensors) attach on the lateral epicondyle and are connected by a single tendon. When muscles work, they pull on one end of the tendon. The other end of the tendon pulls on the bone, causing the bone to move. Because a lot of force is placed through the attachment of the muscles to the outer elbow, that attachment point can become sore and inflamed.
The main symptoms of tennis elbow are tenderness and pain that start at the elbow and spread into the forearm. The pain may even spread down as far as the hand. The forearm muscles may also feel tight and sore. The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow. Lifting items such as a kettle also makes the pain worse, as does opening jars and turning stiff doorhandles or keys.
Overuse of the muscles and tendons of the forearm and hand is the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. In an acute injury, the body undergoes an inflammatory response. Special inflammatory cells make their way to the injured tissues to help them heal. However, tennis elbow often does not always involve inflammation. Rather, the problem is within the structure of the tendon and we call this condition a tendinopathy.
Reducing the strain on the tendon is vital to allow healing to begin. If you persist with painful activities then the inflammation continues, the tendon can become continually weaker and a tear can result. This then requires a much longer time to heal, is harder to treat, and problems can become chronic. In more severe cases cortisone injections, PRP injections or even surgery to repair the tear may be required.
This will depend on the severity and time-frame of your injury. If you seek advice and begin treatment early you could make a full recovery in 8-10 weeks. However, the rate of recovery differs from patient to patient, and in come cases can take 6 months or more.
Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Depending on the severity and length of time you have had your symptoms your physio will determine how much inflammation you have and use specific techniques to manage it.
Hands-on treatments include local massage, soft-tissue releases, joint mobilisations and mobilisations-with-movement. We often use a small elbow brace (a counter-force brace) which can be very effective in reducing the stress put through your tendon and so helps your pain settle much faster while allowing you to continue to be more active. We will also guide you through a home program of ice, self-massage and activity modification to speed up your improvement.
When your muscles are tight they put stress on tendons at the point where tendons attach to the bones. Tight muscles can also change the way you move and can increase stress other parts of your body, for example research shows many patients with tennis elbow also have simultaneous shoulder pain. It is important to get your full muscle length back to prevent or reduce this muscle imbalance, and also to allow your muscle to be re-loaded during strength exercises.
Your physio will use hands-on techniques including muscle and soft-tissue releases, stretches and trigger-point releases to restore your muscle length. They will also get you working on a home program to re-inforce and speed up your improvements in muscle length.
Weak muscles are a major problem when recovering from tennis elbow. Often muscles are weak because they are not being used properly, they have been damaged, or they have been inhibited after an injury. This creates muscle imbalance and can leave you with weak spots that increase your risk of persisting or recurrent pain.
When strengthening muscles you must strengthen the correct muscle and in the way the muscle would normally be used. To regain your muscle strength your physio will guide you through a specific and structured strength program beginning with using small weights or theraband (resistive elastic), and gradually progress you to heavier loading that starts to mimic the strain placed on your elbow during your normal daily activities as well as during sport and exercise.
Your biomechanics (your postures and how you move) play a big role in causing, repairing and preventing injuries – they can also help in improving performance. When treating tennis elbow it is vital to correct the underlying cause of your injury. This often relates to ergonomics (work positions for keyboard and mouse use) and sports technique and equipment if your problem is exercise-induced. Research shows that there is a high co-occurence rate with shoulder pain and tennis elbow so ensuring that you whole arm and shoulder complex are strong and working correctly is important to a complete and lasting recovery.
This is the last phase of your recovery plan and is essential for getting back to your previous level of performance and preventing re-injury. You need to be able to move at full speed and with full force in training first, before returning to your normal level of sport. Persisting background weakness or poor co-ordination will lead to inferior performance and increased risk of re-injury, especially in sports involving throwing such as cricket or baseball, or racquet sports such as tennis and squash.
This phase is achieved by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. Exercises are tailored specifically to your activity to ensure correct technique, co-ordination and strength are restored.
Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.