Tennis Elbow / Extensor tendinopathy is a common overuse injury which typically causes pain on the outer aspect of the elbow. The group of muscles at the back of the forearm are called the forearm extensors and they attach to the outer aspect of the elbow via the Common Extensor tendon. These muscles act to extend the wrist and fingers (i.e. bend the wrist backwards and straighten the fingers). Extensor tendinopathy is usually caused by activities that require repetitive use of the muscles that control the wrist, hand and fingers. The overuse of these muscles can cause tiny tears and degeneration or breakdown of the tendon which can then lead to an increase in blood vessel growth that relates to an increase in pain rather than healing. This is further complicated by an increase of nerve fibres which then pick up painful stimuli and this coincides with an increased in pain producing chemicals to the area. It can become a very painful and debilitating condition.
Elbow pain usually develops gradually. Initially it may only be painful with activity and may disappear as you warm up and then return once you have stopped activity. As the condition progresses it becomes painful with most arm, wrist and hand movements and as the tendinopathy worsens it may become painful all of the time includ- ing disturbing sleep. Extensor tendinopathy generally doesn’t get better on its own. It will feel a little bit better with rest but once you start doing the aggravating exercise or activity again it will become painful again. Continuing to do aggravating activities may advance the process and may significantly prolong the recovery time. The goals of treatment are to identify any predisposing factors, reduce pain and in- flammation and promote healing to restore the muscle and tendon function.
Early treatment may include:
- Modification or Rest from provocative activities.
- Ice or heat (as directed by your physiotherapist).
- Low Level Light Laser Therapy.
- A gentle stretching and strengthening program.
- Massage and soft tissue therapy.
- Dry needling.
- Posture education-posture of the wrist and general upright posture (especially for
people who have a sedentary job and who use the computer a lot). - Bracing or taping may be used to unload the muscle and tendon.
- Assessing and treating any involvement of the neck and upper back which can commonly contribute to symptoms.
Once your pain has settled it is vital that physiotherapy is progressed to ensure complete healing of the area and prevent re-occurrence. Treatment may include:
- Harder and more specific exercises.
- Correction of any predisposing or unusual biomechanics. This may relate to sport; for example using the wrist to hit a backhand in tennis rather then hitting with a stable wrist/forearm. Poor lifting/working technique within the workplace can also be a major predisposing factor. Your physiotherapist will guide you to help change/correct these.
Extensor tendinopathy, if treated properly and managed correctly will not have any long term effects. If not it can lead to prolonged pain on the outside of the elbow and forearm, a prolonged period away from sport/work/aggravating activities and may cause degeneration of the tendons which will cause lingering pain. It can also lead to secondary conditions due to other areas of the body compensating for the original injury.