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Tennis Elbow

Tennis Elbow

Tennis elbow (aka: Lateral epicondylitis or lateral epicondylalgia) is an overuse injury occurring on the lateral side of the elbow, or more specifically, at the common extensor tendon that attaches to the lateral epicondyle of the humerus.

It gets its common name ‘tennis elbow’ from the fact that it is a common injury among tennis players, however, anyone can get this condition if they over-stress the muscles that attach at the elbow.

 What are the signs/symptoms?

  • Pain on the outer part of elbow
  • Gripping objects and wrist extension is usually painful
  • Morning stiffness.
  • Weakness of the forearm

What causes it?

  • Tennis elbow is commonly caused by repetitive microtrauma from overuse of the muscles forearm muscles.
  • Other possible risk factors for lateral epicondylitis include taking up tennis later in life or other unaccustomed strenuous activities.
  • Some studies have shown that trauma such as direct blows to the lateral elbow, a sudden forceful pull, or forceful extension can also cause tennis elbow.

 How can it be treated?

The British Medical Journal (BMJ) tells us that most cases of tennis elbow will get better all on their own within 6-12 months (See reference 1). However, there are treatments that research has found can shorten this recovery time:

 The healthcare professionals at Able Body Health Clinic are experts in the non-surgical treatment of tennis elbow and can advise you on your treatment options.

 Non-surgical treatments that can help

*NOTE: Able Body Health Clinic offers all of these non-surgical treatments

  • Elbow Mobilization – Research studies suggest that elbow joint mobilization can provide immediate, short-, and long-term benefits such as pain reduction and improved function (See reference 2 and reference 3).
  • Low Level Laser Therapy – Research indicates that specific doses and wavelengths of laser light applied directly to the lateral elbow tendon insertions provides short-term pain relief and reduced disability (See reference 4).
  • Chiropractic Spinal Adjustments – The addition of spinal manipulation (adjustments) to the cervical and/or upper-thoracic spine can produce additional improvements in pain and disability (See reference 3 and reference 5).
  • Rehabilitation Exercise – A supervised exercise program consisting of slow progressive eccentric exercises and static stretching of the of wrist extensor tendons has been shown to help reduce pain and improve function (See reference 6).

 What about injections or surgery?

 While more invasive treatments are sometimes required, they are usually not the best first option and are better left as a last-resort. The British Medical Journal (See reference 1) tells us that:

  • Cortisone injections are harmful in the longer term and not recommended.
  • More research is needed for platelet-rich plasma injections and hyaluronan gel injections.
  • Surgery and botulinum toxin injections should only be used in the worst cases that last longer than 6 months.

 References

1) Orchard J & Kountouris A. (2011) The management of tennis elbow. BMJ;10(342):d2687.

2) Vicenzino B, Cleland JA, Bisset L. (2007). Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary. J Man Manip Ther;15(1):50–56.

3) Herd CR, Meserve BB. (2008). A Systematic Review of the Effectiveness of Manipulative Therapy in Treating Lateral Epicondylalgia. J Man Manip Ther;16(4):225–37.

4) Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI. (2008) A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord;9:75.

5) Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BM. (2013) Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013 May 24. [Epub ahead of print]

6) Stasinopoulos D, Stasinopoulos I, Pantelis M, Stasinopoulos K. (2010) Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy. Br J Sports Med;44(8):579-83.