This is the first post of a new series I'll be starting called "Condition of the Month." Each month, I'll try to talk about some of the common conditions that I see during my practice. Stay tuned to see if any of them are applicable to you!
The condition of the month for February is tennis elbow. Apparently, the last day of February (28/29) is International Repetitive Strain Injury Awareness Day, and I cannot think of a better example than tennis elbow.
Overview
Tennis elbow, or lateral epicondylitis, is a painful condition of the outside of the elbow. Not surprisingly, tennis and racquet sport players do get this condition, but it can also be caused by various other activities and occupations as well. From my experience, this condition occurs more commonly due to occupational stresses than sporting activities.
Causes
Our forearm extensor muscles attach to a bone on the outside of the elbow. Tennis elbow occurs when the tissues (forearm extensor muscles and tendons) that attach to the elbow become inflamed, damaged, or torn. This can be as a result of the following:
- Overuse due to repetition of the same movements over and over again (i.e. an electrician pushing and pulling wires, a chef cutting up ingredients, a construction worker drilling and driving screws, someone who is raking leaves, painting, etc.)
- Age (anyone can get tennis elbow if they have the risk factors, but it is most common between ages 30 to 50)
- Sports (i.e. racquet sports like tennis and squash, weightlifting, using improper technique or equipment, etc.)
- Unknown (no specific cause or reason)
Signs and symptoms
- Pain and tenderness on the outside of the elbow; there may be pain on the back of the forearm as well
- Gradual and slow onset, worsening over time
- Weak grip strength
- Pain that is worse with gripping and forearm movements (i.e. holding a coffee cup, opening a door or shaking hands, lifting bags, twisting open jars, etc.)
- There may or may not be redness, swelling, or heat
Physiotherapy Treatment
- Rest: For any type of overuse or repetitive strain injury, rest is the most important as it allows the tiny tears in the tendons to heal.
- Activity modification: You may need to have your form and technique analyzed to see what can be changed. This could mean modifying your sports equipment, implementing certain aids or devices, or simply changing the way you hold and grip tools.
- Modalities: Ultrasound, laser, and shockwave are all effective in controlling inflammation, promoting healing, and relieving pain. They are also helpful in realigning collagen fibers and preventing scar tissue during the healing process. Thermotherapy, such as ice or heat, and electotherapeutic modalities, such as TENS or IFC, may be used for pain relief.
- Acupuncture and dry needling: This is one of my go-to treatments for tennis elbow. I find that needling really helps to relieve the trigger points that are in the forearm extensor muscles.
- Manual therapy: Joint mobilizations, nerve flossing, and soft tissue techniques can be used to decrease tension and reduce stiffness in the forearm muscles.
- Exercise: Stretching is beneficial to prevent muscles from tightening up and becoming stiff. Progressive strengthening exercises help to increase pain-free grip and forearm strength. A good exercise program allows you to return to functional work and sporting activities without feeling pain. Exercises should not only focus on the forearm muscles; sometimes, a lack of mobility or strength in the shoulder could cause one to overuse his or her wrist in order to compensate.
- Bracing and taping: Elbow taping and strapping techniques may be employed to offload the tendon insertion point on the bone. This is to temporarily relieve the stress placed on the elbow to allow for healing to occur. It is not a permanent solution to the problem because disuse of your muscles can cause them to atrophy.
Other treatments
Non-physiotherapy treatments may include, but are not limited, to the following:
- Medications
- Cortisone shots
- Autologous blood injection
- Surgical intervention
