In the wake of Wimbledon, we have decided to dedicate our recent blog post to tennis elbow, aka lateral epicondylosis.
This blog will examine the anatomy and mechanisms involved in this common condition and provide insight into how we treat it here at Strada Health and Fitness.
Anatomy 101
The elbow is made up of three bones; The humerus (arm bone), radius and ulna (forearm bones).
Near the elbow, the humerus forms two bumps, known as epicondyles. The bump on the outside of the arm is known as the lateral epicondyle.
The extensor muscles originate from the lateral epicondyle in a common extensor tendon.
Lateral epicondylosis, or tennis elbow, involves these extensor muscles and the most commonly affected is the extensor carpi radials brevis (ECRB).
Pathology 101
The current consensus is that tennis elbow begins as degenerative microtears, most often within the origin of the extensor carpi radials brevis muscle (ECRB). These tissues undergo a process called angiofibroblastic hyperplasia, which means that there is an accumulation of disorganized scar tissue and blood vessels with no signs of acute or chronic inflammation. This process can also occur in the extensor digitorum communis or extensor carpi radials longus.
Who is Affected by Tennis Elbow/Lateral Epicondylosis?
It's not just a tennis problem! There is an annual prevalence of 1-3% in the general population. Office workers are at risk as it has been suggested to affect up to 15% of workers who perform repetitive tasks such as typing. Those who play tennis regularly are at the highest risk with an estimated 10-50% of those experiencing symptoms at some point during their career.
Tennis elbow doesn't discriminate! Men and women are affected equally and although it is most commonly experienced in your 40s and 50s, it can occur at any age. Either arm can be affected, but 75% of people will experience symptoms in their dominant arm.
Do I Have Tennis Elbow/Lateral Epicondylosis?
Tennis Elbow/Lateral Epicondylosis is characterized by pain at the lateral epicondyle that often radiates into the forearm. The pain or discomfort comes on gradually over time and a history of repetitive strain or overuse is often identified. Tenderness can be felt 2 to 5 mm down from the lateral epicondyle. Resisted wrist and finger extension with an outstretched arm can intensify the pain as well as passive stretching of the extensors by flexing the wrist with the elbow extended. Painful resisted middle or ring finger extension implicates extensor digitorum communis.
I Have Tennis Elbow. Will It Go Away On Its Own?
Tennis elbow/lateral epicondylosis can be a frustrating condition with a natural history of 6 to 24 months. If left alone, 80% of patients will experience complete relief within 12 months but who wants to wait that long. The good news is that there is a lot we can do to manage this condition.
The Strada Approach to the Management of Tennis Elbow/Lateral Epicondylosis.
Identify the cause of your symptoms:
Whether it be tennis, typing, or any other repetitive motion, it is important to remove or minimize any stressors that may continue to irritate your symptoms.
Suggest modifications:
If tennis is the culprit, there are specific techniques, equipment, or playing surfaces that could contribute to your symptoms. Poor stroke mechanics, improper grip size, greater racket weight, and racket stringing techniques can generate higher surface loads on the forearm muscles. Harder court surfaces generate greater momentum through the ball and increase the force transmitted through the racket to the elbow. If you think any of these could contribute to your condition, have your equipment checked and seek the opinion of a tennis professional on ways to minimize these stressors on your body. If your complaint is work related, having an ergonomic assessment could help identify potentially unnecessary risk factors.
Manual therapy:
We use a variety of modalities to treat this complicated condition. In the initial stages we focus on decreasing pain and increasing function. Acupuncture has been proven effective in decreasing pain in acute and chronic tennis elbow. Mobilization and manipulation of the neck, elbow, and wrist are used for a further reduction in pain and improvement in function. As mentioned above, tennis elbow/lateral epicondylosis is characterized by an accumulation of disorganized scar tissue or adhesions. At Strada, we utilize several soft tissue techniques aimed to break down this scar tissue, including Massage Therapy, Graston Technique, and Active Release Technique (click on technique to learn more).
Strengthen through exercise:
Active rehabilitation programs help to improve strength in the extensor muscles. Specifically designed exercises focusing on strength and flexibility of the wrist extensors and flexors help absorb greater force and reduce those transferred to the elbow.
If you are suffering from tennis elbow/lateral epicondylosis, don't wait!
References:
Gliedt, J., Daniels, C. (2014) Chiropractic treatment of lateral epicondylitis: a case report utilizing active release techniques. Journal of Chiropractic Medicine. 13(2); 104-9.
Howitt, S. (2006). Lateral epicondylosis: a case study of conservative care utilizing ART and rehabilitation. JCCA. 50(3):182-189.
Jobe, F., Ciccotti, M. (1994). Lateral and medial epicondylitis of the elbow. Journal of American Academy of Orthopaedic Surgeons. 2:1-8.
Tang, H., Fan, H., Chen, J., et al. (2015). Acupuncture for lateral epicondylitis: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2015:1-13.
Weber, C., Thai, V., Neuheuser, K., et al. (2015). Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis. Musculoskeletal Disorders. 16:223.