Tennis Elbow

Brendan Regan

Tennis elbow, or Lateral Epicondylalgia (LE) is the most frequent cause of elbow pain with approximately 1% to 3% of the population being diagnosed in their lifetime. It usually stems from repetitive loading of the extensor muscles of the forearm resulting in a degenerative process of the common extensor origin’s muscles and tendon. This usually results in pain with basic tasks such as gripping, holding a jug, turning a tap, opening a jar or even just bending and straightening your elbow joint. The condition is particularly common in 35 to 50 year olds in the workforce and can produce significant disability affecting work productivity and activities of daily living.  Office workers, manual workers and tennis players have an increased risk, with the excess stress placed on the outer forearm muscles in these occupations.


Common Causes

Increase in demand for gripping activities is a common cause - increased weights training, new renovation projects, long gardening or landscaping days are common ways the extensor muscles of your forearm gets overused. A direct blunt force to the elbow may also set off an irritation of the common extensor tendon. 


Diagnosis generally includes a history of repetitive wrist extension movements, changes in workload and potential sources of trauma. Physical examination should reproduce pain in the area of the lateral epicondyle in at least one of three ways: palpation of the attachment site of the muscles/tendon, resisted extension of the wrist, index or middle finger, or a firm grip. Imaging may be useful in confidently excluding a diagnosis of LE in the form of both ultrasound and MRI- however a patient’s history and clinical findings are generally sufficient. 


Management strategies for LE include physiotherapy, medication, bracing, injection therapies and surgical interventions. Principles of treatment include controlling pain, preserving movement, improving grip strength, returning to daily activities and preventing further decline. The majority of patients recover in the first year, and as such conservative treatment with rest and physiotherapy is recommended before considering invasive treatment. Exercise and manual therapy are at the core of rehabilitation; implementation of appropriate functional tasks, graded increase of load in the wrist extensors and motor control exercises coupled with massage, treating the neck and improving posture.

Physiotherapy management also focuses on reassurance about outcomes, education on self-management and strategies to avoid aggravation.

The Best Advice

  1. Reduce the risk of injury.  Whatever your age, sudden increases in exercise, particularly the intensity of exercise is a key cause of tendon injuries

  2. If you have pain with exercise, stop the activity that caused it.  Come in to see us if your pain doesn’t settle in a couple of days. It could save you months of pain and lost time in your favourite sport!

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