April 10, 2018 7 min read
Tennis Elbow has taken on the role of an all-encompassing term for pain on the outside of the elbow. There is generally an early stage and late-stage which exhibit different characteristics but are generally both termed Tennis Elbow.
Clinically speaking, tennis elbow is caused when there is a repetitive force through the tendon located towards the outside of the arm, called the common extensor tendon, which attaches to the lateral epicondyle, also known as “the bony bit on the outside of your elbow”.
The main causes of tennis elbow are;
Tennis elbow can last anywhere between 6 weeks and 6 months, with severe cases sometimes lasting up to two years.
Diagnosing the exact cause of tennis elbow is complicated at best, as a number of possibilities exist which can exhibit similar symptoms. Three examples are listed below, which are all very different, yet will all be diagnosed as tennis elbow, and require similar treatment. Tap the headings to change.
The common extensor tendon is wrapped within a sheath, and under the conditions outlined above in the main causes of tennis elbow, this sheath can cause friction on the tendon, leading to inflammation and pain.
Remember the lateral epicondyle? The bony part of the outside of your elbow… well, one cause of tennis elbow is where strain is put on this attachment site and the tendon becomes weaker in this area, again leading to pain during movement.
Probably the fuzziest cause of tennis elbow, a weak or inefficient tendon can be the result of the body simply not being ready for the activity which you make it do, or a tendon can be damaged by either the sheath or at the attachment site, and weakness can occur over time, generally leading to persistent tennis elbow. The longer the condition persists, the more likely this will become the main cause of pain, even if this was not the trigger. As a damaged tendon starts to undergo actual structural changes known as cross-hatching (for the avoidance of doubt, tendon fibres work best when they all point in the same direction), which make the tendon inefficient.
Whichever cause may have triggered your symptoms, the likelihood is that you are experiencing pain during activity, general weakness in the arm exhibited through a weakness in holding, lifting and grip strength. Some people stop short of describing the sensation of pain and instead use the word throbbing. As always, we are all different, and the different ways in which we all process information will have a bearing on how your symptoms manifest.
One of the main causes of the condition is it’s namesake, playing tennis. The powerful, fast swings of a tensed arm creating a perfect storm of conditions for tennis elbow to manifest. Often this can strike new players due to the suddenly increased workload that the elbow has to contend with, however, even pros who don’t take the time to warm up properly or are poorly conditioned (including from overuse) can face lengthy spells of recovery.
The condition isn’t just limited to tennis, however, and any racquet sport where the arm is being swung repeatedly can trigger the condition, indeed anything which requires a lot of gripping can trigger tennis elbow.
Jobs which tennis elbow is often seen include:
While most cases of tennis elbow will clear themselves up within 6 weeks to 6 months you should be on the lookout for a few things.
If you have taken the steps soon to be outlined, reduced your workload, purchased an elbow support strap and you are allowing significant rest yet your symptoms still get significantly worse, or don’t seem to start getting better over the cause of the standard recovery period, then please follow standard procedure and see your GP.
However, it must be said, that standard GP remedies like anti-inflammatory injections do not historically have a good outcome with treating this condition, and generally, the best thing your GP could do would be to refer you to a physiotherapist for some rehabilitation exercises.
As always, the information provided by Essential Wellness is backed by chartered physiotherapists giving best practice advice and guidance, as opposed to a medical diagnosis. Every human body is slightly different, we urge you to trust and listen to yours, and to apply your own judgement to your unique set of circumstances.
The best treatment for tennis elbow is three-fold and is achieved by first giving the elbow complete rest wherever possible. This means putting your long-term health above short-term goals and allowing the body time to recover from its injuries.
However, there are of course times where it is not possible to fully rest the elbow, such as when required to continue working etc.., and in these times the use of an elbow support strap with a pressure pad is essential in anchoring the common extendor tendon thus helping to limit the amount of workload transmitted through the injured tendon.
The use of an elbow support strap may also increase grip strength as commonly with tennis elbow the weakness of the arm is actually caused by pain inhibition, rather than a physical weakening of the arm. When purchasing your elbow support strap, the best kind include a protruding pressure pad, which should be positioned over the tendon which is located on the outside of the arm, just below the elbow.
Please do note that tennis elbow should not be confused with golfer’s elbow, which usually manifests on the other side of the elbow. The elbow support strap can, of course, be twisted round to relieve this condition also.
If your condition has been brought on by sporting activities, consider reducing your workload while the condition resolves itself, wearing an elbow support strap both during sport and rest periods can provide adequate rest to the tendon and stop the condition from being further aggravated.
Recovery speed is dependant upon the severity of the injury, how much rest is given to the injured elbow and your own natural body restoration speed. However, if proper rest and support are given to the elbow, typically you can expect minor occurrences to clear up within 6 weeks to 6 months, and major occurrences to be resolved within 6 to 12 months. Occasionally, in severe cases or more likely, where a further injury is caused to an already damaged common extensor tendon the condition can become persistent and can trouble a person for a couple of years.
Factors like whether you are a smoker and whether you modify your activity levels and allow proper recovery time can play a big part in the speed of your recovery. Severe cases which persist for a long time, actually cause a structural change in the tendon which takes a long time to recover from. As always, once you notice the signs of tennis elbow, early intervention is the best policy.
Summary of best practice treatment
Prevention will always be the best remedy, and there are a number of best practice steps you can take to reduce the likelihood of suffering from tennis elbow in the future. For example, stretching properly is always best practice, however, to specifically avoid tennis elbow the following should be considered.
Where heavy impact or strain is likely to occur, you should gently ease yourself into it first. While on a long-distance drive, deadheading roses or hitting the court for a tennis session consider taking an early break in the action to allow the body to acclimatise more gradually. In the case of tennis, save your ‘do or die’ tennis for the backend of your time on the court, not right at the start.
Just as important as pacing yourself, is taking regular breaks. Especially if you become aware of the repetition of the task. Highly repetitive tasks are prime suspects for causing tennis elbow, and they can appear in some of the most seemingly mundane tasks.
Staying well-hydrated is always a good shout, and can have a big impact on how injury-prone the body is, and as a side effect, you’ll also enjoy increased mental acuity afforded by a well-hydrated body.
If you are prone to injury, or you have suffered from the condition in the past, you should consider wearing an elbow support strap during activity and shortly afterwards. This will not only help prevent major aggravation of the tendon but also give the elbow sufficient time to rest and recuperate after exercise.
Lifestyle plays the biggest part in whether you are likely to suffer from tennis elbow. New players to racquet sports should ensure that they perform adequate stretches beforehand. A common occurrence of tennis elbow happens when players who have not performed adequate stretching suddenly are required to explosively swing their arm and meet a ball hurtling the other way. The sudden strain of the impact being the injury-causing element in this scenario.
As mentioned, however, many activities can cause tennis elbow and prime candidates are tasks which involve you gripping for long periods of time. For ease of reference, the earlier included list of likely job roles is repeated again.
There is no statistical difference in the likelihood of suffering from tennis elbow between males and females and tennis elbow is most common between the ages of 40 - 60.
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