Physical Therapy for Tennis Elbow
Physical Therapy for Tennis Elbow
We’ve Got No Love for Tennis Elbow
If you are experiencing pain on the outer elbow or forearm with wrist, hand or elbow movements, you may have a condition called tennis elbow. Known formally as lateral epicondylitis, tennis elbow is a condition in which the tendons on the outside of the elbow become inflamed, irritated, and painful resulting in the symptoms noted above. Not a tennis player? While this condition was named due to the stressing of these tendons during an improper tennis swing, this condition is not limited only to tennis players.
Let’s dive deeper into this condition and how physical therapy can be used to treat it.
ANATOMY OF TENNIS ELBOW
If you lay your forearm out on the table in front of you, palm up, the bony area on the outside of the elbow is known as the lateral epicondyle. A sheath housing several tendons attaches to the bone here and acts as an anchor point for muscles that extend the wrist and hand. Repetition of these movements can stress the tendons at their attachment points under certain conditions. When this happens, the irritated or inflamed tendons cause pain, burning or aching at the lateral (outside) of the elbow and sometimes extending down toward the wrist.
Symptoms may initially be present only during activities requiring repetitive wrist extension such as during a game of tennis, but can eventually become symptomatic even at rest. In more severe cases you may experience stiffness in the elbow and even weakness in the forearm and hand with gripping can occur over time. Pain may occur at night.
WHAT CAUSES THIS CONDITION?
Tendons are built to withstand a lot of force but repetitive stress which exceeds the tolerance of the tendon can lead to injury. The overloading of the tendon may be caused by ramping up the volume of a new activity too quickly, due to muscle strength or length impairments, movement pattern inefficiencies or biomechanical errors in and around the wrist and elbow.
While this condition is termed “tennis elbow” due to its prevalence among racket sport athletes such as tennis and racquetball players, any activity that requires repeated wrist extension can lead to tennis elbow. Painters, plumbers and carpenters, for example, are prone to developing this condition because of the tools they use and the movements they perform for their jobs. Butchers, cooks and workers in the automobile industry are similarly at risk.
Initially, the symptoms of pain and soreness may be caused by localized inflammation–known as tendonitis ( “itis” = inflammation ). In this case anti-inflammatory medications and other treatments aimed at reducing inflammation are often effective as long as the tendon is allowed to rest.
Oftentimes, however, ongoing symptoms are not caused by persisting inflammation which is why anti-inflammatory medications and ice, for example, may lose effectiveness over time. In this case the tendon is likely not inflamed but has undergone some degeneration leading to chronic symptoms. This is called tendinopathy and likely accounts for ongoing symptoms in many chronic tendon injuries. Why does this matter? This matters because while rest may be helpful for an inflamed tendon, it is not the best treatment for tendinopathy. In fact, it may have the opposite effect.
PHYSICAL THERAPY CAN HELP
Tennis elbow can often be diagnosed through a careful history and examination. During an initial evaluation, your physical therapist will ask you about when the symptoms started and if you started any new activities or increased the time or intensity of these activities before the symptoms began. They may also ask you about how long your symptoms take to resolve and what you can do, if anything, to help reduce them.
Examining the arm will help your physical therapist to determine the most likely cause of your symptoms and to identify contributing factors such as strength asymmetries, range of motion deficits, tissue mobility problems or biomechanical errors in the arm. This will help your therapist to develop a comprehensive elbow physical therapy treatment plan.
If your therapist suspects your symptoms are caused by tendonitis, you can expect your treatment may initially include modalities such as ice, ultrasound physical therapy, or electrical stimulation to manage pain and swelling, and education on your injury including any necessary activity modifications. They may also apply gentle manual techniques such as passive range of motion and possibly taping or bracing to protect the injured area and allow the body’s healing process to proceed.
If your therapist suspects your symptoms are no longer inflammation-based and more likely a tendinopathy, there will likely be less emphasis on passive modalities that would normally be used to calm inflammation, and more emphasis on interventions that will help remodel the structure of the tendon. The goal of treatment for tendinopathy is to apply graded stress to the tendon and increase its stiffness so that it becomes more resilient to the repetitive forces of your work tasks and favorite sports. Resting the tendon will not contribute to this process and will predispose you to experience recurrence of these symptoms when you resume your previous level of activities. To do this correctly, your PT will guide you on appropriate dosing of specific activities and may also utilize tools such as ASTYM or Graston to encourage collagen production and remodeling.
Whether your physical therapy program will emphasize calming inflammation or remodeling the tendons you can be sure that addressing other contributing factors such as muscle weakness, flexibility impairments and poor biomechanics is also important to prevent injury recurrence. This is another example of how working with a physical therapist can get you faster and more long-lasting results. With their expertise they can individualize your program to treat the factors that are causing your specific case of tennis elbow.
So if you have been experiencing pain or tenderness along the outside of your elbow and forearm, grip weakness or elbow stiffness, call and set up an appointment with a physical therapist at Evolve. Our therapists do not just treat symptoms, but we get to the root of the problem. We strive to enable our patients to live pain free, continue doing the activities they love, and prevent the recurrence of related issues.
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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