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. If you place your fingers on the muscles just below the lateral epicondyle and actively extend your wrist, you will feel them contract beneath your fingers. The term lateral epicondylitis refers to inflammation (itis) of the lateral epicondyle where the tendons attach. This condition can have several causes but all involve activities that rely on wrist extension such as the back swing of a tennis racket. Below are some ways lateral epicondylitis can develop:

• Increasing the volume of an activity too quickly
• Not taking enough rest from an activity
• Performing an activity with suboptimal form or technique
• Muscle weakness, motor control impairments or muscle length impairments that stress the tendons of the muscles

Tendons are strong but when repeated stress exceeds the tolerance of a tendon it can become inflamed or irritated at the attachment point. When this happens, symptoms of lateral epicondylitis can develop. If you have any of the following symptoms you may have lateral epicondylitis:

• Aching or burning pain at the lateral (outer) elbow sometimes radiating down toward the wrist
• Stiffness at the elbow
• Weakness in the forearm muscles
• Grip weakness
• Tenderness over the extensor muscles and tendons near the elbow
• Initially, pain may be present only when participating in activities requiring repeated wrist extension
• Over time symptoms can be present even at rest or at night

If you decide to work with a physical therapist to help correct your elbow issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY TREATMENT FOR LATERAL EPICONDYLITIS

As noted above, the approach to managing chronic or acute cases of lateral epicondylitis tends to differ. If you have a new or newly-exacerbated case of tennis elbow, inflammation around the tendon is likely present. While your physical therapy program will always be individualized, below are physical therapy treatments often prescribed to address acute lateral epicondylitis:

• Education on the likely cause as well as the pathophysiology of tennis elbow
• Recommendations on activity modification and rest to allow inflammation to subside
• Application of modalities such as ice, ultrasound, electrical stimulation or laser therapy to manage pain and inflammation
• Recommendations on the use of splints, taping or bracing as needed to minimize discomfort and allow for healing in the acute phase

As inflammation subsides, or in the case of a chronic tennis elbow where tendon degeneration is the primary issue, addressing contributing factors and improving tendon stiffness and muscle weakness are the primary goals of physical therapy. Below are common physical therapy treatments to address this type of tennis elbow:

• Soft tissue mobilization using tools like ASTYM, dry needling or Graston to remodel the injured tendon and encourage collagen production
• Exercises to enhance tendon stiffness and make it more resilient to stress
• These are often eccentric-focused exercises with special parameters around pain and symptom-provocation
• Exercises to address strength, muscle length and neuromuscular control around the elbow, forearm and wrist
• Training in movement technique and biomechanics to reduce repetitive stress on the tendons during sport, work or daily tasks
• Graded return to full activities