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Anyone for Tennis?

Tennis Elbow is one of those funny conditions that sound almost comical, until you get it yourself. Perhaps surprisingly, very few people with Tennis Elbow actually get the symptoms from playing tennis, but rather from either a short burst of intense forearm use or prolonged overuse associated with poor technique. D.I.Y. can often be the culprit. A weekend of painting walls, screwing up shelves, lifting heavy furniture or laying patio slabs may cause some local damage to muscle around the elbow. Over time pain in the elbow and forearm begins to effect any and all activities of the arm including driving, playing various sports, even using a pen or computer mouse. When it is really bad, symptoms can even affect sleep, as the weight of the body lying on the sore arm sets off pain in severe cases.

So what exactly is Tennis Elbow? To give it the correct title, lateral epicondylitis starts as a local overuse injury to the soft tissues, the tendon or muscle on the outside of the forearm, just on or below the bony point of the outer elbow. The soft tissues become injured, initially involving microscopic tears which damage the cells. Think of it like an old versus a new shoe lace. The new shoe lace is firm and strong. It is difficult to break. An old well used lace becomes frayed and less firm. Eventually the fibres in the lace shred apart. As this occurs the strength of the shoelace is compromised. It becomes prone to breaking. Ultimately the lace requires replacing with a new one.

In lateral epicondylitis excessive force from repeated overuse or overload causes microscopic tearing of the muscle or tendon. This leads to tiny bruising around the damaged area, accompanied by swelling. If untreated the swelling becomes like a sticky glue, impacting on the smooth function of muscle and other soft tissues in the local area. In persistent cases, this swelling may also involve the two joints of the elbow and a major nerve which supplies muscles of the hand and wrist. Initially the pain may be local to the elbow bone but in severe cases it can radiate down the forearm. The pain is always worse with activity, but when severe a dull ache can persist at rest. If the pain has a burning quality it is considered that the underlying nerve is also involved. This is more difficult to treat as very often when the nerve is involved, the spine can show associated symptom as also. Local stiffness and pain can be palpated in the mid neck and upper back in chronic Tennis Elbow.

It is this complexity that can make it difficult to both diagnose and treat. There is no single sure fire cure for lateral epicondylitis. Usually a combination of treatments approaches and lifestyle changes will be needed to bring about full recovery.

Initial early treatment can be home based: rest, avoid tasks that bring on pain, local use of ice and application of anti-inflammatory gel. If symptoms persist longer tha three weeks in spite of home approach, or if they are worsening, next step is a combined one of taking a course of anti-inflammatory medication prescribed by a G.P. and receiving treatment for the problem: either physiotherapy or acupuncture. In a straightforward case, this should clear symptoms in a couple of weeks. In a more complex case, usually where pain is persistent over a prolonged time, the Chartered Physiotherapist will manually work on the inflamed tendon or muscle, restore movement to the two joints in the elbow region and the tethered nerve, adding restrengthening to the muscle when it is ready. S/he should also check and treat any stiffness that has developed as a secondary consequence in the neck and upper back.

A step-wise graduated rehabilitation programme is an important component of recovery. Without this the damaged muscle will not regain strength and is liable re- tear.

Factors that aggravate the problem will be discussed. Advice will be offered on altering these factors. For example, advice on correct gripping, reducing excessive gripping of the steering wheel, increasing the size if the grip of the tennis racquet, hurley or golf stick, using a fatter pen or pencil, reducing the workload of the sore arm, perhaps by moving the mouse to the opposite and avoiding carrying things on the sore arm.

Sometimes even all this is not enough to clear pain. The final steps are to have steroid medication injected to the inflamed area. Though this often brings great short term relief of pain, symptoms can re-occur unless aggravating factors have been well addressed. A small number of intractable cases require surgery to clear away scarring around the tendon before repositioning the tendon on the bone so that it operates from a slightly different angle. Surgery for Tennis Elbow is not without risks and can take a long time to recover from, so this route is a true ‘last resort’.

So, if your elbow region is sore, don’t ignore it. Early self-management is essential. If this does not fully resolve the pain, it is best to seek the assistance of your local Chartered Physiotherapist and G.P, who will address this painful presentation as a team, treating the symptoms locally as well as with medication.
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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