Lateral epicondylitis also known as tennis elbow is a relatively common condition that is seen equally as prevalent in both men and women. Throughout this blog post the terms “tennis elbow” and “lateral epicondylitis” will be used interchangeably.
What is tennis elbow?
Tennis elbow is a condition characterised by pain located at the outer aspect of the elbow (common extensor tendon). Commonly this elbow pain is aggravated by extending the wrist and/or gripping objects.
Why is it called tennis elbow?
Although tennis elbow accounts for 75-80% of recreational tennis players who complain of lateral elbow pain, tennis players account for only 5% of patients that suffer from tennis elbow / lateral epicondylitis (1).
I don’t play tennis, how could I have tennis elbow?
By far the most commonly reported causes of tennis elbow are related to work activities. Between 35% and 61% of tennis elbow complaints are related to work. 27% are related to leisure activities. Whilst only 5% of all cases are attributed to playing tennis (2).
What causes tennis elbow?
Tennis elbow is caused by overuse of the extensor muscles in the lateral forearm. Repetitive extension of the hand leads to tearing of the wrist extensor musculature. Despite the name lateral epicondylitis (“itis” is a suffix meaning inflammation) the condition is degenerative, not inflammatory as once thought.
Occupations that are particularly prone to developing tennis elbow include, plumbers, carpenters, painters, cooks and repetitive keyboarding jobs. It is seen more often between the age of 40 and 60 years old. Tennis elbow results in an average time off from work of 12 weeks in as many as 30% of those suffering from the condition (3).
Tennis elbow management
Your chiropractor will assess your condition in order to best determine which treatment modalities and options are best suited to you. Management of tennis elbow varies depending on how long you have had the injury, lifestyle, causative factors and pain intensity.
In the acute phase rest from the aggravating activity is essential. Ice may also be applied to the affected area to aid pain relief. The use of a tennis elbow brace may be recommended by your chiropractor in order to further onload and rest the painful wrist extensor tendons located in the elbow area. Taping to support the elbow is also an option your chiropractor may use.
During the sub-acute phase your chiropractor may perform soft tissue massage techniques to the affected tight forearm musculature. Manipulation of the elbow, wrist, shoulder, neck and thoracic spine areas may be utilised to increase range of motion and improve the biomechanics of the upper limb and spine. Mobilisation of the thoracic spine has been shown to significantly increase pain free grip strength in patients suffering from tennis elbow (4).
All the chiropractors at Atlas Chiropractic are trained in dry needling techniques for tennis elbow treatment. Dry needling has been shown to decrease pain and increase grip strength in patients suffering from tennis elbow. A recent 2021 study found that dry needling afforded significant improvements in pain and function (2). This study compared dry needling therapy to corticosteroid injections. The study concluded that dry needling was more effective (5).
Atlas Chiropractic clinic also offers shockwave therapy. Similarly, to dry needling, shockwave therapy has been shown to reduce pain and increase grip strength in patients suffering from tennis elbow. The combination of dry needling and shockwave therapy is proven to be more effective than shockwave therapy alone (6).
Your chiropractor will instruct you on wrist exercises to perform depending on your pain intensity and stage of healing. In the early phases of the injury the exercises will be geared towards reducing pain. During the later stages of the healing process the exercises will be more challenging and aimed at resolving the issue and preventing having future episodes of tennis elbow.
An important factor in management of tennis elbow is lifestyle modification. Identifying the cause of tennis elbow is important and thus your chiropractor will spend time understanding the tasks and stresses placed on your body by your lifestyle. This is different for everyone, your chiropractor will give you advice regarding activity, ergonomics and lifestyle modifications that will aid in managing your tennis elbow and preventing future episodes.
Tips for tennis players suffering from tennis elbow
- Ensure your tennis racquet has the correct grip size for you.
- One method of determining the correct grip size is by measuring in inches the distance from the middle of the proximal palmar crease of the hand to the distal tip of the ring finger – see picture (7).
- Use natural gut strings on your racquet as these strings are the most elastic and best shock absorbing strings.
- Lower the string tension 1.5Kg to 2.5Kg lower than what you are used to.
- Gruchow HW, Pelletier D. An epidemiologic study of tennis elbow. Incidence, recurrence and effectiveness of prevention strategies. Am J Sports Med. 1979;7(4):234-238.
- Binder AI, Hazleman BL. Lateral humeral epicondylitis – a study of natural history and the effect of conservative therapy. Br J Rheumatol. 1983;22(2):73-76.
- Verhaar JA. Tennis Elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop. 1994;18(5):263-267/
- Zunke P, Auffarth A, Hitzl W, Moursy M. The effect of manual therapy to the thoracic spine on pain-free grip and sympathetic activity in patients with lateral epicondylalgia humeri. A randomized, sample sized planned, placebo-controlled, patient-blinded monocentric trial. BMC musculoskeletal disorders. 2020 Dec;21(1):1-1.
- Uygur E, Aktaş B, Yilmazoglu EG. The use of dry needling vs. corticosteroid injection to treat lateral epicondylitis: a prospective, randomized, controlled study. Journal of Shoulder and Elbow Surgery. 2021 Jan;30(1):134-9.
- Bağcıer F, Yılmaz N. The Impact of Extracorporeal Shock Wave Therapy and Dry Needling Combination on the Pain, Grip Strength and Functionality in Patients Diagnosed with Lateral Epicondylitis. Turkish Journal of Osteoporosis/Turk Osteoporoz Dergisi. 2019 Aug 1;25(2).
- 2011. Determining grip size for tennis racket. [online] Available at: <https://somepomed.org/articulos/contents/mobipreview.htm?27/54/28516#:~:text=The%20Nirschl%20criteria%20suggest%20that,and%20treatment%20of%20tennis%20elbow.> [Accessed 22 April 2021].