Those we have recently seen in clinic have commonly reported changes to their exercise routines as a result of lockdown. For some, exercise has been difficult to maintain during this time and the ability to get back to your previous fitness levels will be a huge success. For others — maybe as a result of more free time — there has been a conscious effort to try and do more physical activity. Whether your activity has been more gardening or P.E. with Joe Wicks, the benefits to physical activity are clear.
What is Tennis Elbow? #
Tennis elbow is a common musculoskeletal complaint. The pain or discomfort is located on the tendon attachment at the bony prominence on the outer side of your elbow. It involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers, as well as stabilising your wrist. The symptoms arise when the wrist is required to maintain a stable position to produce force e.g. gripping shopping bags.
Although this injury can happen to anyone, it appears to be most common in people aged between 40 – 60 and affect men and women equally. Although named ‘Tennis Elbow’, this complaint is seen frequently in non-tennis players and up to 3% of the UK is said to be experiencing this it.
What Symptoms Should I Expect? #
For most, symptoms will be located around the outside of the elbow, in particular over the bony prominence. The pain may also extend into the back of the forearm and grip strength is usually weakened. It is usually exacerbated with day to day activities such as gripping shopping bags, preparing meals, taking off lids or shaking hands (although that has undoubtedly been less of a problem recently).
Every person will have a very different experience of, and reasons for, their symptoms. These will always be specific to you. The pain, felt on the outside of the elbow, can range from mild discomfort to an inability to function as normal.
If you have symptoms in the elbow following recent trauma, a loss of range of motion or changes to the sensation in your arm and hand, then it would be worthwhile discussing this further with a clinician.
Other Factors to Consider #
As mentioned already the most obvious contributing factor for many will be a change in your usual activities, hobbies or lifestyle. Tennis Elbow has been associated with multiple lifestyle contributors, which can include: any co-existing medical complaints, your work, the support you receive at work, social circumstances, stress levels and any current symptoms in your neck or shoulder. Therefore, when considering possible contributing factors, it is likely that these will be different for every individual.
What Can I Do About My Elbow pain? #
Patients with tennis elbow will normally experience a good recovery. Often an active approach or exercise programme proves to be very important. Strong scientific evidence demonstrates those prescribed an exercise plan see significant improvements in both the medium and long-term stages of recovery. A general ‘google’ search for treatment of tennis elbow will result in varying recommended treatments, with limited scientific weighting, and ultimately these may prove ineffective when applied to your individual injury.
The type of exercise required will be individual to you and your current complaint, and is likely to consist of specific (focusing on the elbow and surrounding muscles) and some non-specific exercises (building strength in the whole body or neighbouring area e.g. the shoulder), as well as looking at your approach to fulfilling your moderate or vigorous levels of physical activity. If there is a failure to see any improvement, a reflection on the diagnosis and contributing variables may be required with your treating clinician. At this point your clinician will consider the input of other disciplines and treatments, which is where our multidisciplinary team comes in handy.
Below are some FAQs we have been asked when working with patients who have elbow pain:
- Should I stop painful activities?
Continuing activity is important, but the amount and possibly type of activity may need to be temporarily modified.
- When should I seek help?
Professional guidance should prove beneficial if you have high levels of pain and discomfort, your function is reduced, your symptoms are persistent or have upcoming competitions/events you have concerns about competing in.
- Will a brace help?
There is some support for the use of these, in reducing symptoms during the painful activity but it is unlikely to impact your long-term outcome.
- Will an injection help?
Although most feel immediate relief, cortico-steroid injections have shown poor long-term outcomes, when compared to no treatment at all and a greater rate of recurrence, therefore usually is not advised.
- Are there any exercises I could try?
Exercise prescription should be individual to you, and it is important that the exercise intensity is tailored for you also; compared to a general programme. The exercises prescribed will be a mix of both specific and general considerations which your treating clinical will advise on. Please see the videos below for some basic exercises.
A couple of points to consider:
- Initially trial 3 sets between 8 – 15 repetitions. These parameters can be modified accordingly, but to see benefit some challenge is likely required.
- You should not have any discomfort for hours-days after initiating your exercises.
Basic Exercises for Non-Tennis Players
If you are experiencing pain on the outside of your elbow, I would suggest seeing one of our team for an initial assessment to begin your recovery journey. If you’re aware of the cause a Physiotherapist would be a good point of call, however if you are unsure what has caused it, a Consultant in Sport, Exercise and Musculoskeletal Medicine is the person you should to speak to first.
References:
- Winston et al 2015 Tennis Elbow: Definition, Causes, Epidemiology. Tennis Elbow
- Titchener 2012. Risk factors in lateral epicondylitis (tennis elbow): A case-control study. Journal of Hand Surgery 38
- Bisset et al 2005. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine. 39