Tennis Elbow Exercises | Symptoms and Treatment

Tennis Elbow

Tennis elbow is a condition where the outer part of the elbow becomes sore and tender. It is a condition that is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anybody. One method of eliminating the pain is by perfoming tennis elbow exercises. Symptoms include:

• Pain on the outer part of elbow (lateral epicondyle).
• Point tenderness over the lateral epicondyle – a prominent part of the bone on the outside of the elbow.
• Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.
• Activities that use the muscles that extend the wrist (e.g. pouring a pitcher or gallon of milk, lifting with the palm down) are characteristically painful.
• Morning stiffness.

The strongest risk factor for lateral epicondylosis is age. The peak incidence is between 30 to 60 years of age. No difference in incidence between men and women or association between tennis elbow symptoms and the dominant hand has been demonstrated.

The pathophysiology of lateral epicondylosis is degenerative. Non-inflammatory, chronic degenerative changes of the origin of the extensor carpi radialis brevis muscle are identified in surgical pathology specimens. It is unclear if the pathology is affected by prior injection of corticosteroid.

Among tennis players, it is believed to be caused by the "repetitive nature of hitting thousands and thousands of tennis balls" which lead to tiny tears in the forearm tendon attachment at the elbow.

Tennis Elbow Symptoms

The diagnosis is made by clinical signs and symptoms, which are usually both discrete and characteristic. There should be point tenderness over the origin of the extensor carpi radialis brevis muscle from the lateral epicondyle (ECRB origin). There should also be pain with passive wrist flexion and also with resisted wrist extension (Cozen's test), both tested with the elbow extended.

MRI typically shows fluid in the ECRB origin. There may also be a defect in this tissue. The use of the word "tear" to refer to this defect can be misleading. The word "tear" implies injury and the need for repair--both of which are probably inaccurate and inappropriate for this degenerative enthesopathy.

Tennis Elbow Exercises

There are several recommendations regarding symptoms, prevention, treatment, and avoidance of recurrence that are largely speculative including:

1. Exercises including stretches and progressive strengthening tennis elbow exercises to prevent re-irritation of the tendon.
2. Progressive strengthening exercises involving use of weights or elastic theraband to increase pain free grip strength and forearm strength;
3. Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff, scapulothoracic and abdominal muscles by Physiotherapists to help reduce any overcompensation in the wrist extensors during gross shoulder and arm movements;
4. Soft Tissue Release or simply Massage can help reduce the muscular tightness and reduce the tension on the tendons; and
5. Strapping of the forearm can help realign the muscle fibers and redistribute the load.
6. Use of a racket designed to dampen the effect of ball striking.

Other treatments with limited scientific support include:

• Acupuncture
• Blood injection (possibly augmented by plateletpheresis)
• Botulinum toxin
• Extra-corporeal shock wave therapy (lithotriptor)
• Heat therapy
• Immobilization of the forearm and elbow using a splint for two to three weeks
• Local injection of cortisone and a numbing medicine
• Low level laser therapy
• Platelet-rich plasma
• Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area
• Sclerotherapy
• Trigger point therapy

There are clinical trials addressing many of these proposed curative treatments, but the quality of these trials is generally poor.

We have some very good links to tennis elbow exercises and treatment that can help alleviate the pain of tennis elbow.