Tennis elbow originally got its name because of the large incidence amongst tennis players. This diagnosis is old fashioned because it can actually happen to anyone, even if you do not play tennis. Now, the most correct term to use is wrist extensor tendinopathy.
Anatomy
In the forearm there are two main groups of muscles. The wrist flexors sit on the palm side of your arm.The wrist extensors sit on the other side. Towards the elbow the muscles form a tendon allowing the muscles to anchor to the bone. The wrist flexor tendon attaches to the medial epicondyle bone. The wrist extensor tendon attaches to the lateral epicondyle bone.
The wrist flexors bend the wrist forward and the wrist extensors extend the wrist back. Tennis elbow is from over loading the wrist extensors.
Why does it happen?
- PAINTER THE WHOLE HOUSE - When painting it is common for people to flick their wrist causing load through the wrist extensors
- RESUMING ACTIVITIES AFTER A BREAK - eg: returning to your job as a brick layer, after a holiday
- PLAYING TENNIS - poor technique, individuals can begin to flick their wrist when playing tennis increasing the load to the wrist extensors
- COMPUTER USE
What happens to the tendon?
In the past wrist extensor tendinopathy (tennis elbow) was also referred to lateral epicondylitis. In Latin ‘itis’ refers to inflammation, so the term lateral epicondylitis means inflammation over the lateral epicondyle. With inflammation treatment is ice, elevation, stretching, massage. Rest of 6 weeks, let the structure heal and return to sport.
Whilst there may be some inflammation involved in wrist extensor tendinopathy (tennis elbow) when there is VERY severe pain, we now believe the pain is driven by a structural change within the tendon. The structural change happens as a result of sudden increases in load through the wrist extensors.
Normally the fibres of a tendon are arranged parallel to each other, allowing forces to move through it as you move your wrist. With a sudden increase in load through the wrist extensors the fibres become disorganised, meaning the tendon is not strong enough for the exercise/activity you are trying to perform. Treatment has to be focused on load modification and strengthening.
How do I know I have it?
You will have pain in your lateral elbow that is made worse with repetitive wrist movements. However, there are many other issues that can also produce a similar pain such as referred pain from the neck, shoulder weakness or a wrist injury.
How to fix it?
You must get an accurate diagnosis and so Physiotherapy is the best place to determine why the elbow pain is there.
Minimise movements that cause the pain
It usually takes 3 weeks to reduce the pain but it can take some months to improve your strength.
In Summary
Tennis Elbow is an old fashioned term to describe elbow pain that often occurs in the tennis playing population.
This pain is actually caused by wrist extensor muscle tendinopathy, which occurs as a result of increased activity/exercise that predominately requires the use of these wrist muscles.
Of course it can be caused by tennis, but elbow pain can also be caused by many activities/exercise including painting, brick laying or even computer use. Physiotherapy treatment is needed to rule out the input from a stiff neck, help you change the offending activity and progress you through wrist strengthening exercises.
Unless you specifically strengthen the muscles, which can take a few months, this pain will come and go depending on your wrist movements, for years sometimes!
