How To Diagnose And Self-Treat Tennis Elbow
Lateral (outside) elbow pain, also known as ‘Tennis Elbow’ or ‘Lateral Epicondylitis/Epicondylalgia’, effects 1-3% of the population with the majority of cases occurring between the ages of 35-54.
HOW DO WE DIAGNOSE IT?
When a client presents with lateral elbow pain, we can determine whether it is likely to be tennis elbow by resisting the extension of the wrist.
Place your forearm on a table with your hand bent over the end so that your fingers are pointing to the floor, attempt to raise the hand while resisting this movement with the opposite hand.
If this reproduces your elbow pain, it is likely that you have tennis elbow. To make sure of this diagnosis resist your third finger rather than the entire wrist in the above test. If both are positive, it is more likely that you have the correct diagnosis.
Other sources of pain could be referred pain from the nerves in your neck, but we would also expect you to mention:
- pins and needles or numbness,
- also that you have a stiff or painful.
(Bisset & Vicenzino, 2015)
TENDONITIS OR TENDINOSIS? I AM CONFUSED!
After this, we need to determine whether you have a tendon-itis or -osis or both!!
If it is tendonitis, you will respond well to ibuprofen BUT if it is an ‘osis’ you will not (Bass, 2012).
However, both need to follow a graded strengthening program to return you to pain-free function.
Put a weight in your hand, or can of beans, with your forearm resting on a table and your palm off the edge facing down. Lower and lift your hand for 3 x 15 reps.
We want you to work into a maximum 4/10 on a pain scale (0 = no pain and 10 = Wort pain imaginable) but not aggravate it to the point that it hurts too much to use your arm afterwards.
(Khan et al., 2000)
HOW DO WE PREVENT THIS FROM REOCCURRING? …….
It is complicated, but I will try to make it simple.
Tendons generally become painful due to a sudden increase in loads. An example of this is playing two games of tennis in a day rather than the usual one game or returning to gardening after the winter period, i.e. starting a familiar activity after a period of rest.
We need to load tendons progressively. Therefore, aim for a phased return to activity whether that be a sport or a daily activity which is physically more demanding than your daily activities.
ARE THERE ANY OTHER CONTRIBUTING AREAS?
Another common presentation is when people compensate for shoulder weakness by increasing their grip which leads to an overloading of the elbow. Assessing the stability of the shoulder and improving the movement control at this joint will provide a stable platform for the elbow and wrist to work off.
HOW LONG WILL IT TAKE TO RECOVER FULLY?
We would expect the pain to improve from anywhere between 2 – 12 weeks but full recovery of a tendinosis injury can take up to 9-12 months depending on several factors (Bass, 2012).
Due to the range of possible structures that can contribute to this injury, it’s worth having an assessment if you haven’t felt improvements after 6-12 weeks.
Bass E. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. International Journal of Therapeutic Massage & Bodywork. 2012;5(1):14-17.
Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother. 2015;61(4):174-181.
Khan K, Cook J, Taunton J, Bonar F. Overuse tendinosis, not tendinitis: a new paradigm for a difficult clinical problem. Phys Sportsmed.2000;28:38-48.