What is Tennis Elbow?
Lateral epicondylitis, otherwise known as ‘Tennis Elbow’, is one of the most frequently encountered conditions in the upper body and is recognized as the most common overuse elbow injury (Fleck et al. 2017; Richer et al. 2017). It is most frequently seen in patients between the ages of 35-55, with an equal distribution between men and women (Fleck et al. 2017). The perceived mechanism in the development of ‘Tennis Elbow’ is due to highly repetitive motions, making labourers increasingly susceptible (Fleck et al. 2017).
Mechanism of Injury
Due to the repetitive nature of the movements, microtears occur in the extensors of the forearm (the muscles bringing the top of the your hand towards you when your palm is down), with the extensor carpi radialis brevis muscle being involved in 90% of the cases. When the tissues continue to be overloaded without modifications, it is believed that there is a failure of the extensor tendons to heal appropriately, resulting in weakened tissues (Fleck, et al. 2017). The injured tissues can then result in the sensation of pain or burning on the outside of the elbow, leading to weakness, a loss of grip strength and function (Fleck et al. 2017; Richer et al. 2017).
Physiotherapy versus Medication
Episodes of lateral epicondylitis can last from 6 months up to 2 years, with a high recurrence rate (Richer et al. 2017). Medications like corticosteroid injection have been shown to have a beneficial effect in the short term but lack longevity of relief from symptoms in the longer term. It has also been found that there is no significant difference between physiotherapy with a corticiosteroid injection and physiotherapy alone (Olaussen et al. 2013). Due to the longevity of the condition, early physiotherapy intervention is essential in order to mitigate the lasting effects, as there have been significant positive effects seen in as little as 4 weeks of treatment (Richer et al. 2017).
Various treatment options are available in regards to lateral epicondylitis, with manual therapy, exercise prescription, ultrasound, laser therapy and extracorporal shock therapy showing beneficial effects in regards to the conservative treatment options available. Stretching and eccentric exercises that are prescribed by the physiotherapist have demonstrated positive effects in both the short and long term (Olaussen et al. 2013). The conservative options have been validated as a reliable option in the treatment of Tennis Elbow, as it has been shown to have a 97% success rate in the successful treatment of the condition (Knutsen et al. 2012).
Fleck, K.E., Field, E.D. & Field, L.D., 2017. Lateral and Medial Epicondylitis in the Athlete. Operative Techniques in Sports Medicine, 25(4), pp.269–278. Available at: http://dx.doi.org/10.1053/j.otsm.2017.08.005.
Knutsen, E.J. et al., 2012. Factors Associated With Failure of Nonoperative Treatment in Lateral Epicondylitis. , pp.2133–2137.
Olaussen, M. et al., 2013. Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy : a systematic review.
Richer, N., Marchand, A. & Descarreaux, M., 2017. Management of Chronic Lateral Epicondylitis With Manual Therapy and Local Cryostimulation : A Pilot Study. Journal of Chiropractic Medicine, 16(4), pp.279–288. Available at: https://doi.org/10.1016/j.jcm.2017.07.001.