Every year, it’s the same.
Wimbledon brings me straight back there.
Me (Sampras – a bit dull, but highly effective) against my neighbour (Agassi – he was always the flash one) duking it out over three days on a court carved out of a field in Kilkenny. When Mahut finally outlasted Isner 70-68 in the fifth set at Wimbledon in 2010, we scoffed. Our game was more like 70 sets to 68. Agassi won; and if the World Cup hadn’t been starting the next day, I’m sure it would have scarred me forever.
In all those years of our long, hot tennis matches, however, I don’t remember ever suffering from Tennis Elbow. And that’s the thing about it. It is estimated that only 5% of cases are from tennis.
What is Tennis Elbow?
So, let me explain. Lateral elbow pain is an extremely common presentation among manual workers, computer workers and certain sports people. Pain around the lateral elbow is known by a variety of names including ‘‘tennis elbow’’ and ‘‘lateral epicondylitis’’. The use of the term epicondylitis was questioned over time. Any medical term that ends with “itis” generally refers to an inflammatory condition. But numerous studies of tennis elbow have failed to show inflammatory cells in the affected tissue.
Tennis elbow has been described in more recent literature as a degenerative process which is associated with overuse of the wrist extensor muscles which in turn causes collagen disarray in the tissue. It is a painful and debilitating musculoskeletal condition that impacts substantially on society and extensively challenges the healthcare industry (Bisset et al., 2005). It is characterised by pain around the lateral elbow which often radiates toward the forearm, reduced forearm extensor muscle strength, pain on resisted wrist extension, and reduced grip strength.
What should it be called?
Some people call it “tennis elbow”, but it rarely effects tennis players and others call it lateral epicondylitis. However, it’s not inflammatory (as suggested above) and it’s not a condition which generally affects the lateral epicondyl itself, but the tendon which attaches to it. Confused? Don’t worry – so is half of the medical world! This condition generally effects the Extensor Carpi Radialis Brevis Muscle (ECRB), so we shall therefore, from now on, refer to it as Extensor tendinopathy.
How is it caused?
Research has shown that the lesion* where the tendinopathy exists has an excess of both fibroblasts and blood vessels. This consists of a large number of nociceptive**/painful fibres which may explain why the condition is often so painful. With continued use after the initial stages of discomfort, the lesion may develop small microscopic tears at the tendon, or the tendinopathy may develop after an initial tear. Extensor tendinopathy is reported as being among the most common upper extremity syndromes, especially amongst those exposed to repetitive hand tasks and awkward upper extremity postures. This condition may affect any age group, but its peak incidence generally occurs between the ages of 40-50.
When it effects tennis players, it is often associated with using a new racquet, new grip, playing excessively against the wind or when hitting late (thus overusing the extensor muscles, as the body weight is not correctly transferred). For the average Joe Soap, it may occur due to a single incidence of over exposure of the wrist extensors when using a screw driver over a weekend or spending excessive time on the computer with poor ergonomics.
How do we treat Extensor tendinopathy?
Despite a reasonably straight forward clinical picture, there is little agreement in the literature on the exact cause(s) of the condition, which is thought to be multi-factorial in nature. As a result, no single treatment has been proven to be totally effective in the treatment of this condition.
Therefore, integrating a combined approach which includes ergonomics into the physiotherapy treatment is essential in the management of this condition. Although there is a wide variety of treatment options, to date no treatment has emerged as the superior option. The best approach is an in-depth assessment of the wrist, elbow, forearm, thoracic spine and cervical spine to identify where the injury has come from. When the diagnosis and reason for onset is established, a combination of various treatments such as soft tissue techniques, dry needling, manipulation, mobilisation and concentric/eccentric strengthening exercises is essential in the management of this condition.
However, the key to the resolution of Extensor tendinopathy is not the treatment applied, but the management of the aggravating factors and the management of how and when the treatment is applied. Tendinopathies are particularly difficult to manage and can often be problematic for years.
Don’t become a victim of persistent overuse injuries – such as Extensor, tibialis posterior, Achilles or patella tendinopathies. Make an enquiry or appointment to see one of our specialist team of physiotherapists, who will not only treat your over-use injury, but will manage your condition and get you back to activity fitter and stronger than before the condition began.
*a lesion is a region in an organ or tissue which has suffered damage through injury or disease
**a ‘nociceptor’ is a receptor that responds to damaging or potentially damaging stimuli by sending “possible threat” signals to the spinal cord and the brain