So You Have Elbow Pain?
You may have heard of the terms tennis elbow and golfer’s elbow, and chances are that if you have pain in your elbow, you probably have one of these two conditions.
Tennis elbow (also referred to as lateral epicondylitis, lateral epicondylalgia, and lateral elbow tendinopathy) is pain on the outside of the elbow (most noticed at the lateral epicondyle – see image). Whereas, golfer’s elbow (also referred to as medial epicondylitis, medial epicondylalgia, or medial elbow tendinopathy) is pain on the inside of the elbow (most noticed at the medial epicondyle).
Tennis elbow is a far more common complaint than golfer’s elbow, and for this reason we will continue to focus on tennis elbow. The advice, exercises, and treatment modalities will apply the same way for golfer’s elbow, except being on the inside of the elbow.
What Causes It?
Tennis elbow is prevalent in approximately 1-3% of the general population and is typically the result of repetitive activity, excessive loading, or new/unaccustomed activity.
Computer users are arguably the most commonly affected, due to repetitive movements associated with mouse and keyboard use.
Other examples of possible causes of tennis elbow include recent spurts of gardening or renovation work around the house, taking up a new sport or increasing the training load/frequency, and repetitive grip activities.
The pain you are experiencing is not solely linked to what is happening in the muscles or tendons at your elbow.
Multiple factors may contribute to your elbow pain, such as:
o Changes in the tendon tissue structure
o Sensitivity in the nervous system associated with pain
o Repetitive work tasks or postural strains affecting the upper limb
o Smoking history, older age, and rotator cuff pathology are also shown to have an association
How Long Does It Take To Resolve?
When it comes to research into treating tennis elbow (and golfer’s elbow) the prognosis is variable. One important thing to remind yourself of is ‘the majority of cases will resolve with or without treatment’, though implementing or participating in various treatment options will likely assist in pain reduction, or shorten the time you are experiencing tennis elbow.
Some authors report natural history of tennis elbow being 6 months – 2 years. Some studies have reported over 50% of individuals seeing a general practitioner (GP) for their pain still experience pain after 12 months.
The natural progression of your pain is individual, with many daily factors contributing to the problem, so it is not possible to know how long your tennis elbow complaint will last.
So What Treatment Should You Seek?
Firstly, this is very individual, so if a treatment is not working for you (i.e. you are not noticing any improvement in 6-12 weeks) then try something or someone else.
o Manual therapy has shown improvements in pain and grip strength. This may include massage, mobilisation of the elbow, wrist, and neck, and manipulation of the elbow, wrist, and/or neck.
o Exercise is currently the best intervention for tennis elbow (and golfer’s elbow). Exercise may consist of gentle range of motion, weighted or band-resisted exercises targeting forearm muscles, or stretches and mobility.
o Dry needling and acupuncture appear to have some positive outcomes on pain
o Cortisone injections may provide short-term pain relief (average 2-6 weeks).
o Braces, compression sleeves, and taping may also provide pain relief when in use. This can be a simple and effective way of continuing to work with reduced pain and disability (if rest from work is not possible).
o Laser, ultrasound, and shockwave therapy have shown some short-term benefit, but no better than placebo or other treatments.
o Surgery may be an option if the elbow pain fails to resolve in the expected time, or is progressing to a level that affects daily function severely enough. Surgery is often not advised unless the complaint is not responding to typical intervention or exceeds normal natural history.
Combination treatment is the best current treatment, which typically includes manual therapy, exercise, and activity modification (to reduce or eliminate loads on the wrist and forearm).
There is hope! Just remember…..
“The majority of Tennis/Golfer’s elbow cases will spontaneously resolve regardless of what treatment you seek”
– Though manual therapy, exercise, and activity modification have all been shown to reduce pain, improve grip strength, and improve outcomes
Exercises You Can Do At Home
o Self-massage to the forearm and elbow muscles. Work within a tolerable pressure limit. Work through the muscles of the forearm and elbow, using kneading, squeezing, stripping techniques. Alternatively, you can use a lacrosse ball or similar to massage the forearm muscles.
o Exercises to focus on isolated wrist extension. Lay the forearm and wrist on a flat surface and extend the wrist in a controlled manner, while focusing on not extending the fingers. Repeat 10-20 times
o Light strengthening of the wrist extensors. Using a light weight or resistance band, with the wrist in neutral (not bend left or right), and the elbow bent and resting on a flat surface. Lift the wrist back into extension and then lower back to neutral. Repeat 10-20 times
o Isometric wrist extension. Using the opposite hand, hold the hand on the affected side and attempt to extend the wrist while the other hand resists the movement. Hold this resisted contraction for 30-60 seconds. Repeat several times