By Kyle Temme, PT, DPT
If you play tennis, golf, volleyball, or similar sports, you might start noticing pain in your elbow. It might start out as mildly irritating but progress with time, and before you know it, your once favorite sport now brings you pain instead of relaxation or enjoyment. If this is happening to you, chances are, you might be experiencing tennis elbow, a common and very treatable condition that can resolve with prompt attention from a physical therapist.
Tennis elbow, known as lateral epicondylitis (epicondylopathy or epicondylalgia) is an injury affecting the lateral epicondyle of the humerus. While the condition is commonly associated with tennis players, interestingly, the majority of people diagnosed with tennis elbow are not involved in the sport. Research has found that fewer than 10% of those with tennis elbow actually play tennis, meaning the remaining 90% develop this injury through activities unrelated to tennis.
What else can cause tennis elbow?
Tennis elbow is primarily caused by repetitive strain on the common extensor tendon of the elbow, often due to repeated gripping or wrist extension.
While racket sports like tennis are common culprits, those who work physically demanding jobs are also at risk. Activities such as repeated elbow flexion and extension (bending and straightening), constant gripping, and the use of vibrating tools can irritate the common extensor tendon.
​​Interestingly, shoulder strength may also play a role in the development of tennis elbow. Research has shown correlations between weak rotator cuff and scapular muscles and a higher incidence of the condition. Scapular strength and positioning are especially important—it turns out that the position of the scapula affects elbow positioning and grip strength. Patients with a more adducted (retracted) scapula tend to have stronger grip strength, while those with a more abducted scapula often have weaker grip strength. When scapular engagement is poor and grip strength is diminished, more stress is placed on the extensor tendon during grasping activities, potentially leading to overuse and injury.
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How do I know if it’s tennis elbow?
A physical therapist can help diagnose tennis elbow with a thorough assessment that includes a combination of subjective history, pain location, and specialized tests. By understanding your activities, symptoms, and the area of discomfort, they can accurately rule in the diagnosis and distinguish tennis elbow from other conditions.
Will tennis elbow go away on it’s own?
While tennis elbow can resolve on it’s own, it’s also possible that your tennis elbow may not heal or it may continue to become agitated. The natural, next step when you suspect you have tennis elbow is to see a physical therapist as the exercises and therapies for tennis elbow not only help promote healing, but are preventative.
Treatment for tennis elbow
Since overuse is the primary issue, activity modification plays a crucial role in the rehabilitation process. Continuing the activity that aggravates the symptoms without making necessary adjustments will only lead to further strain on the already overworked tendon, preventing it from healing. It’s important to either take a break or modify the activity to give the tendon time to recover.
However, while the tendon rests from activity, it also needs to be retrained through targeted, appropriately dosed exercises.. Research shows that tennis elbow is often not an inflammatory condition, but rather a tendinopathy. This means the pain is not typically due to swelling, but rather a degenerative process of the tendon from overuse. In tendinopathy, the collagen fibers in the tendon become disorganized, which weakens the tendon’s ability to handle stress.
To reorganize these collagen fibers and restore function, the muscle-tendon complex requires a balance of rest from the aggravating activity and progressive strength training. Simply resting the tendon without exercise may temporarily ease symptoms, but it doesn’t address the underlying issue of poor load tolerance. Applying the right intensity of stress to the tendon helps:
- Remodel the tendon collagen fibers to better handle stress.
- Strengthen the wrist extensor muscles, allowing them to absorb more of the load and reduce strain on the tendon.
Working with a Physical Therapist for Your Tennis Elbow
Tennis elbow can be a frustrating and persistent condition, but through physical therapy, most people will recover and return to their activities without limitation. The key to successful treatment lies in modifying aggravating activities, giving the tendon time to heal, and then gradually strengthening it through targeted exercises. In many cases, it may be necessary to address deficits in the shoulder to reduce the risk of reinjury of the elbow. Addressing the root cause takes time, there is no quick fix to treating tennis elbow. Research studies argue that someone should continue with rehab for up to 6 months prior to seeking alternative solutions.
If you’re dealing with tennis elbow, working with a physical therapist can help you develop a personalized treatment plan to get back to doing what you love without pain. Please feel free to reach out to us for a consultation! Our Therapists in any of our Evolution locations are trained to manage and treat tennis elbow, so check out one of our locations nearest you today.
