Tennis Elbow: Your Guide to Preventing, Identifying, and Treating this Common Injury

Tennis elbow (also called lateral epicondylitis) is a condition affecting the origin of the tendon of the muscles that extend/straighten the wrist. There is local tenderness on the outside of the elbow at the common extensor tendon origin (where the tendon attaches to the bone) and aching and pain in the back of the forearm.

With 20 million tennis players in North America and the numbers growing, we know that at least half of these people will suffer from elbow problems, particularly if they are over the age of 35.

While this alone represents a significant number, we can add at least as many sufferers outside of the tennis community.

Tennis elbow is frequently seen in individuals carrying out forceful forearm rotation motions, heavy lifting and repetitive hammering, and is definitely not limited to tennis and other racquet sports.

Stages of Tennis Elbow:

Stage 1

– Immediate swelling
– Pain during activity
– Minor aching, usually after activity

Stage 2

– Constant swelling and scar development initiated pain during activity and at rest.

Stage 3

– Extensive scar tissue present
– Small tears in the tendon, sometimes leading to a large tear of the tendon
– Pain at rest, sometimes night pain
– Pain reproduced with numerous activities of daily living
If you are experiencing the Stage 1 symptoms, you should initiate the Home Stretching Program detailed below.

Daily Home Stretching Program

Often athletes and physical laborers develop strong forearm muscles and grip strength. These forearm muscles, if not stretched, will adaptively shorten and this places even more stress on the common extensor tendon.

If you can lengthen these muscles, you will reduce additional stress to the extensor carpi radialis brevis muscle and tendon at the common extensor tendon.

It is important to maintain a balance of flexibility in the forearm to prevent injury on the other side of the elbow by stretching the opposite side of the forearm.

1) Heat the forearm up in warm water for 10 minutes.
2) Do the 2 stretches as illustrated in the images below. Stretches should be held for 30 seconds and repeated 3 times, alternating from one side to the other.
3) Apply ice to the lateral elbow for 15 minutes with the elbow straight, resting on a table and the wrist bent down in a relaxed position over the edge of the table (palm down).

• Stretch the outer forearm muscles by placing your hand on a platform palm up and apply gentle pressure to bend your wrist backward. DO NOT apply downward pressure as this could damage the wrist joint.
• Remember to balance your stretches. Once you have stretched your forearm with your palm up, place your hand palm down on the platform and perform a similar stretch for the inner part of your forearm.

After doing this program for 2 weeks, if the pain has not changed you need to seek medical attention. If you are experiencing Stage 2 or 3 symptoms, you should begin Physiotherapy as soon as possible. In Physiotherapy you will be taught an eccentric loading wrist curl exercise once your full flexibility has been obtained. Your Therapist may apply modalities such as Ultrasound or Laser, and Interferential Current to facilitate further healing of the soft tissue.

Tennis elbow is a preventable condition if you:

1) Stretch the tight forearm muscles
2) Modify your technique at play and at work
3) Identify lateral elbow pain early and initiate the home stretching program
4) Seek help sooner rather than later

Early Identification

If tennis elbow is treated in the early stages, the tendonitis will respond well to Physiotherapy. Unfortunately clients are often seen when they are in the chronic phase, 3 months after the initial signs were noticed. In this case patience must prevail because often the recovery is a slow process.

But how can something as simple as swinging a tennis racquet injure my elbow?

Tennis elbow is an anatomical flaw in that the majority of muscles that extend our wrist come up the forearm and attach to the same common tendon. This creates a lot of stress on the tendon and with repetitive use, it slowly breaks down. Studies show that after the age of 35 the circulation to this tendon is not as good, so if injured it takes longer to recover.

The two most common sites for a tear to occur are where the tendon attaches to the bone and where the muscle attaches to the tendon. In the common extensor tendon, 90% of the tearing occurs in the extensor carpi radialis brevis muscle, which is a powerful wrist extensor.

Stretching doesn’t seem like enough. What else can I do?

If you are a racquet sport enthusiast experiencing these tennis elbow symptoms, we recommend that you review and correct your technique with your coach or local professional. If you are a laborer, we recommend that you consult with a senior staff about your workstation or request a temporary change in the workstation if you cannot modify your technique.

How can I be sure it’s tennis elbow?

If you have pain in your elbow but it doesn’t quite feel like the symptoms described here, or the discomfort is causing you concern, consult your Physician. There could be something other than tennis elbow causing you pain and the wrong self diagnosis could lead to the wrong treatment and further complications. Other structures which could be involved in lateral elbow pain are:

1) Joint cartilage on the end of the radius bone in elbow
2) Bursae-sacs of fluid between the tendon and the bone which swells up from overuse
3) Capsular lining around the joint, which gets pinched in the radiohumeral joint where the rotation takes place in the forearm
4) Annular and radial collateral ligaments
5) Posterior branch of the radial nerve that passes by the extensor carpi radialis brevis muscle muscle and tendon.

Note: Another way to reduce tension generated at the common extensor tendon is the application of a tennis elbow strap. The strap limits the expansion of the forearm muscles when you contract and therefore limits the amount of tension that can be generated at the common extensor tendon. Your Physiotherapist or Physician should prescribe the application of this strap.

Stay tuned to our website for our recommended exercises that help with tennis elbow, coming soon!

To book an appointment with Blair, please call our Beddington location at 587.355.2738

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