Lateral epicondylitis or tennis elbow is an inflammation of the forearm tendons (most commonly the Exensor Carpi Radials Brevis Muscle). This inflammation occurs as a result of hand and wrist overuse. When repetitive gripping and carrying activity occurs over a period of time, micro tears can occur in the tissue causing pain, inflammation and limitations with activity.
The pain is typically describes as “achy” or “sharp” depending on how long you have had it. Symptoms occur on the lateral aspect of the elbow and may radiate into the forearm or into the back of the arm. Tennis elbow occurs in people primarily between ages 30-50.
When evaluating the elbow, proper screening of the neck and upper extremity must be performed as well. Sometimes nerve root involvement in the cervical spine (primarily C5/C6) can cause a weakness in the wrist extensors presenting similar to symptoms of tennis elbow. Specific testing and palpation techniques will help determine the cause of the symptoms.
Several studies have shown that proper rest and exercises are key in recovering from tennis elbow.
A research study conducted by Peterson et al. evaluated tennis elbow outcomes using a randomized control clinical trial. Exercises versus wait-listed (non treatment) groups were analyzed in chronic tennis elbow subjects.
The treatment group received a daily exercise regimen with progressive exercises for a three month period. The reference group continued to perform their normal daily routine with no intervention. The exercise group had faster recovery than the reference “wait and see” group.
Following simple and consistent daily exercises will significantly reduce tennis elbow symptoms leading to return of previous activity.
I’ve listed some important self management techniques and exercises to follow for treatment of tennis elbow:
Stretching:
Wrist Extensor Stretch
1) Extend your arm in front of you with palm down
2) Bend your wrist pointing your hand toward the floor
3) With your opposite hand, gently bend the wrist further until you feel a moderate pull in the forearm.
Wrist Flexor Stretch
1) Extend your arm in front of you with palm up
2) Bend your wrist pointing your hand toward the floor
3) With your opposite hand, gently bend the wrist further until you feel a moderate pull.
* Hold stretches for 30 sec. Repeat 3x. Perform 3x daily.
Ice Cup– Ice slows blood flow to the area and helps to reduce inflammation. Move the ice cup continuously for 3-5 min. over the area. Perform up to 3-5x daily.
Massage and Rolling: Performing massage, rolling and/or trigger point pressure to the area will help to loosen the soft tissue and provide more extensibility. This flex bar can be used for self rolling and eventually forearm gripping and strengthening when appropriate.
Strengthening – Initiation of strength should start when the pain has calmed down. Proper training of the shoulder and upper extremity will help prevent recurrence of symptoms. Conditioning the entire body as well as focusing on postural correction will also aid in the recovery process.
Shown here is a beginner strengthening exercise for the forearm. Start with a 1-3 lb dumbbell. With the arm supported, extend the hand upward then lower slowly. Repeat 2 sets of 10-15 reps. 1-2x daily.
References:
Magnus Peterson, Stephen Butler, Margaretha Eriksson & Kurt Svärdsudd (2011) A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis), Upsala Journal of Medical Sciences, 116:4, 269-279.
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