Updated: Feb 25
Known as an overuse injury, Tennis Elbow is a tendonosis, not a tendonitis. So what does that mean? Well a tendonosis occurs over time and leads to degenerative changes in that tendon. This particular injury affects the lateral side of the humerus, unlike golfer's elbow, which affects the medial side.
So the key to treating this, is in the description of the condition, it is a Tendonosis. This has occurred over time, it isn't an acute injury, the tendon hasn't been damaged in an acute way (torn), it is damaged due to the loads asked of it over a long period of time. So what can cause damage to this area over a prolonged period of time?
Overloading any muscle beyond its abilities over a long period of time will cause damage and this is no different in the elbow. It is commonly known as Tennis Elbow as tennis players classically suffer, often over gripping on their rackets causing overuse of this area, but this is the same of carpenters, electricians, hairdressers, therapists! Anyone who overuses their hands and wrists.
What can we do?
It is an overuse injury, so the first thing we need to do is to work out why the area is being overused. Is this a compensation for some other weakness elsewhere in the body. Is the hand and wrist just too weak for the job you are asking of it? So initial treatment such as ice, frictions, stretching and using a brace to protect the tendons all work well. But we need to look at the strength issues to truly fix it. It maybe that asking the tennis coach, if you aren't one, to check their grip size is correct, is all that is needed. But more likely some strengthening work will be needed and eccentric strengthening has been shown to work well when issues are mainly tendon based. So strengthening the wrist flexors are certainly something you need to do with this condition.
What effect has it had further up the body?
So fixing the tendon, although this may take a while, is relatively simple, if you take away the trigger causing it. But what effect has this weak forearm had on the rest of the body? Well let's follow the chain up to the neck. If you try to grip something but aren't strong enough to do so your upper arm will try to assist. Like in so many other wrist conditions, such as Carpal Tunnel, the issue is rarely just a localised one. The biceps will assist, causing the shoulder, over time to protract. This, in turn, will weaken the stability in the gleno-humeral joint, as the head of humerus starts to position itself in an anterior position. This stability weakness will cause the larger muscles of the shoulder to assist, causing them to over work and many of these muscles end up in the neck. Any protracted shoulder that is left for long enough is likely to lead to a forward head posture and now we have multiple issues running through the body that will lead to dysfunction in areas other than the elbow.
How to we treat the cause, not just the symptom?
So this condition has taken a while to come on, it is an overuse injury, so there was lots of time to spot this before it started to affect your client. Are you a massage therapist who is constantly treating those tight shoulders and arms? If this is due to rounded shoulders then perhaps suggest your client hits the gym and strengthens those shoulder muscles, it will help the whole line. Or partner up with a personal trainer and ask them to train this area.
Personal trainers, you are in the perfect position to spot this in the early stages. Perhaps your personal training client tells you they have just retrained as a carpenter and are really excited by their new job, check their posture, add in wrist, forearms, and upper back strengthening exercises so you can be sure their new job doesn't leave them in pain. Again, link in with a hands on therapist as they will certainly benefit from regular loosening.
If using this for CPD take a look at the question below:
Refresh your knowledge of which structures attach around the lateral epicondlye of the humerus. Think about the muscles, fascia, bones, even the nerves running around that area.
With these anatomical structures in mind, take a think about what happens when the extensor tendons become weak, how do the muscles compensate, what happens to the bones and nerves. Follow the line as far as you can.
Now think about what you need to rehabilitate to solve the issue completely, for the whole body, not just the elbow.
Then write it all up in your CPD logbook. For your FREE Reinge Education logbook, click here and sign up to our newsletter. For more information on this condition, have a look at our Bitesized CPD video on the subject by clicking here.
Reinge Education provide CPD courses for therapists and trainers across the country, these are in both an online format and in face to face workshops. Our unique combination of knowledge allows us to provide a fresh approach, looking at how anatomy affects function within the body, merging therapy and sports science to give a unique perspective.