I don’t even play tennis but my physio told me I have tennis elbow! What the heck is up with that? Lateral epicondylitis or tennis elbow or as it is commonly referred to affects about 1-3% of the population. People between the ages of 45-54 are more commonly afflicted with the condition. Risk factors for developing this condition are forceful or repetitive movements.
Tennis elbow is generally known as pain that presents on the outside of the elbow. Though the pain may feel the same, there may different tissues at fault for the pain that we experience with this condition and each may require different forms of treatment.
The general consensus on why we get pain in our lateral epicondyle, is that there is a breakdown in the tendon’s sheath near where its inserts on the bone (lateral epicondyle). Basically, lateral epicondylitis is an inflammatory response in the tendons but studies show that when biopsies of the tendons are performed, they often do not find the markers for inflammation. This may be a reason why taking an anti-inflammatory type of medication (i.e. ibuprofen, acetylsalicylic acid, naproxen) does not provide you with much relief. Often what is found is a lack of vascularization (i.e. lack of blood vessels) in the tendons and poorly organized tendon collagen. This can be why these problems tend to be so difficult to treat as it is hard to improve the health of the tendon without a good supply of oxygen and nutrients of which the blood provides.
Radial tunnel syndrome may also be mistaken for tennis elbow. In this condition, a portion of the radial nerve which starts in the neck and runs down the arm and across your elbow, becomes entrapped in the soft tissue/muscles around the elbow. If this is the case it is also possible that the neck could be influencing your elbow pain.
It has been documented in scientific literature that a “double crush” of a nerve, can lead to greater injury of a nerve at its more distal location. This means if the nerve becomes impinged at your neck, you can be more susceptible to injury of the nerve at the elbow. The impingement doesn’t have to be obvious either. There have been many times I have helped to fix a “tennis elbow” where I’ve spent most of my time working on the patient’s neck. Often times these patients had no obvious symptoms in the neck. This is important to know since if you are dealing with a persistent, hard-to-treat tennis elbow and your healthcare practitioner hasn’t assessed your neck, this might be the missing link to your recovery.
The last thing to consider when dealing with a tennis elbow, is to look at what might be causing in the first place. Poor workstation ergonomics, weak muscles in the forearm/shoulder, job demands that are above what the body can withstand, poor work: rest ratios, postural habits, among others can all influence your injury. Without addressing the cause of the injury it can be very difficult to achieve complete recovery.
Here at Easthill Physiotherapy and Acupuncture we may chose a variety of treatment options depending on your presentation, goals and preferences. We always begin with a thorough assessment to determine what actually is causing your symptom at the elbow and follow that with manual therapy techniques, education about how to help your own recovery, strengthening/stretching exercises, and possibly acupuncture or “dry needling”. Tired of that elbow pain, come see us today!
Chris Burk – Registered Physiotherapist – Elbow Guru
Sources: Am J Epidemiol (2006) 164 (11): 1065-1074
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