Also known as Lateral Epicondylitis, tennis elbow is a condition in which a patient experiences major pain in lateral elbow. The pain is mostly triggered by over activity. When you use your arm constantly in some kind of repetitive motion, the tendons present at the end of the elbow in a muscle called the ECRB or extensor carpi radialis brevis muscle develop small tears.
- Overuse: the condition is often attributed to repetitive activity with sports like tennis, golf, weight lifting or with various occupations like keyboard entry, plumbers, painters, carpenters, cooks and autoworkers.
- Age: In most cases, the patients are aged between 30 to 50 years. However, poor technique may cause this condition in patients of any age group.
- Change in activity: The symptoms frequently start following some kind of change in frequency or type of activity; such as with a sport, or any recreational or professional work.
- The symptoms normally begin rather slowly but then worsen gradually over several weeks or months.
- Burning sensations or pain may be felt over lateral elbow; the pain may sometimes extend down one’s forearm to wrist.
- Loss of general grip strength.
- The pain is increased by various types of forearm activities, like shaking hands, using a tool or holding a racquet
Conservative treatment is successful in more than 90% of all cases. It is been proven that better outcomes are usually achieved when the treatment is started earlier. Various types of anti-Inflammatory medications and/or local steroid injections can be used alongside PT so that a progressive exercise program can be started.
- Relative Rest – In order to initiate healing, it is important to take some rest from any kind of aggravating activity. A successful PT involves effective re-introduction of activity only gradually after the patient starts responding to this eccentric exercise program.
- Ice – The patient should be educated on the benefits of using ice. Ice must be applied rather immediately after any kind of aggravating activity like sport or work has been completed.
- Manual Therapy – The soft-tissue release techniques can be applied for preventing adhesions around the tendon attachment. Such techniques can also be used for releasing tightness in opposing muscle group i.e. the flexors. Targeted joint treatments can be applied around the cervical spine in case involvement is observed from the assessment. Powerful joint mobilization methods can be applied to the elbow which can help in improving grip strength, improving function and decreasing pain.
The First 24 to 48 Hours
For the initial 24-48 hours after acute pain has begun, treatment includes:
- Avoiding stressful activities to rest the arm and also modifying techniques that you use for doing other tasks
- Carrying out ice treatments for 10 to 20 minutes
- Using supports or elastic bandages for taking pressure off from the painful muscles
The physical therapist is going to tell you whether you need to use brace or some other kind of support effective protect your muscles as the area starts to heal. Depending on the severity of the situation, your therapist might recommend you to consult with another professional health care provider who may advice you on further testing or perform additional treatments and recommend medications. In some rare instances, treatments like surgery or cortisone injection might be required. Your physical therapist might be able to help you in determining if you need the assistance of another medical healthcare expert.
Based on your individual requirements, your physical therapist may be able to design a custom treatment program that can help in speedy recovery. You may also be recommended a number of exercises as well as other treatments which you can do at home. The physical therapist can also use special types of physical therapy treatments for helping in relieving the pain, like special exercises, manual therapy as well as heat or ice treatments or even both.
While treating an “acute” tennis elbow case that has developed only in the last few weeks, it is very important to start medical treatment as quickly as possible. If left untreated, the symptoms of tennis elbow may eventually become chronic and even last for many months or years. This is particularly true in cases where the treatment is mainly focused on easing the pain and discomfort and not on actually correcting muscle weakness and the negative habits which may have led to this condition.
Improve Your Ability to Move
The physical therapist can use manual therapy methods for enabling your muscles and joints so that you can move freely with much less pain.
Improve Your Strength
It is a well known fact that insufficient muscle strength often leads to tennis elbow. There can be weakness in muscles of forearm and wrist. In several cases, the problem actually starts from weakness of core or the supporting postural muscles. You might also find that it becomes necessary to enhance your general levels of fitness if you are looking to manage this elbow condition. According to the evaluation, the physical therapist is going to determine the exercises that will be right for you.
The physical therapists may prescribe diverse forms of exercises which can help you to recover from tennis elbow:
- During the early phase of the treatment when painful sensations are most intense, the therapist may recommend various types of passive exercises which can help you to move your elbow and wrist without express use of the muscles.
- Once the symptoms begin to improve, you may start moving the elbow and wrist actively without any assistance.
- The symptoms will minimize as the muscles start becoming stronger. During this stage you can start lifting weights and using resistance bands for increasing your strength further. The overall amount of weight that you can carry must be monitored carefully so as to ensure that you continue steadily progressing and steer clear of re-injuring the muscles.
Return to Your Activities
The physical therapist is going to help you in remaining active by slowly teaching you the ways to modify your day to day activities. This can help you to avoid pain as well as any further injury. In some cases it may become necessary to implement some changes at work, in your home or on playing field. Your physical therapist will be able to guide you to make simple and easy modifications to your computer system set-up, your work site, your sports equipments, your kitchen devices and your gardening tools so that they may put less stress in your hands, forearms and wrists. Your therapist is also going to emphasize the overall importance of regularly taking stretch breaks in order to provide frequent rest to your muscles from all kinds of repetitive movements as well as from sitting or standing in same position for long.
The sport of tennis may lead to the condition of tennis elbow for numerous reasons. For instance, over-training may lead to the condition itself. In other instances, the weight of racquet and its grip can cause this condition which is why they must be adjusted. In case of others, the issue may stem from poor overall fitness, improper form, or even lack of proper strength in “core” muscles present in shoulder blades and the trunk. A physical therapist will be able to analyze the causing factor and help in finding a solution.