What is tennis elbow?

Tennis elbow, otherwise known as lateral epicondylitis or lateral elbow tendinopathy, is a debilitating overuse injury which involves the lateral aspect (or outside) of the elbow, known as the lateral epicondyle. This is a bony prominence where the muscles involved in wrist extension attach through the common forearm extensor tendon. When this tendon becomes overloaded pathology can develop which leads to pain and dysfunction with wrist movement and loading.

Who is at risk?

Despite its name the occurrence of tennis elbow is not exclusive to tennis players. As with any tendinopathy its pathology develops secondary to an excessive increase in loading of the tendon and the muscle belly to which it is attached. In tennis elbow this can occur with any activity which involves repetitive or prolonged gripping or movement of the wrist. Examples include lifting weights, carrying heavy shopping bags, hammering nails and typing. These activities can cause micro-trauma to the common forearm extensor tendon when the tissue is unable to adapt to the applied loads.

Other risk factors especially relevant to tennis players include:

• A change in racket size or string tension
• A relatively thick grip on the player’s racket
• A change in technique, particularly moving to a single-handed backhand
• Poor shoulder range of motion
• Reduced lower and/ or upper back mobility
• Poor flexibility of the shoulder and upper back muscles

What can I expect from a physiotherapy assessment?

• A detailed subjective history to determine the cause of your condition and your personal goals for recovery, so a treatment plan can be tailored to your needs.
• A thorough physical examination to ensure accurate diagnosis to find the specific impairments which have led to the development of your condition
• A functional assessment which considers the specific tasks which you are restricted from completing.

Physiotherapy treatment may include

• Prescription of non-medicated anti-inflammatory cream and ice to help manage acute symptoms
• Prescription of tennis elbow brace to help offload the common forearm extensor tendon
• Education on the activities to avoid and the pathology of your condition with relevance to your individual circumstance and goals

• Discussion about expected recovery times to return to completing the tasks which are most meaningful to you
• Setting clear expectations regarding the expected timeframe of different phases of rehabilitation
• Discussion about different forms of medical treatment that may be required as part of conservative management to further assist such as Platelet-rich plasma (PRP) injections and surgical debridement.

• Soft tissue therapy
• Prescription of stretching and strengthening exercises to allow the region to be able to accommodate the required physical load when performing functional related tasks 

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