Part 1: What is ‘tennis elbow’?
It’s that nagging ache on the outside of your elbow that tends to be more bothersome when trying to grip, lift or carry things. Most of the time, it has absolutely nothing to do with playing tennis, which makes the name ‘tennis elbow’ seem slightly daft.
‘Tennis elbow’ is also known as ‘Lateral elbow tendinopathy’. It has many other names which all refer to the same problem; lateral epicondylitis, lateral epicondylosis, lateral epicondylagia, common extensor origin tendinopathy… the list goes on. We’ll stick with ‘lateral elbow tendinopathy’ though for now, as this is the up-to-date term for it in the most recent scientific literature – it basically means ‘a problem with the tendons on the outside of the elbow’. For some reason, medical people love to turn simple descriptions half into Latin, but ‘lateral elbow tendinopathy’ does fit the bill better than ‘tennis elbow’.
What do tendons do?
Tendons are there to attach muscles to bone. Many of the muscles in the back of the hand, wrist and forearm all attach via a common tendon to the outside of the elbow on the ‘lateral epicondyle’ – the source of pain in lateral elbow tendinopathy. When you grip, lift or carry things, these muscles are put to work and load the tendon attachment.
Why do tendons get irritated?
Like most of the tendon problems that start without any obvious trauma or accident, lateral elbow tendinopathy is usually caused by a mismatch between the load being placed on the tendon versus the load it can consistently cope with. In real terms, the sudden increase in load might have been from chopping a stack of logs, completing a DIY job, starting a new regime at the gym or completing a particularly nasty CrossFit WOD. Sometimes it can be from resuming normal activities but following a period of relative deconditioning – like if you had been out of action for a period of time, and sometimes it can be a more gradual build-up such as a change in job or workstation set up over a period of several months.
How do tendons recover?
The earlier you deal with an irritated tendon the quicker it can recover. Generally speaking, the management of lateral elbow tendinopathy tends to follow the same stages as any other tendon problem:
OFFLOAD – temporarily modify activities so the tendon doesn’t get irritated and has a chance to settle down;
REHAB – address underlying individual biomechanical issues, work out what loads are tolerated without causing an increase in pain and start working on them (this is the bit a physio can be of most help after a thorough assessment);
STRENGTHEN – gradually add resistance to the exercises, strategically progressing the type and amount of loading, working towards your individual goal;
RECONDITION / GRADUAL RETURN TO LOAD – gradual return to the activity that may have caused the overload in the first place, but in much better condition so it doesn’t happen again!
Other causes for pain on the outside of the elbow
It’s not just lateral elbow tendons that can be the cause for pain on the outer elbow. Problems with the neck and/or shoulder can lead to similar symptoms, as can irritated nerves, or rarely some other more unusual medical causes. If you’re not sure, it’s best to get a healthcare professional to assess it for you. Lateral elbow tendinopathy is usually easy to diagnose based on the history, the symptoms and presentation without the need for a scan.
About the Author
Steph is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can follow Steph on LinkedIn.
Scott A, Docking S, Vicenzino B, et al (2013) Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012 British Journal of Sports Medicine; 47:536-544