Pain on the outside of the elbow is a common complaint known as ‘tennis elbow’. It can be caused by tennis, but we see it more often due to excess gardening, computer work, or a blow to the outside of the elbow. The pain is usually intermittent with gripping, lifting or twisting (eg. unscrewing lids) but can become constant over time. Most of us know someone who has had it, but what is it?
It is a tendinopathy or weakening of the wrist extensor tendons where they attach to the elbow. Our muscles are attached to the bone by tendons. Tendons are made of collagen and act like springs. With excessive work the tendon and muscle become slightly damaged. Normally they rebuild over a couple days and become even stronger. But if they are made to work too hard before they have had the chance to rebuild, they can progressively weaken. The tendon doesn’t become inflamed; instead the fibres become disorganised and weakened. This is why anti-inflammatories and injections may have a limited, short-term effect. The long-term answer is to remove the contributing factors and re-strengthen the tendon gradually. Contributing factors might include tennis technique, posture and hand position on the mouse/keyboard or general workload. There may also be weakness in the other muscles of the arm that normally help share the load.
Physio management of tennis elbow is usually very effective. If the condition has been present for months and the pain severe it will take longer to treat and vice versa. We first manage the pain and workload of the tendon with braces, massage and better posture/technique. We identify and remove the contributing factors and set-up a graded exercise program. This strengthening is the key and must be done gradually so the tendon has time to rebuild before the next work-out. It can take 1-2 months in severe cases but with persistence it can be treated.
