Tennis elbow is one of the most common causes of elbow pain seen in general practice (4). Some of the muscles that control the movement of your wrist, hand and fingers attach to the outside of your elbow via a thick, strong tendon. Sometimes this tendon becomes irritable and painful. Tennis elbow can often be seen in people who perform repetitive daily activities, such as carpenters, plumbers and people who work at a computer. However, it is also seen in people who play sport and those who are also inactive (5).
Tendon pain is ‘dose-dependent which means the pain will be aggravated based on the amount of load it is subjected to (6). If you load the tendon excessively by exposing it to higher tensile forces, or by performing repetitive movements in a relatively short period of time, the tendon cannot adapt quickly enough and may begin to become irritable, leading to pain and the risk of developing tennis elbow.
Tennis elbow, like any form of tendon pain, is caused by the relationship between the demand placed on the tendon (load) and the rate at which the tendon can adapt or regenerate (repair) (6, 7). Tissue samples taken from people with tendon pain tend to show similar findings, which suggest the tendon has tried and failed, to regenerate and cope with the load placed upon it (6). This in turn can lead to pain and weakness with activities that place further demand on the tendon. It is important to note that rarely is there evidence of tendon “damage” and findings on medical images do not correlate well with pain or function (8).
This is not an exhaustive list. These factors could increase the likelihood of someone developing tennis elbow. It does not mean everyone with these risk factors will develop symptoms.
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or ultrasound scan are usually not required to achieve a working diagnosis, but in unusual presentations, they may be warranted.
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help recovery from your tennis elbow. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
Research is very clear that modifying the load that goes through the tendon is the key element that stimulates recovery (9). Recovery can take some time as the speed of tendon regeneration is much slower than other structures in the body.
Below are three rehabilitation programmes created by our specialist musculoskeletal physiotherapists targeted at addressing tennis elbow. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
This programme focuses on maintaining a range of movement around the wrist and elbow and appropriate early loading of the affected tendon. We suggest you carry this out once a day for approximately 2-6 weeks as pain allows. We can work into pain during these exercises but ideally, this should not exceed any more than 4/10 on your perceived pain scale.
Progress onto this programme once the early programme no longer becomes challenging and pain during aggravating activities has settled to between 0-3 on the pain scale. More focus is given to progressive loading of the tendon with an increased number of repetitions, greater levels of resistance or performing the exercise through a bigger range of movement. This should not exceed any more than 5/10 on your perceived pain scale.
This programme is a further progression with challenging progressive loading of the affected tendon complex to enable your tendon to manage the demands of day-to-day activities. This should not exceed any more than 5/10 on your perceived pain scale.
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
Steroid injections may be offered to help manage pain in the short term but have been shown to be inadequate for long-term recovery (4, 10). Surgery should be the last option if all other treatment attempts have been exhausted (4).
Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.
We have Pure Physiotherapy clinics across the country including Norwich, Great Yarmouth, Manchester, Stockport, Sheffield and Rotherham. Please view our clinics to find the closest physiotherapy clinic for you.
Above normal movement or flexibility. A condition that is on a spectrum, meaning you can have mild to extreme levels of hypermobility.
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