Its Wimbledon week! And as the repetitive strain of raising yet another spoonful piled high with strawberries and cream started to take effect, I couldn’t help thinking about tennis elbow.
(By the way, the term “Tennis Elbow” has been criticised for being misleading and there are several other names used in the scientific papers. But in this article I am going to stick with “tennis elbow” because that’s what most people recognise).
What are the symptoms of tennis elbow?
People feel pain on the outside of the elbow, which may be tender to the touch. Gripping and twisting activities are particularly painful.
Who gets tennis elbow?
Although 40% of tennis players get tennis elbow, there are many other groups of people that develop it too. As you would expect, manual workers are quite prone to this condition. The gripping and twisting demands of their job can often exacerbate the symptoms. However it’s not just confined to active people. Obesity, diabetes, high cholesterol and smoking are all risk factors, showing how our lifestyle affects the health of our tissues.
What actually goes wrong?
Muscles from the fingers and wrist run up the back of our forearm and attach onto the elbow. These muscles become tendons as they attach onto bone, and it is these tendons that develop the problems of tennis elbow. Tendons are made of strands of collagen, wrapped into strong fibres like a rope. They are very good at holding and transmitting forces, but they may become inflamed after doing excessive work or sport. If the tendons are young and healthy they should quickly recover with a few days of rest. However, tendons which are deconditioned may struggle to bounce back, and the pain can last for weeks or months.
What else could it be?
5-10% of people diagnosed with tennis elbow may actually have a nerve entrapment. If someone tells me the pain runs further down their forearm I will start to look for signs of nerve entrapment. This could be weakness in the muscles of the hand or altered sensation in the hand (e.g. pins and needles).
Tennis elbow usually comes on gradually, or you don’t notice it until after the work or exercise has finished. If someone remembers a specific incident such as sudden pain on striking the ball, then I may suspect a tear in the muscle or tendon, which is different from tennis elbow.
Sometimes a fold of membrane from inside the joint, called a plica, may cause pain resembling tennis elbow. This is often accompanied by a snapping or clicking when you straighten the elbow.
What can you do about tennis elbow?
Tendons are strong and resilient and will respond to exercise. Most of the evidence supports loading the tendons, but the trick is to find the right balance. Too little exercise leads to weakness and deconditioning, but too much stirs up the pain.
An osteopath will look beyond just the wrist and elbow. One research group found that in people with tennis elbow, almost all muscles in the upper limb were weak. So an osteopath might look at how the shoulder, neck and upper back are being used, or look for improvements in technique. The assessment may even extend down to the trunk or lower limbs. Research shows that in a tennis shot, about 50% of the power comes from the legs. So sometimes better technique, or strength in the legs may be the answer.
What are the best exercises for tennis elbow?
The one group of muscles that wasn’t found to be weak was the long muscles that straighten the fingers. These were strong but overworked. A lot of the exercises you might find online suggest holding a weight and pulling up from the wrist. But exercises like these use those long finger muscles which are already overworked. So I normally start people off with a loop of theraband over the back of the hand. In this position you can do a variety of exercises, some static, some dynamic, which strengthen the wrist muscles up to the elbow. Once the tendons start to respond and become less painful, you can bring in more advanced exercises.
This is OK, but ….
…this is better