Lateral elbow pain is a regular complaint from athletes to manual workers, even office workers are exposed to the risks of these injuries. Sometimes this injury can be difficult to shake off without the necessary changes being made.
Why tennis elbow and what should we call it?
The diagnosis of “tennis elbow’ dates back to 1882 described as “lawn tennis arm”. While it effects up to 50% of tennis players throughout their careers there are many other activities other than tennis that cause this problem.
Lateral Elbow Tendinopathy (LET) is a more appropriate and clinical description of the injury. It encapsulates both a tendinitis (inflammation of the tendon) and tendinosis (micro-tears of the tendon).
With repetitive use of the arm, whether you’re doing a swing, cleaning a 60KG barbell, hammering together a fence or typing up endless reports. As the muscles in the forearm are being used continuously without rest the immune and metabolic bi-products cause micro tears in the tendon, leading to scarring, swelling and lateral elbow pain over time.
What can cause LET?
The most common cause for LET is mentioned above, the small tearing of tendon inserting into the lateral epicondyle (outer elbow). Most commonly the tear occurs with the small muscle Extensor Carpi Radialus Brevis due to its weak insertion into the extensor tendon. But there are several other wrist extensors that can also overload this tendon complex.
For a long time, it was thought the sole problem was with the tendon and its connecting muscle. But the most recent model of LET suggests that as well as inadequate muscle power and endurance, there are also external factors influencing the pain.
These external factors could be…
- Neck and mid back dysfunctions – Particularly the lower Cervical spine, the nerves that supply the lateral elbow have nerve roots at this level (C5-6). If nerve roots are irritated at these levels it can enhance the feeling of pain in its pathway down the arm, into the elbow. Following the Law of Denervation (This is a whole other blog!).
- Posterior shoulder trigger points – Following that same C5-6 nerve root into the shoulder, it supplies posterior shoulder muscles. The development of trigger points in these muscles can irritate the nerve branches travelling down the arm causing enhanced pain into the elbow.
- Thoracic Outlet Syndrome – This is another condition that effects the nerves supplying the arm. The pressure places on these nerves can also cause pain in the elbow.
As you can see all these external factors add a nerve component to the elbow pain and should be cleared in assessment to ensure they’re not involved or treated appropriately.
How long it takes to recover?
Like all injuries, it will vary. Depending on the severity and how irritable you are this could be a few weeks to a few months. Following the guidance and management of the injury from physio you will have greater success than treating it on your own.
If symptoms persist, with no overall improvement over 12 weeks an ultrasound scan may be indicated, followed by an assessment from an orthopaedic specialist.
How do I prevent LET?
LET is a silent assassin, it’s one of these conditions that develops unknowingly (with scarring and tissue inflammation) until it’s too late (when you feel pain).
If you’re involved in sport or work that uses repetitive motion at the elbow, you’re already a candidate for this type of injury. Consider that your warning and take control.
Firstly, those forearm extensors need to be managed. Taking regular breaks to stretch and strengthen the wrists will help. Rolling the lacrosse ball into the forearm and back of the shoulder to reduce tightness. Consider your posture when sat at work or in the car, aim for your head to be over the shoulders.
For those in the gym, look at your wrist position. Most movements other than front rack and press positions, you want to maintain a neutral wrist. Look at your kettle bell swing or pull up, keeping the wrist close to neutral will reduce the force through the muscles of the forearm.
How can physio help?
Depending your presentation when assessed there are a range of treatments that could include…
- Soft tissue manipulation of the wrist extensors, neck and shoulder
- Joint mobilisations to the elbow, cervical and thoracic spine
- Dry needling of forearm wrist flexors/extensors, deep neck extensors, posterior rotator cuff.
- Mobilisations with movement for the elbow, neck and shoulder
- Strapping of rigid or kinesio tape
- Prescription of elbow brace/clasp
- Specific exercises to strength and stretching exercises for the wrist, shoulder and cervical spine
- Mobility exercises for thoracic and cervical spine
There are many treatment options available but to help with a quick recovery it’s important to provide a tailored treatment plan to meet your individual needs.