Tennis elbow is the leading cause of elbow pain. It can affect anyone, causing moderate to intense pain in and around your forearm. Luckily, tennis elbow is treatable, and you don't need to be a medical expert to tackle it.
You can relieve the pain and return to your routine with simple at-home remedies, such as foam rolling with an arm massager or ice therapy. This guide provides a comprehensive look into what causes tennis elbow, how to identify it, and your available treatment options.
What Is Tennis Elbow?
Tennis elbow, or lateral epicondylitis (LET), is an overuse injury characterized by inflammation of the elbow's extensor tendons. When these tendons are repeatedly strained and overused, they can develop microscopic tears and eventually lose their ability to function.
It typically affects between 1% and 3% of the population. It is the most common cause of elbow pain in men and women between the ages of 35 and 50. A hallmark symptom of tennis elbow is recurring pain on the outside of your upper forearm just below the edge of your elbow. You might feel this discomfort further down your arm, toward your wrist. If your elbow pain is severe enough, it could prevent you from lifting objects.
It's more common to develop a tennis elbow in your dominant arm. Still, it's not uncommon to develop the condition in your nondominant arm or even both arms simultaneously.
What Causes Tennis Elbow?
Tennis elbow develops primarily due to repetitive stress and overuse of the extensor carpi radialis brevis (ECRB) tendon. This tendon connects the ECRB muscle to the lateral epicondyle of the humerus, a bony bump on the outer part of your elbow.
According to one systematic review, these activities are a significant contributor to the development of tennis elbow;
- Handling tools heavier than 1 kg
- Carrying loads of over 20 kg more than 10 hours per day, and
- Performing repetitive movements more than 2 hours per day
Whenever you use your wrist to lift, grip, or twist, the ECRB muscle contracts. Its tendon transmits that force to your elbow joint, allowing you to perform these movements efficiently. However, when you repeatedly stress this tendon, it can become overworked and strained. This overuse leads to tiny tears and inflammation in the ECRB tendon, causing the pain and discomfort known as tennis elbow.
How Tennis Elbow Progresses
Understanding the progression of tennis elbow can help you take the proper steps to manage and treat it effectively. Based on Nirschl's classification, here's a look at the stages of lateral epicondylitis and what happens in each stage.
Stage 1: Inflammatory Changes (Reversible)
In Stage 1, your body is sending you the first warning signs. Inflammation is starting to take hold of the extensor carpi radialis brevis (ECRB) tendon, which links your forearm muscles to your elbow.
You might feel mild pain and tenderness on the outer part of your elbow, especially after intense or repetitive activities. The good news is that this stage is reversible if you take action now.
Stage 2: Nonreversible Pathologic Changes to the Origin of the ECRB
Stage 2 means the condition is digging in a bit deeper. Pain becomes more persistent, with possible mild swelling and discomfort, nagging you during and after activities.
The ECRB tendon degenerates, leading to microtears and a weakened tendon structure. At this stage, some damage is permanent, so ongoing management is essential.
Stage 3: Rupture of the Origin of the ECRB
In this stage, the ECRB tendon may partially or entirely rupture at its origin, leading to substantial damage and loss of tendon integrity.
What this means is that pain ramps up to severe, with significant loss of strength and elbow function. What once caused mild or moderate pain now results in sharp, debilitating pain even at rest.
Stage 4: Scar Formation
Stage 4 is when your body tries to patch things up somehow, but not always successfully. Sometimes, your body's repair efforts lead to scar formation or calcification, further impairing tendon function and elbow mobility.
You'll start experiencing chronic pain, stiffness, and significant limitations in mobility. Due to calcification, the affected area may swell and feel hard or lumpy.
Diagnosing Tennis Elbow
When you start feeling a burning pain in your elbow during everyday activities, it's a sign that something might be wrong. Schedule an appointment with your doctor to rule out any serious issues.
Medical Examination
A quick physical exam is usually sufficient to diagnose tennis elbow. During the exam, your doctor will assess your lifestyle and daily activities, focusing on anything that involves repetitive forearm motion.
They may also ask you to perform the Chair test. For this test, you will place your hands on the back of a chair with your palms facing down and elbows straight, then try to lift the chair. If this causes pain on the outside of your elbow, it likely indicates tennis elbow.
Your doctor will also ask about the location, severity, and frequency of your pain. This information helps accurately diagnose tennis elbow and rule out other conditions, such as arthritis or an elbow joint injury.
Imaging Tests
In some situations, the physician may order imaging tests, such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans. These scans help identify damage to your forearm's tendons, muscles, or bones. Electromyography (EMG) tests can check for any issues related to nerve compression.
Treating Tennis Elbow
The goal of tennis elbow treatment is to decrease pain and preserve function. Depending on the severity of your tendon injury, your doctor may recommend self-care measures, professional help, or a combination of both. Prompt treatment gives you up to a 90% chance of recovering within a year.
Rest, Ice, Compression, Elevation
Implementing RICE (rest, ice, compression, and elevation) immediately after the onset of symptoms is vital. While this method is not an instant cure for tennis elbow, it can provide short-term relief by reducing inflammation and pain. Most importantly, it can stop your condition from progressing.
- Rest: Try to avoid activities that strain your tendons.
- Ice: Apply an ice pack on your elbow area for 15 minutes every two to three hours.
- Compression: Wrist and forearm support can help provide rest to your forearm and limit its use, aiding your recovery.
- Elevation: Lift the affected arm above your heart level whenever possible to reduce swelling.
Foam Rolling
Foam rolling is a self-myofascial release technique that can help soothe symptoms of tennis elbow. Try using this self-massage technique over tight, inflamed areas, known as "trigger points," along your forearm. As you foam roll, receptors along your muscle fibers send signals that kick start muscle relaxation, allowing you to experience foam rolling benefits like:
- Pain relief
- Enhanced blood flow
- Better flexibility & mobility
- Faster recovery
- Decreased complications
- Injury prevention
Physical Therapy
Rest is essential, but as your pain eases, it's equally critical to resume activity gradually. Physical therapy plays a significant part in the management of tennis elbow. It helps you heal and strengthens your muscles to prevent future injuries. Techniques like Mulligan mobilization, myofascial release, and cross-friction massage are designed to stretch and strengthen your forearm muscles and tendons.
In one study, physical therapy had a long-term success rate of 91%, significantly better than steroid shots and marginally better than the wait-and-see technique.
Pain Medications
Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or ketorolac could make a big difference for mild to moderate pain.
Injection Therapies
Various injection therapies are available to reduce inflammation and promote healing for tennis elbow. Corticosteroid injections, for instance, can significantly decrease pain scores almost instantly. However, studies show that steroid use is associated with higher rates of recurrence of symptoms compared with physical therapy.
Platelet-rich plasma (PRP) and botulinum toxin (Botox) injections are another option. PRP injections harness the power of your blood to promote healing. When injected at the point where the extensor tendon attaches to the lateral epicondyle, Botox has been shown to improve pain significantly compared to placebo.
Braces & Supports
Elbow orthoses, such as straps or sleeves, offer immediate pain relief and restore grip strength by applying gentle pressure to the muscles and tendons around your elbow. This pressure redistributes forces away from the injured tendon, alleviating strain and reducing pain.
Surgical Options
Most cases of tennis elbow improve with non-surgical treatments within a few months. However, more invasive methods might be needed if you're dealing with a severe case. These procedures include open or arthroscopic surgery to remove damaged tissue and reattach healthy tendons.
Surgical treatment for tennis elbow is usually an outpatient procedure. If the open approach is used, your elbow will typically be protected with a splint or brace at a 90° angle for seven to 10 days. After that, you'll follow a slow, progressive mobilization process with limited lifting for about four weeks.
You might start early motion in a brace three to five days after surgery, with strengthening exercises beginning by the third week, depending on your symptoms. Most people can return to sports in six months. Depending on your job requirements, you could return to work in six to 12 weeks. However, job modifications or the persistent use of a counterforce brace during work activities might be necessary.
How to Prevent Tennis Elbow
Understanding the risks, being proactive, and adopting preventative measures can go a long way in protecting yourself from this condition.
Use Proper Technique
Proper techniques are crucial, whether practicing a sport or performing a job. Meet with a physical therapist who can show you the correct methods and determine when your elbow, forearm, and wrist are solid and ready to handle the same action again.
Perform Strengthening Exercises
Incorporating therapeutic exercises into your daily routine can help you avoid the risk of tennis elbow. A physical therapist can guide you on strengthening your muscles and increasing your flexibility to prevent future injury.
Modify Your Equipment
The tool you use for your task plays a significant role, too. For example, adjusting the tension of the strings on your racket or implementing other changes as suggested by a sports medicine professional could reduce your risk of tennis elbow. Consider using a forearm band one to two inches below your elbow to relieve tension on your tendons.
Frequently Asked Questions
What are some preventative measures for tennis elbow?
There are three main prevention strategies for tennis elbow:
- Practicing the proper form & technique
- Incorporating strengthening exercises into your wellness routine
- Adjusting your tennis equipment to your individual physical needs
What is the significance of adjusting your equipment for tennis elbow?
Adjusting your racket can significantly lower your risk of developing tennis elbow. Correctly fitted and adjusted equipment can reduce the strain and pressure on your elbow, ultimately helping with injury prevention.
Can tennis elbow heal by itself?
Tennis elbow can heal entirely within a few months to a year if you follow your treatment plan and address any pain immediately.
Who can guide you in preventing tennis elbow?
Physical therapists can guide you in practicing proper techniques, recommend strengthening exercises, and assist with equipment modifications, all of which can help you prevent tennis elbow.
Image by Jo Panuwat D from Adobe Stock