Lateral epicondylitis, otherwise known as "tennis elbow", is a common condition found in tennis players. Although commonly found in tennis players, lateral epicondylitis can develop in professions with repetitive gripping including carpenters, plumbers, electricians, etc. This condition is characterized by pain on the lateral(outside) aspect of the elbow of which is worse with gripping activities. The two muscles that are commonly involved are the extensor carpi radialis longus(ECRL) and extensor carpi radialis brevis(ECRB), specifically their proximal tendons of which attach on the elbow. Fun fact! If you'd like to identify yourself which muscle is affected then do this: push down/resist your pointer finger, if this causes pain then it's ECRL. Next, resist/push down on your middle finger, if this causes pain then it's your ECRB.
This condition is extremely painful and debilitating for tennis players. If left untreated, tennis elbow will quickly become a chronic condition which is why it's best to seek treatment early!
There are a variety of treatment options for tennis elbow ranging from conservative to surgical. Elbow braces are commonly used which provide temporary relief while playing, however they do not "fix" the problem. Corticosteroid injections are efficient for short term relief, however once again do not "fix" the problem. Luckily for you, conservative treatment such as physical therapy is extremely effective in treating tennis elbow!
You may ask, I've been playing tennis for a long time, why did I just now develop this? Great question! Unfortunately there is no "right" answer and is usually due to more than one impairment. For example, impairments could be rotator cuff weakness in the shoulder causing extra work from elbow musculature; poor elbow joint mobility; tightness in wrist extensors; weakness in triceps. With a thorough evaluation, your physical therapist will discover your impairments and treat accordingly.
The first objective is to reduce the inflammation and stress being placed on the extensor tendons. Pain felt in the tendons, is due to tightness from the muscle belly(refer to pic above). Thereby loosening the muscle, will in turn take stress off their corresponding tendons. An efficient method in reducing tightness in the muscle, is a modality called "dry needling". A small, monofilament needle is placed within the muscle belly eliciting a local muscle contraction thereby causing that muscle to relax. Most people see great results after only one dry needle session!
After reducing stress and tightness on the extensor tendons, the second objective is treating the specific impairments of which caused tennis elbow to occur. This is achieved through target specific exercise prescriptions tailored to that individual. As stated above, impairments vary by individual so exercise prescriptions differ.
Regardless of impairments, appropriate loading must be placed on the extensors muscles to ensure they are strong enough to endure future tensile loads. Pain-free eccentric strengthening for the wrist extensors is essential for increasing the tensile load on the tendons. "Eccentric exercise" is when the muscle is lengthening in response to an external resistance. Eccentric wrist exercises, as depicted below, can be achieved through a variety of different exercise techniques.
The last phase of rehabilitation is return to sport. After your wrist extensors are sufficiently strengthened and your specific impairments have been addressed accordingly, we put it all together! This is crucial to ensure there will be no chance of re-injury. Through various functional exercises, your physical therapist will get you hitting aces again!
Steven Schwab PT, DPT
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