Tennis elbow – not just for tennis players
What is tennis elbow?
Tennis elbow (lateral elbow tendinopathy) is an overloaded tendon on the outside of the elbow. Despite the name, this tendon anchors the muscles on the back of your forearm, which extend your wrist and fingers, so its main job is controlling your wrist rather than moving your elbow.
Every time you grip, this tendon absorbs the force and helps keep your wrist steady, so it's working even when your wrist isn't moving. That's why tasks like using tools, a mouse or lifting a kettle often bring on the pain.
What causes it?
Tendons are very sensitive to changes in load. Build up gradually and they adapt and get stronger. Do too much, too soon, and they can become painful, and over time their structure can start to change.
Examples of activities that can load the tendon:
- Manual and trade work: using tools, painting, plastering, screwdrivers and vibrating power tools like drills
- Repetitive computer mouse use
- Gardening or pruning
- Racquet sports, especially with poor technique or the wrong grip size
How do we manage this?
Getting the diagnosis right
Pain from the neck, shoulder or nerves can mimic tennis elbow, so your physio will screen these areas as part of a thorough assessment. Getting the diagnosis right means you're addressing the true source.
Wrist position
Your grip is strongest when your wrist is slightly bent back. When your wrist drops forward or twists, your grip weakens, so you squeeze harder and the tendon works overtime.
Small changes to how you position your wrist can take a surprising amount of load off the tendon.
Practical advice for work
For desk workers, small changes to your setup and work habits can make a big difference. Small modifications like adjusting your wrist posture or how you rest your wrist or the type of mouse you use can manage unintended overload.
For tradies, your physio can suggest changes to how you hold and grip tools, or adjustments to the tools themselves to reduce load on the elbow.
Looking at the whole arm
The elbow is one link in a chain, starting from your shoulder down to your hand. When one part of that chain isn't doing its job, the others pick up the slack, and the elbow often ends up taking more than its fair share. Your shoulder and shoulder blade give your arm a stable base to work from. If the muscles around them are weak or tire quickly, your forearm may have to work harder and that might mean gripping tighter which adds load to the tendon.
The right exercises at the right time
Tendon pain sits on a continuum, and the best exercise depends on where your tendon is.
A reactive tendon is usually the result of a sudden spike in load, like a big weekend of gardening or an afternoon assembling IKEA flat-pack furniture. It tends to be irritable and sore, so the focus is on calming it down before gradually easing back into aggravating activities.
A degenerative tendon has usually been painful on and off for months or longer. Its structure has changed and it can't cope with as much load. It's often less irritable day to day, but it needs progressive, heavier strengthening over time to rebuild resilience.
How physiotherapy can help
- Hands on therapy like joint mobilisation, massage, or dry needling to ease pain
- Shoulder strengthening: targeting the shoulder if it's the weak link in the chain contributing to the overload of your elbow
- Taping and bracing: depending on your presentation, taping or a brace at the wrist or elbow can offload the tendon during aggravating tasks
- Ergonomic advice: for work, racquet sports, using tools, and everyday tasks like chores and gardening
- Targeted loading: wrist and forearm exercises to build muscle and tendon resilience, so it can cope with the loads you need it to
Sim completed her physiotherapy degree at the University of Queensland and is currently completing her Master of Sports and Exercise Physiotherapy at La Trobe University. Sim has many years of private practice experience and additionally has worked with state and national level soccer, cricket and AFL.
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REFERENCES
1.Bisset, L. M., Russell, T., Bradley, S., Ha, B., & Vicenzino, B. T. (2006). Bilateral Sensorimotor Abnormalities in Unilateral Lateral Epicondylalgia. Archives of Physical Medicine and Rehabilitation, 87(4), 490-495. https://doi.org/10.1016/j.apmr.2005.11.029
2. Coombes BK, Bisset L, Vicenzino B. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. J Orthop Sports Phys Ther. 2015 Nov;45(11):938-49. doi: 10.2519/jospt.2015.5841. Epub 2015 Sep 17. PMID: 26381484.
3. Manickaraj, N., Bisset, L. M., & Kavanagh, J. J. (2018). Lateral epicondylalgia exhibits adaptive muscle activation strategies based on wrist posture and levels of grip force: a case-control study. Journal of musculoskeletal & neuronal interactions, 18(3), 323–332.
