Lateral elbow tendinopathy or 'tennis elbow' as it is commonly known as is the most common condition of the elbow. It affects the tendons of the elbow and is caused by overuse & repetitive loading of the wrist extensor muscles (on their attachment site to the elbow). We know that tendinopathy's are not due to inflammation but degeneration, disorganization and changes in load...this can be subtle changes, it doesn't have to included heavy lifting or tennis. More mouse work? Cleaning? Sewing? Gardening? Hammering?
Risk factors:
It most commonly presents in men and women between the ages of 35-54
Smoking and other systemic factors such as obesity and diabetes.
Manual workers (repetitive movements)
Tennis players (40% will be affected at some point in their 'career')
Signs and symptoms:
Decrease function of the elbow and surrounding muscles
Pain on gripping
Pain on wrist extension (action of acceleration on motor bike)
Pain with house hold chores - picking up sauce pans, mouse and computer work, opening jars and gripping door handles
Tenderness over the outside of the elbow
Management:
While the diagnosis of lateral elbow tendinopathy is usually straight forward, management needs to be tailored to the patient.
Tendinopathy does not improve with rest.
Settling tendon pain requires load modification, i.e. reducing (in the short term) any abusive tendon load.
Exercise has the most evidence for treatment of tendons, they must be loaded progressively to tolerate activities in day to day life. Most tendon problems won’t improve without this.
Tendinopathy responds very slowly to exercise. Patience is required, exercises should be correct and progressed appropriately. There are no short cuts!
What about steroid injections...??
Research shows that steroid injections as a first line of treatment have a worse outcome after 6 and 12 months, compared to either a wait-and-see approach or physical therapy management, with high recurrence rates. The injections are also shown to negate the positive effects of exercise therapy. So, in short..NO to steroid injections. As mentioned above, exercise therapy is the gold standard for treatment of tendinopathy.
If you are unsure about the cause of your pain or how to manage it, came in and see one of us. Appointments can as always be made online HERE. Or call the clinic on (03) 9855 0606 to have a chat and see how we can help.
References:
- https://www.jospt.org/doi/full/10.2519/jospt.2015.5841
- https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990766/