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With Summer in full swing, don't become the next victim of the most common elbow complaint seen by healthcare practitioners, "Tennis Elbow".

"Tennis elbow", or lateral epicondylitis is the term frequently given to pain felt around the bone on the outside part of the elbow, where the forearm muscles attach.  The pain usually comes on gradually, due to repetitive gripping activities such as pruning, lifting weights, prolonged use of hand tools, and of course racquet sports.  When these wrist extensor tendons are regularly overloaded, microscopic tears occur and can progress to a degenerative state of failed healing and chronic pain ("tendinosis"). 

The pain is often described as sharp during gripping or lifting activities, followed by a dull ache that may last into the evening and even disturb sleep.  The elbow may be stiff like a rusty hinge in the morning and need to be warmed up.  Often if the symptoms have been present for a while, one can develop associated tightness in the neck or shoulder girdle that can magnify or perpetuate the pain. 

Early management is best, with icing and rest from provocative activities, plus preventative strategies such as technique correction, changing hands where possible, and controlled loading - eg. building up slowly with a new weights program, or asking yourself "Do I really need to prune all 20 roses in one hit?"

Physiotherapy management of established tennis elbow may include; 

Manual Therapy - massage, deep tendon frictions, stretching and mobilising of the muscles, joints and nerves of the elbow and forearm, and where indicated the neck and shoulder also.

Exercises - specific stretches and strengthening exercises form the most important and scientifically validated component of treatment.  Your physio will prescribe a program of resistance exercises for the arm and usually include eccentric work (lengthening contractions) for the wrist extensors to promote tendon repair.

Taping or Counterforce Bracing - can be magic to offload the painful tendon and allow you to continue your work as you recover.

Dry Needling - the use of very fine acupuncture needles into myofascial trigger points and tight muscular bands can effectively reduce pain and muscle tightness.

Electrotherapy modalities such as ultrasound or electrical stimulation, as well as advice regarding Heat and Ice and Gels/Creams for you to use at home.

Medical interventions - analgesic and anti-inflammatory drugs, as well as injections of cortisone or autologous (one's own) blood can augment rehabilitation and are appropriate in a lot of cases where pain and disability are severe, and more conservative measures have been tried.  Diagnostic ultrasound imaging or MRI can be useful to confirm the extent of tissue pathology and is useful prior to considering these more invasive interventions.

Peter Biskup 
B.Physio(Hons), M.Physio(Musc)
APA Titled Musculoskeletal Physiotherapist

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