Epicondylitis: how to treat tennis elbow

Despite the name, we don’t necessarily have to be Roger Federer or Novak Djokovic to suffer from the so-called Tennis Elbow. Epicondylitis, in fact, in most cases is an inflammation caused by overload, affecting people who for work or leisure perform activities that require repeated movements of the elbow and wrist. In this detailed article, let’s read of the main symptoms of tennis elbow and how to treat epicondylitis in a specific rehabilitation programme.

What is Epicondylitis and why is it also known as Tennis Elbow?

Lateral Epicondylitis, or Tennis Elbow, is a disorder caused by overload, consisting in pain in the outer elbow, and more specifically in the area of tendon insertion of the extensor muscles of the forearm (epicondyle). The pain becomes more acute when pressure is exerted on the epicondyle area and when the wrist is bent backwards and/or the third finger of the hand is pressed against a resisting force.

Epicondylitis is a very common type of tendonitis, with peak occurrence when aged between 40 and 50. Despite the definition, tennis is only the direct cause of this inflammation in 5% of the cases, while the absolute majority is found among those who perform work activities with repeated movements of the wrist and elbow (electrician, plumber, bricklayer, gardener etc.).

Anatomy of the Elbow: How this joint works

The elbow is a joint that joins the arm and forearm, connecting the Humerus (arm bone) with the Radius and Ulna (forearm bones). The elbow enables broad movements of bending and stretching, as well as more limited movements of pronation and supination (inward and outward turning).

The Epicondyle is a bone protuberance in the distal section of the Humerus, i.e. the area closest to the elbow. This protuberance is present both on the inner and outer side of the Humerus:

• The extensor muscles of the forearm insert onto the Lateral Epicondyle
• The flexor muscles of the forearm insert onto the Medial Epicondyle (or Epitroclea)

The elbow is made up of three joints: the joint between the Humerus and Ulna, the joint between the Humerus and Radius and the joint between the Radius and the Ulna. Together with the various muscles that insert onto the two Epicondyles, the three elbow joints are kept in contact with one another by a fibrous sleeve called Joint Capsule, in turn reinforced and stabilised by various ligaments.

Causes and symptoms of Epicondylitis

There are various possible causes of Epicondylitis, which should be adequately assessed by a specialised physiotherapist:

1. Overload due to a sports or work activity that we were not used to
2. Repeated microtraumas with consequent degeneration of the extensor muscle tendons
3. Dysfunction of one of the three elbow joints
4. Inflammation of the Annular Ligament of the Radius
5. Neuro-dynamic problems deriving from the cervical spine (in particular needing investigation of the zone from C5 to T1)

The typical symptom of Epicondylitis is pain, localised in the outer elbow. At times the pain can spread downwards, extending to the forearm. The pain occurs above all in activities where we need to pull or lift weights and/or move the elbow, such as lifting a shopping bag, using a screwdriver, lifting weights in the gym, playing tennis etc. In more acute cases, pain also occurs at rest and in apparently mild activities such as opening a bottle or squeezing someone’s hand.

The difference between Epicondylitis (Tennis Elbow) and Medial Epicondylitis (or Golfer’s Elbow) lies in the location of the pain, which in the latter case is felt on the inner elbow. As regards the causes, activities that cause these two types of inflammation of the tendons are very similar.

Remedies: How to treat Epicondylitis

The treatment of Epicondylitis mainly consists in a complete physiotherapy programme, focussed firstly on identifying the initial cause and secondly on reducing the inflammation. Rehabilitation for Epicondylitis is thus divided into three phases: Acute phase, sub-acute phase and final phase.

1. In the initial acute phase, the aim is to understand the causes of Epicondylitis and to reduce the pain caused by inflammation. In this phase rest and physiotherapy are essential, and comprise manual therapy, instrumental therapy (LASER, TECAR, Ultrasound), careful stretching exercises and isometric exercises.
2. In the sub-acute phase the essential factors are active strengthening and return to functional activities: concentric and eccentric exercises, exercises for flexibility of the transverse muscular chain and gradual recovery of movements that caused the pain, with the possible use of a support or brace on the elbow, specifically designed for Epicondylitis.
3. Meanwhile, in the final phase, the aim is to return completely to work or sports activities, increasing strengthening exercises and setting up a maintenance programme.

The Physiotherapist’s tips on treating Tennis Elbow

In the case of elbow pain that does not go away with rest, do not hesitate to contact a physiotherapist to assess the best treatment and avoid any worsening of the pain. Here are some tips to follow on what to do if you suspect inflammation caused by overload, in the classic case of Tennis Elbow:

• Remember that a skilled physiotherapist, in the case of Epicondylitis, should always investigate other areas as well as that of the elbow: cervical spine, shoulder, spinal column, wrist and hand as they may also be involved in the inflammation.
• For a total solution of the problem, both passive therapies (manual and instrumental) and active therapies (specific exercises) are necessary.
• An ultrasound exam is also recommended to assess the condition of the tendons and muscles in the area of pain, above all in the case of elbow pain that persists over several weeks.
• The elbow brace specifically for Epicondylitis serves to reduce contractions of the extensor muscles of the forearm, thereby decreasing the traction forces on the inflamed tendon and consequently reducing pain. It can be useful in the initial phases of returning to normal activities, but it must only be a temporary measure to prevent the body getting used to this support.