Lateral epicondylalgia, also known as tennis elbow, is a common overuse injury of the wrist extensors. Pain is often located on the outside of the elbow and may refer down into the wrist and hand. Pain is usually aggravated with gripping and/or extending the wrist. Despite the name, tennis elbow doesn’t only occur in tennis players. It is common in people who perform repetitive activities with their wrist in extension, such as bricklayers and sewers. Generally lateral epicondylalgia occurs insidiously, meaning it develops over time without a particular incident or injury occurring. It most often occurs in the dominant hand and in people aged between 30 and 60.
Treatment of lateral epicondylalgia is multifactorial. Initially, pain management is the primary goal. This is achieved through active rest, activity modification, soft tissue release of the forearm and taping to offload the wrist extensors.
Strengthening & Stretching
Following this, pain free strengthening of the wrist extensors commences. Your physiotherapist will be able to apply a manual technique to help facilitate strengthening of the correct muscles whilst decreasing pain. In conjunction with strengthening your physiotherapist will also show you how to stretch your wrist extensors, as below:
- Wrist extensor stretch: straighten your elbow with your palm facing down and make a fist. Holding this position bend your wrist down until you feel a stretch along the top of your forearm.
In people with lateral epicondylalgia we often see poor gripping technique, which results in overuse of the wrist extensors and therefore pain. When you grip a pen for example, your wrist naturally extends. Try it yourself! In people with lateral epicondylalgia we often see a loss of the natural extension of the wrist with gripping. This results in a decrease of strength of the grip. Therefore, we will help to retrain your muscles to improve your grip strength and technique.
We are often asked if corticosteroid injections will help reduce pain, and yes a corticosteroid injection may help in the short term. But evidence shows that there is a high recurrence rate of pain following a corticosteroid injection, and that long term effects are greater with physiotherapy.
Finally, pain with lateral epicondylalgia may also be coming from stiffness of the upper back and neck, or poor sports related technique, such as with a backhand in tennis. Your physiotherapist will be able to perform a full assessment to determine the drivers of your pain and treat as required. So if you suspect that you have lateral epicondylalgia please see your physiotherapist to kick start your rehab! Click here to see our availabilities.