Elbow Pain – Tennis and Golfer’s Elbow

What is Tennis and Golfer’s Elbow

Lateral and medial epicondylalgia, commonly referred to as tennis and golfer’s elbow respectively, are the most common musculoskeletal cause of elbow pain. As seen below, the muscles which extend the wrist and fingers, originate via tendon attachment from the lateral epicondyle of the humerus, the bone above the elbow joint. The muscles flexing the wrist and fingers originate from the medial epicondyle of the humerus. Tennis and golfer’s elbow are a tendinopathy of these tendons. The word tendinopathy is used to describe a pathological change to the tendon which consists of microtears, degeneration of collagen fibres with replacement by scar tissue and premature death of tendon cells (tenocyte apoptosis). Tendinopathies develop as a failed healing response due chronic overload. As such, these injuries are most commonly seen in occupations and sports that involve quick, repetitive wrist and elbow movements.

Signs & Symptoms

The most common symptom of these conditions is pain and/or weakness with resisted wrist and finger movements and pain on palpation over and below the lateral/medial epicondyle. Pain will often radiate down the forearm and up the upper arm on the inside or outside, depending on which condition is present. People may find they develop this pain after a recent increase to their workloads/training, or perhaps with a change to their equipment (tennis racquet, golf clubs, tools etc.)

Diagnosis

By taking a careful history and objective testing, your Physiotherapist can not only diagnose your golfer’s or tennis elbow but also identify the underlying biomechanical cause of the injury. Some common underlying causes may include insufficient forearm muscle strength/muscular imbalance, reduced muscle tissue length, poor technique (i.e. golf swing or tennis serve) and even lack of shoulder mobility. Your Physiotherapist will also screen for other conditions which may cause elbow pain, referred pain from the cervical spine (neck) is often misdiagnosed as tennis or golfer’s elbow.

Treatment

Physiotherapy is demonstrated to be an effective intervention to tennis and golfer’s elbow. Physiotherapy treatments aim to reduce pain by aiding tissue repair, normalising muscle length and strength, restoring proper joint motion and addressing poor technique. This can be achieved through a range of modalities such as soft tissue massage, dry needling, taping/bracing, joint mobilisation, neural mobilisation, ice therapy and heat therapy. Research has demonstrated the most effective treatment for these conditions is a progressively loaded, strength-based exercise program. This will encourage the tendon to heal and enable it to correctly adapt to the loads it is being placed under. Steroid injections can also be a useful treatment option in providing short term pain relief (approximately 3 months on average), suggesting they are best used in adjunct with conservative treatment.

References

Ciccotti, M., et al. (2004) ‘Diagnosis and treatment of medial epicondylitis of the elbow), Clinics in Sports Medicine, 23(4), pp. 693-705.

Bisset, L., & Vicenzino, B. (2015) ‘Physiotherapy management of lateral epicondylalgia’ Journal of Physiotherapy, 61(4), pp. 174-181. https://doi.org/10.1016/j.jphys.2015.07.015

Struijs, P. A., et al. (2004) ‘Conservative Treatment of Lateral Epicondylitis: Brace Versus Physical Therapy or a Combination of Both—A Randomized Clinical Trial’, The American Journal of Sports Medicine, 32(2), pp. 462–469. doi: 10.1177/0095399703258714.

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