by Evie Ullman, DPT
Tennis elbow is not just for tennis players. It can affect anyone who plays racket sports or has a job requiring a lot of gripping and grasping, especially for those who repetitively use hand-held tools throughout their workday.
The muscles that extend the wrist and fingers meet at the elbow forming a tendon known as the common extensor tendon. The specific area of bone that the tendon attaches to is called the lateral epicondyle, hence the name “lateral epicondylitis.” When these extensor muscles are overused, the result is a repetitive stress injury in the common extensor tendon. There can be a tremendous amount of pain and inflammation. It can be so painful that it wakes you up at night and makes you wince when you pick up a cup of coffee after that night of bad sleep!
If left untreated while continuing to engage in the activities that aggravate it, tennis elbow will only get worse, leading to degradation and tearing of the common extensor tendon. In advanced cases, surgery may be indicated. Cortisone injections are not an effective treatment for tennis elbow. They do provide short term relief, but many people will have a cortisone injection and immediately go back to performing the very same activities that caused the injury without any rehabilitation. It is an absolute guarantee that the tennis elbow will come back, and it will likely come back with a vengeance.
If you have tennis elbow, you need to STOP the activities that make it worse and allow the tendon to rest. If it is impossible to stop entirely, your PT can help you figure out ways to modify the activity. A tennis elbow brace can also help, as it takes some mechanical stress off the common extensor tendon.
Modalities such as ultrasound, ice and cold laser applied by your PT will help with pain and inflammation. Friction massage performed by the PT will also help remodel the tendon and desensitize it, easing the pain. Since tennis elbow is a tendon injury, eccentric exercises will help immensely, as they remodel the tendon and build tensile strength. I give my patients this exercise known as the Tyler Twist, which is performed with a Therabar:
http://www.youtube.com/watch?v=gsKGbqA9aNo
We have the Therabar in our clinic, but it is worth purchasing your own Therabar if you have suffered from tennis elbow more than once in your life and you frequently engage in activities that place you at risk.
Dr. Ullman is a Physical Therapist at Boston Sports Medicine
