Tennis elbow / lateral epicondylitis is due to overload of the wrist's stretch muscle (wrist extensors). Tennis elbow / lateral epicondylitis can greatly impact on quality of life and job satisfaction.
Tennis elbow / lateral epicondylitis is often caused by repetitive movements such as computer work, painting or the like. Treatment of tennis elbow / lateral epicondylitis involves relief from the causative cause, eccentric training of the muscles involved, as well as any pressure wave and / or laser treatment. It is the wrist extensors that give the condition tennis elbow / lateral epicondylitis (among other things extensor carpi radialis or extensor carpi ulnaris myalgia / myosis).
The image above illustrates a lateral epicondylitis damage. In the muscle / tendon attachment to the lateral epicondyle (which you find on the outside of the elbow) small micro-tears occur, which often due to continuing with the causative cause can worsen so that it becomes difficult for the body's own healing process to do something about. In such cases, external help from a physiotherapist, chiropractor or manual therapist is required. The treatment will usually consist of eccentric training in combination with a pressure wave and / or laser treatment, as well as relief from the causes that started the problem.
Lateral epicondylitis: An extra-articular congestion state located at the origin of the wrist's stretch muscles or tendons on the outside of the elbow. Repeated full extension (backward bending) of the wrist during the workday is the most common cause.
- Pain and tenderness towards the outside of the elbow. The pain can also go down towards the forearm and worsen with certain movements.
- Stiff elbow. The elbow may feel stiff and it can be painful to tie the hand to a fist.
- Cracking of the elbow. There may be a cracking sound in the elbow in such a dysfunction.
Weakness in the hands or fingers. Occasionally, tennis elbow can give weakness in the hand on the affected side.
- Iling down towards the hand, especially towards the ring finger or little finger.
The best evidence for the treatment of lateral epicondylitis is eccentric exercise (see Exercises here), preferably in combination with pressure wave and / or laser treatment - other forms of treatment with evidence include elbow joint mobilization / manipulation. Standard protocol for treatment of tennis elbow with Shockwave Therapy is on about 5 treatments, with about 5-7 days in between treatments so that the recovery / rest period should be optimal.
What can I do even for elbow pain?
1. General exercise, specific exercise, stretching and activity are recommended, but stay within the pain limit. Two walks a day of 20-40 minutes make good for the whole body and sore muscles.
2. Trigger point / massage balls we strongly recommend - they come in different sizes so you can hit well even on all parts of the body. There is no better self help than this! We recommend the following (click the image below) - which is a complete set of 5 trigger point / massage balls in different sizes:
3. Training: Specific training with training tricks of various opponents (such as this complete set of 6 knits of different resistance) can help you train strength and function. Knit training often involves more specific training, which in turn can lead to more effective injury prevention and pain reduction.
4. Pain Relief - Cooling: Biofreeze is a natural product that can relieve pain by cooling the area gently. Cooling is especially recommended when the pain is very severe. When they have calmed down then heat treatment is recommended - it is therefore advisable to have both cooling and heating available.
5. Pain Relief - Heating: Warming up tight muscles can increase blood circulation and reduce pain. We recommend the following reusable hot / cold gasket (click here to read more about it) - which can be used both for cooling (can be frozen) and for heating (can be heated in the microwave).
Recommended products for pain relief for elbow pain
Biofreeze (Cold / cryotherapy)
needle treatment used frequently for elbow pain. It can be effective against conditions such as tennis elbow (lateral epicondylitis), golf elbow (medial epicondylitis), and general muscular dysfunction (myalgia). Here you can watch a video of an acupuncture treatment for tennis elbow.
- Acupuncture / needle treatment
- Soft tissue work / massage
- Electrotherapy / current therapy
- Ice treatment
- Laser treatment
- Joint corrective treatment
- Muscle knot treatment / trigger point therapy
- Heat treatment
Recommended products for pain relief in tennis elbow / lateral epicondylitis
Biofreeze (Cold / cryotherapy)
A larger RCT (Bisset 2006) - also known as a randomized controlled trial - published in the British Medical Journal (BMJ), showed that physical treatment of lateral epicondylitis consisting of elbow joint manipulation and specific exercise had a significantly greater effect in the form of pain relief and functional improvementcompared to waiting and looking in the short term, and also in the long term compared to cortisone injections. The same study also showed that cortisone has a short-term effect, but that, paradoxically, in the long term it increases the chance of relapse and leads to slower healing of the injury. Another study (Smidt 2002) also supports these findings.
One of the most important things about congestion injuries is that you simply and easily cut down on the activity that has irritated the muscle and tendon attachment, this can be done by making ergonomic changes in the workplace or taking a break from the painful movements. However, it is important not to stop completely, as this hurts more than good in the long run.
Elbow relief support is also recommended. We recommend Shock Doctor elbow support.
Grip Training: Press a soft ball and hold for 5 seconds. Perform 2 sets of 15 reps.
Forearm pronation and supination strengthening: Hold a soup box or similar in your hand and bend your elbow 90 degrees. Slowly turn the hand so that the hand is facing upwards and slowly turn back to face down. Repeat 2 sets of 15 reps.
Resistance training for elbow flexion and extension: Hold a soup can or similar with your hand facing up. Bend your elbow so that your hand is facing your shoulder. Then lower your arm until it is fully extended. Do 2 sets of 15 reps. Gradually increase your resistance as you get stronger.
Wrist mobilization in flexion and extension: Bend your wrist into flexion (forward bend) and extension (back bend) as far as you can get. Do 2 sets of 15 repetitions.
Wrist extension: Press the back of your hand with your other hand to get a bend in your wrist. Hold with custom pressure for 15 to 30 seconds. Then change movement and stretch by pushing the front of the hand backwards. Hold this position for 15 to 30 seconds. Keep in mind that the arm should be straight when performing these stretching exercises. Perform 3 sets.
Forearm pronation and supination: Bend the elbow on the aching arm 90 degrees while holding the elbow to the body. Turn the palm up and hold this position for 5 seconds. Then slowly lower your palm down and hold this position for 5 seconds. Do this in 2 sets of 15 repetitions in each set.
- Surgery / surgery
- Pain injection
If conservative treatment is fully tried and the pain only persists, then tennis elbow / lateral epicondylitis surgery may be appropriate. But due to risk and chance of deterioration, this is considered a last resort.
A treatment option that can be tested before surgery, if conservative treatment is fully tested and the pain only persists, then it may be relevant with injection in the treatment of tennis elbow / lateral epicondylitis. Normally, cortisone injection is the most commonly used, but there are other options. Unfortunately, cortisone injections can lead to worsening pain in the long run. This is something you want to try out before any surgery.
Learn more in this book: Injection Techniques in Musculoskeletal Medicine (for clinicians and especially interested)
Picture of the book:
Eccentric training is recommended in treatment for tennis elbow / lateral epicondylitis. The following video shows eccentric training for lateral epicondylitis.
Did you know: - Blueberry extract has a proven analgesic and anti-inflammatory effect?
Both MRI examination and diagnostic ultrasound can be useful imaging studies in case of suspected tennis elbow / lateral epicondylitis. Normally, one will manage without performing such imaging tests, as the diagnosis and symptoms are usually very clear to a clinician.
MRI examination image of tennis elbow / lateral epicondylitis
Here we see an MRI image of tennis elbow / lateral epicondylitis. There are obvious reactions around the lateral epicondyle.
Diagnostic ultrasound examination image of tennis elbow / lateral epicondylitis
On this ultrasound image, a thickened muscle attachment to the lateral epicondyle on the outside of the elbow is noted.
- Did you know Ginger can reduce muscle pain?
- Chin-up / pull-up exercise bar can be an excellent exercise tool to have at home. It can be attached and detached from the door frame without the use of a drill or tool.
- Cross-trainer / ellipse machine: Excellent fitness training. Good for promoting movement in the body and exercising overall.
- Rubber exercise knit is an excellent tool for you who need to strengthen the shoulder, arm, core and more. Gentle but effective training.
- Kettlebells is a very effective form of training that produces fast and good results.
- Rowing Machines is one of the best forms of training you can use to get good overall strength.
- Spinning ergometer bike: Good to have at home, so you can increase the amount of exercise throughout the year and get better fitness.
Also read: - Sore elbow? You should know this!
- Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilization with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomized trial. BMJ. 2006 Nov 4; 333 (7575): 939. Epub 2006 Sep 29.
- Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet. 2002 Feb 23; 359 (9307): 657-62.
- Tennis Elbow: Clinical Management (click here to learn more)
Description: Tennis elbow - Clinical measures. A very good book written for an evidence-based approach to tennis elbow syndrome.
«Bringing together the current knowledge and evidence about the causes and management of tennis elbow, or lateral epicondylitis, the diagnosis and various treatment options for this common sports injury are presented in detail. Generally attributed to overexertion or repetitive motion of the elbow joint, tennis elbow causes pain, tenderness and stiffness in the elbow and wrist even in non-athletic, day-to-day activities, such as lifting and pulling. Beginning with its etiology, subsequent chapters explore both conservative and surgical treatments, from physical therapy, joint injections and acupuncture to arthroscopy, open surgery and denervation. Outcomes, rehabilitation and return to play are also discussed, as are techniques and indications for handling complications and revision surgery. Ideal for orthopedic surgeons and sports medicine practitioners, Tennis Elbow: Clinical Management is a practical reference for any clinician treating athletes or active patients. »
- Pain Free: A Revolutionary Method for Stopping Chronic Pain (click here to learn more)
Description: Painless - a revolutionary method of stopping chronic pain. The world-famous Pete Egoscue, who runs the well-known The Egoscue Method Clinic in San Diego, has written this very good book. He has created exercises that he calls E-Cises and in the book he shows step-by-step descriptions with pictures. He himself claims that his method has a full 95 percent success rate. Click here to read more about his book, as well as see a preview. The book is for those who have tried most of the treatment and measures without much success or improvement.
Follow Vondt.net on YOUTUBE
(Follow and comment if you want us to make a video with specific exercises or elaborations for exactly YOUR issues)
Follow Vondt.net on FACEBOOK
(We try to respond to all messages and questions within 24-48 hours. We can also help you interpret MRI responses and the like.)
Frequently asked questions regarding tennis elbow / lateral epicondylitis
Should I get treatment for tennis elbow / lateral epicondylitis?
Yes, if you do not take any action, the condition will probably only worsen further. Seek help for the plague today, so you don't have to carry it with you for the rest of your life. If you cannot afford treatment, then it is probably okay to start with relief measures (elbow support) and customized exercises (see earlier in the article).
Should I icing down tennis elbow / lateral epicondylitis?
Yes, in situations where it is clear that the attachments to the lateral epicondyle are irritated and perhaps even swollen, then icing should be used according to the usual icing protocol. Take care not to damage the tissue with too much cold.
What are the best painkillers or muscle relaxants for tennis elbow / lateral epicondylitis?
If you are going to take non-prescription pain medication then they should be anti-inflammatory, e.g. ibuprofen or voltaren. It is not recommended to apply to painkillers without addressing the very cause of the pain, as this is likely to temporarily mask the pain without any particular improvement to the elbow attachment. The doctor can print prescription muscle relaxing if needed; then most likely tramadol or brexidol. Always consult your doctor or pharmacist before taking any pain medication.
Craftsman, 44 years. It works in the elbow when I lift something. What could be the cause?
The cause is most likely tennis elbow (lateral epicondylitis) or golf elbow (medial epicondylitis) which can both occur due to repetitive strain (eg carpentry). Tears can occur in the muscle attachment to the outside or inside of the elbow - both of which can cause pain when using the hand and wrist. This can also lead to reduced grip strength.