What is a Tennis or Golfers Elbow?
Elbow tendon injuries are commonly referred to as ‘tennis elbow’ or ‘golfer’s elbow’, affecting the outer & inner elbow respectively. Tennis elbow presents as pain over the lateral elbow when gripping objects in the hand. The peak incidence of tennis elbow is between 40-50 years of age. Teenagers do not tend to get elbow pain and the presentation should raise suspicion of osteochondritis dissecans.
The elbow pain often comes on after a recent increase in loading such as during competition time or during the Summer months when people spend more time outdoors. In many cases, however, the pain will appear “out of nowhere” and increases gradually over time.
Tennis elbow or golfer’s elbow can give rise to ongoing issues & a pain intensity can often increase with time. Sometimes elbow pain can be addressed with small tweaks in golf or tennis swing technique. Elbow pain is also very common in those that perform manual work. Manual workers have been shown to have more severe pain and disability in many cases. Tennis elbow is related to disorganisation of collagen. Collagen is the main structural protein of the body’s connective tissue,
Although the name would suggest that the condition occurs only in golfers & tennis players, it is also very common in computer users & manual labourers who undergo repetitive abnormal movement patterns. Pain is normally present in the dominant arm/elbow and is aggravated by activities requiring squeezing or gripping. Population studies show an increased predisposition in those that are diabetic and have a history of smoking.
Occasionally, the elbow tendon patient may describe a history of neck or shoulder pain which preceeded the onset of elbow symptoms. This may suggest a potential link with the neck or shoulder dysfunction.
Treatment of Tennis Elbow/Golfers Elbow
It is our experience that tennis or golfer’s elbow can respond very well to treatment including manual soft tissue techniques & mobilisation. Only in very advanced cases, where the patient has neglected the condition for a significant period of time does the management prove more challenging.
Because the healing time for a tendon is longer than muscle, a consistent approach to rehabilitation is required. Some tendon injuries can persist for 6-12 months, unless treated appropriately
Will Corticosteroid Injections Help Tennis Elbow?
Several clinical trials analysing the impact of corticosteroid injections in tennis elbow have shown remarkably similar patterns of effect. In a randomised clinical trial by Bisset et al. (2006) one group of participants received steroid injections and another group received no treatment. They were advised not to immobilise the arm.
At six week follow-up 78% of participants who received an injection had improved compared with 27% in the non-treated group. These results were reversed by the 26 week stage when only 45% of the injection group reported an improvement versus 83% in the the group who did not receive a steroid injection. In other words, short-term relief is reversed quite quickly due to the longer term harmful impact of steroids on tendon health
When the recurrence rate was analysed it was found that 72% of the injected group experienced recurrence compared with 9% in the non-injected group. These results indicate a clear pattern of short-term relief from the injection followed by long-term regression and a much higher risk of recurrence when compared with individuals who had no injection.
Evidence for Physiotherapy Management
Research by Bisset & Vincenzino (2015) reported that physio guided exercise, manual therapy and a combination of physical therapies obtained superior outcomes when compared with placebo-treated or control groups.
Ref: Bisset and Vincenzino. Physiotherapy management of lateral epicondylalgia. Physiotherapy 2015;61(4):174-181. http://www.journalofphysiotherapy.com/article/S1836-9553(15)00091-0/abstract
Research by Vincenzino 2007 found that after 6 weeks of physiotherapy treatment the physiotherapy success rate was 65%. This is more than double the improvement rate of those who had no treatment. At 52 weeks a success rate of 94% for participants undergoing physiotherapy treatment was found. The recurrence rate was very low at 8%, which was way below the recurrence rate of 72% experienced by the injection group.
Ref: Vincenzino B. Physiotherapy for tennis elbow. Evidence Based Medical 2007;12(2):37-8.
Ref: Bisset et al. (2006) Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. British Medical Journal 2006;333(7575):939.
Does racket type impact on tendency to develop elbow pain?
There are a number of changes that can be made to decrease the risk of elbow pain in tennis players. Swing technique and ball strike should be reviewed by your tennis coach to identify abnormalities in the shot. Racquet size and string tension will also impact on force transfer from the ball to the elbow.
Contact Naas Physio Clinic on:
(045) 874 682
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