Been loving the Australian Open? Did you know that tennis elbow isn’t actually that common among tennis players? But it is a very common condition affecting people from all walks of life and across multiple occupations, hobbies, and exercise routines.
The term ‘tennis elbow’ has fallen a bit out of favour. These days we typically use ‘lateral epicondylalgia’ (LE), which literally means ‘pain on the outside of the elbow’ and is not particularly helpful in describing what is causing the pain either!
Why isn’t there a simple name for such a common condition?
Because pain on the outside of the elbow is common, but not simple! There are many causes and contributors to lateral elbow pain, with different anatomical structures involved and varying risk factors and treatment protocols for each. Sometimes there is a single structure involved, and other times there might be a mixed presentation. So initially we use a catch-all term, but then dig deeper to understand what’s happening for each individual and the approach most likely to get a good outcome.
What structures might be involved?
- The common extensor tendon is probably the most common source of lateral elbow pain. Most often the issue is degenerative change within the tendon (a tendinopathy), but it can be torn or inflamed too
- Referred pain from the neck, or muscular trigger points around the neck and shoulder blade
- Restriction in movement of nerve trunks passing through the region
- Mixed presentations are relatively common
What treatment strategies might be used?
It depends on what structures are causing your pain, and what the contributing factors are. Your treatment will involve at least two of:
- Advice and education: the single most important intervention we can make. No matter how well you do your exercises, if you persist with activities that keep hurting your elbow, you’re unlikely to get better. The challenge is that those activities are not things you can stop – they are often essential tasks at work and home, so it’s our job to show you how to get through your day without stirring up your pain.
- Aids and supports: in some cases, bracing, taping and ergonomic aids can be a big help to settle your pain and manage high-load or troublesome activities.
- Exercises: targeting muscular strength or flexibility, nerve mobility, posture and more. These take time, and LE is associated with a slow recovery, but the right exercises make all the difference in actually getting better for the long run.
If I do have LE associated with tennis, aside from the treatments above, what else might help?
- A lighter racquet can help. The pros use heavy racquets because they are strong enough to swing them all day at the same pace as a lighter racquet, and all other things being equal, a heavy racquet will produce more power than a light one. Most recreational players are not strong enough to wield a heavy racquet for hours on end.
- A more forgiving racquet and string combination can help (stiffer racquets = more power but more load through the elbow, meaning a higher risk of LE)
- A grip that is too small or too big for you increases the load through your forearm muscles, so it’s important to get the size right
- Double-handed backhands require much less extensor muscle force than the single-handed alternative.
- Seek treatment! Modifying your gear can help but it is unlikely to resolve the pain on its own.