Longevity Exercise Physiology Drummoyne, EdgecliffMarrickvilleBella VistaRandwick, PymbleBalmain and Neutral Bay examine the role of exercise in managing Lateral Epicondylitis or Tennis Elbow.

 

Lateral Elbow Tendinopathy (also called Lateral Epicondylitis and commonly referred to as Tennis Elbow (TE)), is characterised by pain and tenderness over the outer bony structure of the humerus near the elbow, and pain on resisted dorsiflexion of the wrist, middle finger, or both (Bisset et al., 2011). This often results in decreased functional abilities and grip strength, and could potentially lead to functional impingements of the shoulder due to compensatory effects that come from impaired joint dynamics and muscle imbalances (Lee et al., 2018).

 

“TE currently affects 1-3% of adults each year, with a rate of occurrence around 4-7 per 1000 individuals, with it presenting most commonly in people in their 40’s and 50’s”

(Johns & Shridhar 2020)

 

Although the condition is often referred to as ‘Tennis Elbow’, tennis has been shown to be a direct cause in only 5% of the total population of people with Lateral Epicondylitis (Bisset et al., 2011)!

There have been many explored treatment paths for TE, including corticosteroid injections, oral pain relief and anti-inflammatory drugs, and other forms of injections and invasive treatments. However, exercise has become a leader, increasingly so in recent studies, as an effective conservative treatment method that provides pain relief and strength and muscular endurance to reduce the rate of recurrence.

 

WHAT CAUSES TENNIS ELBOW?

Though frequently referred to as ‘Tennis’ Elbow, the cause of TE in tennis players is generally due to poor technique in a one-handed Backhand. However, with the modern play style, coaching and racquet technology, TE is becoming less of a concern for most players, as the constant strengthening of the tendon through training and strength and conditioning proves to be an effective preventative measure against TE.

 

“TE is most commonly caused by overuse, repetitive movements and muscular weakness.”

(Lee et al., 2018)

 

It is often a work-related or sport-related pain disorder, with the dominant arm being the most heavily affected and its peak prevalence occurs between 30-60 years of age (Dimitrios & Pantelis, 2013). TE also presents for a longer duration and higher severity in women (Dimitrios & Pantelis, 2013)

A sedentary lifestyle that’s subsequently followed by heavy lifting or overuse is another primary cause, and TE can often arise from simple tasks such as lifting a baby, carrying heavy luggage or gardening due to the tendon not being accustomed to the influx of weight bearing activity (Orchard & Kountouris, 2011). However, people who exercise, tennis players, and hard manual labourers are also at risk of developing TE if the load increases too significantly or the rest period between bouts of loading is decreased (Orchard & Kountouris, 2011).

 

EXERCISE CONSIDERATIONS FOR TENNIS ELBOW

 

“Studies have shown that combining static stretches and eccentric loading exercises are the most effective treatment methods in muscular tendinopathies such as Tennis Elbow”

(Dimitrios & Pantelis, 2013)

 

As such, it is recommended to people who are diagnosed with TE to complete these sorts of exercises at home. Stretches can be completed as often as necessary through static holds of 30-40 seconds to alleviate some of the tension in the tendon, and exercises are used to supplement this effect to build strength and loading capacity.

The primary principle in the management of TE is to exercise or load the tendon as close to its limits as possible without exceeding the limit and risking further injury, however under-load and overload are both bad for the tendons (Orchard & Kountouris, 2011). As a method of precaution, always err to the side of under-loading, as it decreases the risk of a more debilitating injury such as a tear.

HOW CAN LONGEVITY EXERCISE PHYSIOLOGY HELP?

Many modern studies have come out supporting the effectiveness of exercise treatments in the management of TE. While it’s possible to find exercises online to aid in your treatment, without understanding your physical capacity and loading ability, there is a high risk of negative outcomes in injury and increased pain through self-prescribing exercise.

As such, it is recommended you seek a professional Exercise Physiologist who is able to tailor a personalised exercise prescription that works within your physical capacity but challenges you enough to be able to get the benefits of exercise in reducing the pain and strengthening the tendons. The Exercise Physiologists at Longevity are all trained in providing effective treatment plans through assessments and functional testing to gauge your loading capacity and provide you with a plan that will provide positive outcomes in the long term.

 

If you or someone you know could benefit from a supervised exercise program for the management of Tennis Elbow, call Longevity Exercise Physiology Edgecliff, Pymble, Marrickville, Randwick, Drummoyne, Balmain, Bella Vista and Neutral Bay on 1300 964 002 to enquire today!

 

Written by Kevin Shu 

 

References:

Peterson, M., Butler, S., Eriksson, M., & Svärdsudd, K. (2014). A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clinical rehabilitation28(9), 862-872.

Bisset, L., Coombes, B., & Vicenzino, B. (2011). Tennis elbow. BMJ clinical evidence2011, 1117.

Johns, N., & Shridhar, V. (2020). Lateral epicondylitis: Current concepts. Australian Journal Of General Practice49(11), 707-709. doi: 10.31128/ajgp-07-20-5519

Dimitrios, S., & Pantelis, M. (2013). Comparing Two Exercise Programmes for the Management of Lateral Elbow Tendinopathy (Tennis Elbow/Lateral Epicondylitis) – A Controlled Clinical Trial. The Open Access Journal of Science and Technology1(4), 1-8.

Lee, J. H., Kim, T. H., & Lim, K. B. (2018). Effects of eccentric control exercise for wrist extensor and shoulder stabilization exercise on the pain and functions of tennis elbow. Journal of Physical Therapy Science30(4), 590-594.

Orchard, J., & Kountouris, A. (2011). The management of tennis elbow. Bmj342.