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Common Causes of Elbow Pain and how can Physiotherapy and Remedial Massage Help?

Common Names
Tennis Elbow, Common Extensor Tendinopathy, Lateral Epicondylagia, Lateral Epicondylitis and Common Extensor Tendinosis


What is the etiology or cause of the tennis elbow?

Tennis elbow, or common extensor tendinopathy, is a chronic overuse condition. It is likely secondary to continued microtrauma coupled with an incomplete or failed healing response; therefore, the collagen and elastin fibres of the tendon become damaged; this can also be referred to as tendinosis (Erickson & Hall, 2015). A good image for this is a rope that has started to fray. It is not entirely severe but not as solid and robust as it should be. This fraying and disruption of the tendon fibres cause pain in the tendon, muscle spasms around the elbow, and pain in the forearm. The most common location of injury is within the common extensor tendon, involving the extensor carpi radialis brevis (ECRB) and the extensor radialis longus (ECRL). The extensor carpi ulnaris can also be involved (Erickson & Hall, 2015). Although anatomical changes have been identified, more recent studies suggest this is not always the reason for pain and that pain can be more related to neurogenic changes (nerve-related).


Epidemiology—Who Does Tennis Elbow Pain Affect?

Tennis elbow, or common extensor tendinopathy, is the most common clinical reason for lateral elbow pain. While most cases settle relatively quickly and are usually self-limiting, some can turn chronic, leading to substantial time away from work and sports (Erickson & Hall, 2015). However, lateral elbow pain affects 1–3% of the general population; however, it will affect 40% of people throughout their lifespan (Bisset & Vicenzino, 2015). It more commonly presents in 30- to 60-year-olds but is not limited to this age group (Bisset & Vicenzino, 2015).


What are the typical clinical signs?

Patients with a common extensor tendinopathy usually report a gradual onset of pain in the dominant arm. Pain can radiate down the forearm. Often, a history of repetitive use precedes this—for example, repetitive gripping and lifting activities such as assembly line work or manual labour such as carpentry—and sports involving racquets can be a cause (Erickson & Hall, 2015). Office workers also frequently report lateral elbow pain, mainly in the hand that uses the mouse. Patients frequently report pain when gripping and opening jars or door handles and are usually tender to pressure on the outside region of the elbow. It is common for patients to have a previous history of a shoulder or rotator cuff injury or to have it concurrently (Bisset & Vicenzino, 2015).


How do we treat tennis elbow or common extensor tendinopathy?

Anti-inflammatory medication has shown low-level evidence to reduce the acute inflammatory process in reactive or sensitive tendons; however, it is not as effective in chronic long-term injuries (Erickson & Hall, 2015). Physiotherapy modalities incorporating targeted manual therapy (joint mobilisation, neural glides, and soft tissue techniques), dry needling, and specific graduated tendon loading programmes effectively reduce pain and disability (Bisset & Vicenzino, 2015; Erickson & Hall, 2015). Tennis elbow braces can also minimise symptomatic pain and disability by offloading the affected area. Injection therapies such as corticosteroid injections, prolotherapy injections, autologous blood injections, platelet-rich plasma injections, and surgical interventions can also be considered case-by-case, with relevant doctors and specialists consulted.


Prognosis

The amount of time the tendon takes to heal or settle depends on how severe the injury is and how long it has been an issue. Very mild cases can be primarily cured in 4-6 weeks, but most patients will take around 8–12 weeks to heal. However, more chronic issues can take 12–24 months for gradual improvement.


If you think you may have Tennis Elbow, contact Inertia Health Group to book an appointment to discuss treatment.

References
Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia Journal of Physiotherapy, 61(4), 174–181. doi:10.1016/j.jphys.2015.07.015
Erickson, J. L., & Hall, M. M. (2015). Evidence-based treatment of common extensor tendinopathy Current Physical Medicine and Rehabilitation Reports, 3(1), 50–59 doi:10.1007/s40141-014-0070-1

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