Dr. Yako Merogi
Tackling tennis elbow: causes, treatment, cure
It usually sneaks up on you. First a twinge on the outer part of the elbow. Then soreness and tightness after intense activity. Next, pain and tenderness when you touch your elbow and forearm. As it progresses, the ache can be constant, and you can experience pain and weakness when doing the simplest of daily activities, like lifting your coffee cup, picking up a bag or shaking hands.
It’s called lateral epicondylitis or more commonly, tennis elbow. It usually starts slowly, but often worsens over time. The pain can intensify and, left untreated, may become chronic, limiting recreation, work and sporting activities.
That’s usually the stage patients are at when they walk through the doors of our clinic looking for relief.
Who gets tennis elbow?
You don’t have to be a tennis player to get tennis elbow! In fact, statistically, only 5% of lateral epicondylitis cases are among tennis players. Most sufferers are between 30 and 50, with men and women affected equally.
In my sports therapy practice, I see tennis elbow among elite athletes and those “weekend warriors” who play racket or other sports recreationally. I also see it in those whose work requires them to do repetitive motions (like assembly line workers, painters, carpenters, plumbers and cooks). Even desk workers who repeatedly use a computer mouse are susceptible. Any activity that involves gripping or twisting and strains the tendons and muscles around your elbow over and over again can cause this frustrating condition.
Tennis elbow can be discouraging for patients who want to have a pain-free active lifestyle. The good news is, with the right treatment, it can be resolved—and you can get back to the activities you love.
How do you know it’s tennis elbow?
It’s always advised that you get a diagnosis from a healthcare provider. If you haven’t done that yet, there are clear indications that what you’re likely dealing with is lateral epicondylitis.
The pain of tennis elbow is focused on the outside of your arm, where your forearm meets your elbow. It may seem that the injury is to the bony bump on the outside of your elbow, but the pain is actually related to the muscle and tendons in your forearm.
Tendons connect your muscles to your bones. When you repeat certain arm movements, the tendons at the elbow may become inflamed and get small tears.
The tears can put stress on the rest of your arm, including muscles, making it painful, especially with certain movements. Patients complain of pain that is primarily focused in the outer elbow, and then expands from there into their forearm and often their wrist and sometimes even their hand. This may be felt as a constant dull ache or sharp pain in the elbow and soreness in the forearm. Or, you might only feel it when you make certain motions such as reaching, grabbing or lifting. Making a fist, raising your hand or straightening your wrist may also cause pain.
A similar condition is golfer’s elbow, or medial epicondylitis. This is also an overuse injury that can be caused by any activity that requires repetitive motion of the arm and wrist. But, while tennis elbow affects the outer (lateral) part of the elbow, golfer’s elbow affects the inside (medial) part of the elbow.
What can you expect at your initial visit?
My approach with all my patients is customized and collaborative, no matter the condition. Every patient I see is unique, and tennis elbow manifests itself differently in each patient. That means that we work together to create a treatment plan that you are comfortable with that gives you the results you want.
For example, a patient may be an elite athlete who cannot take much time off, or someone whose work requires them to continue to use their arm in the same way. Another patient might be comfortable with some therapies, but not others.
No matter the situation, we work together to create the best treatment plan to resolve the issue as soon as possible.
How is tennis elbow treated?
When a patient comes to my office with elbow pain or with a referral for lateral epicondylitis, I initially do an exam to evaluate the condition and its severity. I do a postural check-up to see if there are any spinal, neck or shoulder issues that could be affecting the injured area or causing an overcompensation injury.
We also determine which activities may have caused the injury and talk about how you can refrain from the trigger activity or activities to rest your arm and give it the time it needs to heal. I then create a comprehensive plan with you based on your particular situation.
You will learn exercises to stretch and strengthen the muscles and tendons in your arm. I may also work with you to develop proper form and technique regarding the activity that likely led to the development of your tennis elbow.
Active Release Technique (ART) is one of the first customized treatments we offer for tennis elbow. ART is soft tissue therapy that helps relieve tight muscles and nerve trigger points, greatly reducing joint stress or muscular pains. It involves applying pressure and moving the arm to release tension, scar tissue, adhesions and nerve entrapments.
Next, working with you, I create a plan for homecare, which is a key part of treatment. This could include icing, heat therapy, stretching, modification of activities, and exercises. Home care will be an important part of your treatment, particularly exercises, which can help strengthen forearm muscles and improve function. Custom exercises (depending on the severity of the condition, your job, sports activities, etc.) will play an important part in ensuring that your tennis elbow doesn’t return—which is a major goal of your treatment plan!
Some of the additional treatments for tennis elbow we may also include in your treatment plan are:
Shockwave Therapy, a non-invasive, non-surgical clinical procedure that uses acoustic waves mainly to relieve acute or chronic pain and speed up the healing process in affected tissues (What is shockwave therapy?)
Graston Technique, a form of manual therapy that uses stainless steel tools to effectively locate and treat soft tissue injuries (What is Graston Technique?)
Acupuncture, which involves inserting very thin, filament needles into specific points in the body, and has shown to be an effective treatment for tennis elbow pain
How many sessions will it take?
Every situation is unique, and duration of therapy will vary based on the personalized treatment plan set out in the first session. Most often for tennis elbow, treatment involves four to six sessions of 30 to 40 minutes each. At each session, I evaluate progress and modify the treatment plan if it is necessary. Sometimes, tennis elbow clears up after a few weeks of treatment, but usually it takes longer. In order to speed recovery, it’s important to avoid the aggravating activity completely if possible, adhere to the treatment plan, perform home exercises, and when ready, resume activities very gradually.
The goal, of course it to get you strong and healthy so you can get out there and enjoy life and your favourite activities!
At-home treatments for tennis elbow
Here at BODY CURE Sport & Therapy, we always work with you to customize your treatment to your specific needs. But here are some general guidelines for how you can get relief at home.
Heat and/or ice the affected area for 10 to 15 minutes daily.
Rest your arm and avoid any activities that trigger the pain.
Avoid gym activities that aggravate the elbow.
Be careful when lifting or gripping everyday items, or activities like scrubbing and cleaning. Make sure not to pull and/or push heavy objects during painful phase.
Use your unaffected hand/arm where possible.
Wear a brace on your arm that places direct pressure on the tendon on the top of the forearm if needed.
Consider taking over-the-counter medication, such as ibuprofen, to relieve pain and inflammation.
Consult a healthcare practitioner for a treatment plan and before doing any exercises for tennis elbow.
Get treated for tennis elbow in Woodbridge, Ontario, and the Greater Toronto Area
If tennis elbow is affecting your game, your work, your life, we at BODY CURE Sport & Therapy can help. The team here knows how important it is for you to minimize downtime, be pain-free and healthy, and get back in the game of life as soon as possible. If you would like to learn more about how we can help you achieve your optimal health, please get in touch here.