Have you ever tried to turn a doorknob or take a lid off a jar and have searing pain on the outside of your elbow? If so, this article may be of some interest to you. In this month’s blog post, we will be covering the topic of elbow epicondylitis (or more commonly referred to now in the rehab world as epicondylopathy), otherwise known as: tennis or golfer’s elbow. This can be quite a debilitating condition which can affect all ages and activity levels. We will cover what it is and some of the things you can do to prevent and treat this condition.
Definition
Elbow epicondylopathy is defined as contractile overloads that chronically put stress on the tendons attached to the epicondyles, which is the rounded area of bone at the bottom of the humerus or upper arm (1). In layman’s terms, repetitive stress is placed on the tendons (connection between muscle and bone) around the elbow causing inflammation and pain. Tennis elbow or lateral epicondylopathy (LE) occurs on the outside or lateral epicondyle, while golfer’s elbow or medial epicondylopathy (ME) occurs on the inside or medial epicondyle. Most of the focus of this post will be on tennis elbow (LE) as it is the more common of the conditions.
Symptoms of LE
LE presents itself as pain on the bony prominence on the outside of the elbow. It may be tender to touch and may radiate down the arm to the wrist. It can develop suddenly or over a longer period of time.
Causes
Overload on tendons at the elbow typically seen with elbow epicondylopathy occur most often from repetitive use of the wrist and hand. Most often, LE is an inflammation of the extensor carpi radialis brevis tendon which is connected to the muscle responsible for extending and abducting the wrist (with palm facing forward moving the hand backwards and away from the body). Athletes including weightlifters, golfers, and baseball players can develop epicondylopathy, but the condition is not only isolated to athletes. Plumbers, carpenters, metal workers, and other professions involving significant work doing repetitive hand and arm movements can be at a higher risk to develop the condition.
In my experience training people with this condition, a big risk factor for developing epicondylopathy, is a change in the amount or volume of work or stress on the elbow and arm. Some examples include people coming off of the winter and then deciding that they are going to get a really good head start on their golf game and decide to play 10 rounds of 18 holes in the first few weeks of the season. Another example, is someone who works construction that has their normal day to day tasks and then all of a sudden, a new job comes up that requires them to use a jackhammer for 10 hours per day for a week. Unfortunately, new stimulus on the body without being able to properly adapt to it usually ends up hurting the weakest link in the chain, which in a lot of cases, is our tendons.
Prevention
When possible, try to do movements with both hands instead of only using one hand. Try to take breaks as much as able when doing an activity that is wrist and arm intensive, and rotate jobs at work if able. Positioning the shoulder and elbow in a position that doesn’t put excessive force on the muscles involved in wrist flexion and extension (bending) can also be helpful. Warming up and stretching before activity can also be beneficial.
Treatments
Research shows initial treatment should be non-operative, conservative management. This may include activity modification (limiting activities or changing how you do things), bracing to take tension off of the tendon, and physical therapy. Physical therapy will likely consist of manual therapy (joint mobilization, myofascial release) and exercise prescription that emphasizes eccentric loading to strengthen the region. This conservative management approach shows as high as a 90% success rate for resolving the condition (2). Other treatment options may include ice, anti-inflammatory medication, and in rare cases, surgery (3).
Exercises
Exercises used for prevention and treatment of elbow epicondylopathy focus on grip, wrist, and arm strength. The following is a basic list of exercises one can use for prevention and treatment of this condition:
Towel Squeezes – Rest forearm on table with palm up and squeeze towel in hand. Can be done multiple times for 10-15 second holds.
Wrist Flexion and Extension – Support arm at elbow. With a small dumbbell (2-3lbs) grab weight by the handle and curl weight up and down bending at the wrist. Flexion is bending the wrist with the palm up and extension is bending the wrist with the palm down. Can be done for multiple sets with 10-15 reps per set.
Wrist Supination and Pronation – Same setup as wrist flexion and extension. This time grab dumbbell by its knobby end. Now rotate wrist upwards and downwards. Can be done for multiple sets with 10-15 reps per set.
Towel Twist – Grab towel 5-6” apart. Can be done with palms down, palms up, or a combination of both. Twist one hand forward and one hand back wards. Can be done for multiple sets with 10-15 reps per set.
Hopefully this blog post has been informative and has given you a little background information on elbow epicondylopathy. I have myself suffered from tennis elbow and one underestimates how this condition impacts the rest of your life. Care should be taken to protect your elbows, especially if you are very active and have a job that is repetitive and physically demanding.
-Trent, ET
References
(1) Lateral Epicondylitis. (2018). Retrieved from: https://www.physio-pedia.com/Lateral_Epicondylitis
(2) Schwarzman G, Watson JN, Hutchinson MR (2017) Lateral Epicondylopathy (Aka. Tennis Elbow): A Review of Current Concepts and Treatment. Annals of Sports Medicine and Research 4(5): 1117.
(3) Morteza, N.A., Mahmuudi, A., Salariyeh, M., Amiri, A. Surgical Treatment of Tennis Elbow, Minimal Incision Technique. (2016). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100454/