Tennis elbow (Epicondalgia lateralis)

Tennis elbow is an overuse syndrome of the extensors in the wrist, that is, the symptoms usually develop and worsen gradually. Often, these symptoms arise from many unilateral activities (repetitive movements). Frequent lifting of children or shopping bags can also cause these complaints to develop. Usually, these complaints arise in people aged between 40-50 in the dominant arm. That is, if you are right-handed the complaints are likely to occur on the right. Work that involves a lot of the same movements with the forearm is a risk factor for developing tennis elbow.

The most well-known risk factor for developing tennis elbow is the frequent repetition of the same movements. This may be because you have to do a lot of chores and tinkering, for example, but low-intensity activities such as typing on a keyboard are also associated with the development of tennis elbow. Despite the name, in only 5% of people can tennis elbow be related to playing tennis. In addition, it is an injury more commonly seen in people who have to do a lot of lifting and the complaint usually arises on the dominant side of the body. Despite the fact that this side of the body is often better developed, the complaint arises here precisely because this side also has to endure much more. Especially in people who work a lot with their hands. A tennis elbow occurs most often in people aged between 40-50 years.

The symptom pattern in a tennis elbow consists of a confluence of several factors. So we often see that people have a profession that involves a lot of hand work (or have done a lot more hand work recently). Further fitting the symptom picture is;

• Pain around the outer part of the elbow with possible radiation to the forearm.
• Complaints that develop slowly and increase over time.
• Often relatively little trouble at rest.
• Worsening pain during overhead lifting and wringing/ pinching.

A tennis elbow is often confirmed by pain on tightening, stretching and palpation of the muscle(s) involved. You may be able to see some fluid or damage on an ultrasound image but in most cases, additional examination is not necessary for a muscle injury. This is because the initiated policy will not differ. We often see that the symptoms have been present for some time and have slowly become worse over time.

The expectation in recovery of a tennis elbow is basically good. It is just hard to say how long recovery takes because it varies enormously from one individual to another. Research shows that 80% of people recover in six months and 89% of people with tennis elbow symptoms within 1 year complaint-free is. Sometimes, as people start relieving the affected arm, over time you see symptoms developing in the other arm as well. This is just pure bad luck. Basically, tennis elbow is a self-limiting complaint. That means you would expect it to go away on its own at some point.

When you come to the physiotherapist and the tennis elbow has been established you will naturally get down to treating the complaint. The first step in the process is to provide the right information and advice. Important for recovery is to make (temporary) adjustments in the daily use of the arm. Because in the majority of people the symptoms are work-related, you will therefore have to see if it is possible to rearrange the work. This is going to give the tendon more time to come to rest. Of course, this advice also applies to certain sports and other activities where the arm is put under a lot of strain. For how long this advice applies depends on the course we will see over time. Assume in advance that it is going to be a process of months, then it might just be better than expected.

The physiotherapist has various methods/techniques to help shape treatment in the further treatment process. The following treatment methods are best known for tennis elbow complaints:

Massage/friction
Massage or in tennis elbow complaints also called deep friction massage can bring quite good long-term results.

Exercise therapy
Literature advocates the use of exercise therapy in tendon complaints such as tennis elbow. Mainly, eccentric loading of tendon tissue (loading while lengthening the muscle) seems to be able to provide the right stimulus to reduce symptoms over time. Besides eccentric loading, the training method HSL (heavy slow resistance) works just as well. The idea is that controlled high tension on the tendon will stimulate it to start laying strong new fibres. Besides taxing exercises, stretching the muscle is also used within the realm of exercise therapy. Keeping the muscle/tendon in a stretched position for an extended period of time could produce pain-relieving effects. It is important that exercise therapy is applied with proper regularity and also sufficient rest to recover from the given strain. In principle, exercise therapy can be used in combination with forms of therapy such as friction, kinesio tape and/or dry needling.

Brace/tape/dry needling/shockwave
Using a brace has no scientifically proven effect. In practice, patients' experiences are mixed. Some say they noticed a difference when using a brace, others did not. The question is whether, if a difference was noticeable, it was based on the use of a brace. Based on insufficient scientific evidence, we cannot recommend the use of a brace to date.

Kinesio tape has gained a lot of popularity in recent years for a variety of physical complaints. For a period, kinesio tape was also very widely used for tennis elbow complaints. Fairly recent studies still advocate the use of kinesio tape in the treatment of tennis elbow complaints. This is because good results can be achieved when it comes to pain reduction. However, this treatment method should be used in combination with exercise therapy for best results.

In dry needling, small needles are pricked directly into the muscle or tendon by the physiotherapist. Its aim is to stimulate sensors in the muscle or tendon that produce pain-relieving effects. There are also indications that this form of therapy positively stimulates the body to start using the right repair factors in the affected area. Research shows that dry needling gives significantly better results after several weeks and still after several months than treatments consisting of the use of only medication and a brace.

Several studies have been conducted on the effect of shockwave therapy on tennis elbow complaints. To date, results have been mixed. The literature does not currently recommend the use of shockwave on tennis elbow complaints over other treatment options due to varying results and high costs.

Medicated
Pain-relieving medication may be part of the treatment. This is especially advisable for people who experience a lot of pain. It should be noted, however, that the aim is of course to comply with the advice given. Depending on the symptoms and the severity of pain, a choice can be made between using paracetamol, NSAIDs to be applied to the skin or prescribing ibuprofen, diclofenac or naproxen. Never just go ahead with these. Your GP is the one to talk to when it comes to medication use. So always consult them before starting medication.

Putting a corticosteroid injection is also a well-known drug treatment method. Basically, however, it is not recommended to use this. The pain-relieving effects of the injection are generally good. This is of course nice because then you experience less pain symptoms. The downside is that in most people, this causes them to quickly start straining more, causing the symptoms to return. This is because the injection has a pain-relieving effect; the recovery of the tendon still needs time. Annoying perhaps, but better to just let the process take its course and wait and see.