Training with knee pain

The fast facts:

  • Tennis elbow used to be called epicondylitis lateralis, now epicondalgia lateralis. 
  • It is the most common cause of elbow complaints
  • In tennis elbow, tendons around the elbow are irritated causing the symptoms.
  • With tennis elbow, there is pressure pain on the outside of your elbow
  • Despite its name, in only 5% of people with tennis elbow, tennis is the direct cause of symptoms
Meniscus complaints

Cause of Tennis Elbow

Tennis elbow is an overuse syndrome of the extensors in the wrist, that is, the symptoms usually develop and worsen gradually. Often these complaints arise from many one-sided activities (repetitive movements). Having to lift children or shopping bags frequently can also cause these symptoms to develop. Usually these complaints arise in people between 40-50 years of age in the dominant arm. That is, if you are right-handed the complaints probably also occur on the right. Work in which many of the same movements are made with the forearm is a risk factor for the development of tennis elbow

Types of Tennis Elbow

There are several types of epicondalgia lateralis:

  • Irritation of the tendon of the affected muscle
  • Irritation of the attachment to the bone, in 90% of all cases this involves
  • Irritation of the periosteum to which the tendon attaches 

How is tennis elbow diagnosed

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

Stretch and palpation of the muscle group

With the elbow in the extended position, the forearm is rotated and the wrist with the fingers fully flexed. If there is a recognizable pain, the test is positive. Palpation of the extensors can also give a recognizable pain.

Cozen's test

In the Cozen's test, the patient is asked to place the arm on the table in an extended position. Then, with a clenched fist, the patient is asked to apply force to dorsiflexion/extension and radial deviation. The occurrence of recognizable pain in the attachment region (lateral epicondyle) of the extensors makes the test positive. 

Maudsley's test

In the Maudley's test we see a similar execution to the Cozen's test. The starting position is the same except for the position of the hand. In the Maudsley's test the fingers remain stretched and the therapist asks you to move them up against resistance. This concerns the 2nd and 3rd finger. This is because the attachment points of the extensor carpi radialis longus and extensor carpi radialis brevis are here. Recognizable pain around the lateral epicondyle makes the test positive. 

    Anterior cruciate ligament

    Physical Therapy and Tennis Elbow

    The treatment will consist of different parts: stretching of the muscles, a possible friction massage on the painful tendons and exercises for the affected muscles. In the beginning, the treatments will focus on stretching and the exercises will not be as heavy as they should be. Eccentric training is the way to reduce the symptoms. However, this will have to be built up slowly under supervision. Exercises that you will be given to do at home will help to reduce the symptoms.

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