Tennis elbow or “lateral epicondylitis” is a common condition that I’ve discussed with and treated many patients for. The condition is defined by pain at the common extensor tendon in the outer aspect of the elbow. This is usually a result of “tendinosis” or disorganization/degeneration of the tissues.
The movement that causes this condition is usually explosive wrist extension. A common misconception is that tennis elbow only happens in tennis players. If you’ve ever taken tennis lessons, you may be able to recall your instructor screaming to “keep your wrist stiff!!”. Improper technique however, especially during backhands, can involved “flicking” of the wrist. In other words, tennis player who are predisposed to tennis elbow may want to review their technique. Many other activities/occupations involve explosive wrist extension.
Other occupational factors that have found to be associated with lateral epicondylitis include:
- repetitive wrist motion, especially with the wrist continuously deviating from neutral
- regularly handing loads >20kg
With respect to tennis technique, the following biomechanical factors have been found to predispose players to lateral epicondylitis and should attempt to be corrected:
- backhand: continuous contraction of the wrist extensors or excessive wrist extension, leading with the elbow, insufficient follow through; ?one handed backhands (lacking evidence)
- forehand: excessive forearm pronation (turning the palm towards the ground)
- serve: snapping the wrist
Treatment for lateral epicondylitis includes the following:
- activity modification
- counterforce bracing – a strap placed just distal to the lateral epicondyle which prevents traction on the tendon
- Anti-inflammatories – topical or oral
- Strengthening exercises – eccentric (muscle lengthening) are the most effective, but also concentric (muscle shortening/contraction)
Below are some exercises recommended for lateral epicondylitis: