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In part 1 of our tennis elbow series, we will cover the symptoms and causes of this common issue. Pain on the outside of the elbow is classically called “tennis elbow” or lateral epicondylitis. Although, people who don’t play tennis can also have this pain from grip-heavy or repetitive activities. There are also many structures that can cause this same pain, outside of the usual tendinitis such as your radial nerve or neck.
Tendinitis is thought to be caused by increased inflammation due repetitive stress/overuse in the area and micro-tears to the muscle. Tendinitis is usually acute, meaning it just happened and you just got injured within 6 weeks. However, many people that we see have had symptoms for months or even years and so the process is different and chronic. We call this tendinosis. There is no longer acute inflammation or swelling, rather long-term changes to the tissues in that area from improper healing and continuous repetitive small traumas. So, while many tennis players have pain at their elbow, only a fraction will actually have “tendinitis”.
The area that is irritated to cause the pain at the outside of the elbow is called the extensor tendon. That is, the common tendon where all of the smaller forearm muscles that extend the wrist, join at the elbow.
Pain is usually with usage of the arm and lifting, carry and gripping. You can try to carry things with your palms up and this is usually much less painful or pain free. For acute pain medication, ice, rest and activity modification can help. For chronic issues progressive loading/strengthening in multiple positions works best. Tennis elbow braces and forearm sleeves can also be helpful. Typically trying to reduce the overuse or technique/form issues can prevent recurrence.
Often times, players who are playing frequently throughout the week without proper mobility and recovery plans will present with this issue. Over-gripping the racket is also another major cause.
Another tissue that is often the culprit is the nerves. Nerves course throughout our entire body for muscle function, sensation, etc. Irritation of the nerve, from repetitive activities or rubbing against another structure can send pain signals to the same area. However, treating the muscle in this case will not clear up the symptoms.
The major nerve that runs by the outside of the elbow is called the radial nerve. Muscles nearby are commonly overused in tennis and can compress this nerve causing symptoms. Irritation of this nerve can also begin at the neck causing symptoms that look like tennis elbow.
We often see players who are changing their grip or adding more top spin to their balls tend to have more issues with nerve irritation.
If your symptoms don’t improve with rest, ice, medication or at-home care give us a call and we can direct you and help you to get rid of your pain and return to the activities you love.
About the author: David Potucek, PT, MSPT, CFMT
David is an orthopedic physical therapist with over 20 years of experience. As manual therapist, a lifter, and a climber, he is no stranger to elbow and forearm discomfort. He has treated hundreds of folks with forearm and elbow pain that didn't make improvements with traditional care.
Disclaimer: This blog post is for informational purposes only and does not substitute for professional medical advice. Please consult with a qualified healthcare professional for personalized guidance.
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