Lateral epicondylalgia, better known as tennis elbow, is a common condition that affects people who engage in repetitive arm movements. It is characterized by pain and tenderness on the outside of the elbow, often due to overuse of the extensor tendon. This condition can significantly affect a person's ability to perform daily tasks and participate in sports, especially when it comes to grasping or stretching the wrist. This blog post summarizes and latest insights and provides a comprehensive overview for practitioners or people suffering from this condition who want to improve their understanding and management of this condition.
Risk factors for lateral epicondylalgia: lateral epicondylalgia is a condition that affects many people, especially those who engage in repetitive arm movements or strenuous activities. Although often associated with athletes, this condition can occur in anyone whose daily activities stress the tendons of the forearm. By understanding the key risk factors, you can take proactive steps to identify and effectively address the condition.
Age as a contributing factor: age plays an important role in lateral epicondylalgia, with the condition being more common in people over 40. Degenerative changes in the tendons, which naturally increase with age, are an important factor. However, this does not mean that younger people are immune to the condition - it simply occurs much less often in people under 40 and very rarely in people in their early 20s or younger.
Role of repetitive strain: repetitive strain is one of the main causes of lateral epicondylalgia. Activities involving repetitive grasping of the hand, especially with a stretched and pronated wrist, put heavy pressure on the extensor tendons of the forearm. Over time, this can lead to microtears, overuse injuries and tendon degeneration.
Manual laborers, office workers and recreational athletes are especially at risk due to the repetitive nature of their tasks. For example: manual laborers often perform tasks that require forceful gripping or lifting, which puts heavy strain on the tendons.Athletes who play tennis, golf or squash often perform repetitive arm movements, which increases the risk of developing the condition, especially if the technique or equipment is not optimal.
Assessment of potential lateral epicondylalgia; the assessment begins with a thorough history of the patient and an understanding of the mechanisms of injury and specific pain stimuli. After listening carefully to the patient and removing possible red flags, the assessment usually continues with touching the elbow, focusing on the lateral epicondyle and surrounding musculature, including the common extensor tendons.During the touch, clinicians apply pressure to these areas while asking the patient to perform specific movements. This process helps establish the exact location of the pain and identify any relationship to the tendons involved. In addition, the physical therapist must also assess the patient's range of motion and functional abilities to understand how the condition affects the patient's daily life and activities. Functional assessment may involve observing the patient's ability to perform tasks that exacerbate symptoms, such as grasping or lifting objects. Thus, understanding how the patient's pain is related to his or her daily activities is crucial to creating an effective rehabilitation program.
1. Education and load management: understanding and managing load is fundamental to treatment. As a practitioner, you should teach your patients to avoid aggravating activities, such as repeated grasping or stretching the wrist in a prone position. In addition, encouraging them to use pain as a guide can help. A general rule is that pain during activities should not exceed 3-4 out of 10, and the pain should subside within half an hour to an hour of exercise. If pain persists or symptoms worsen, this should indicate that adjustments are needed.
2. Exercise therapy: exercise has proven to be superior to passive treatments, although not to a great extent. Nevertheless, this treatment method is still superior to all others because of its ability to promote healing and regeneration of tendon tissue. Determining proper loading is crucial, but overloading leads to tissue breakdown and worsens symptoms. It is important to note that you should stay below a NPRS (Numeric Pain Rating Scale) of 3-4 during and after exercise and the pain should subside within 24 hours, but ideally within an hour or two.
3. Complementary therapiesSeveral complementary therapies can supplement exercise therapy to provide optimal pain relief and support recovery:
Taping: Techniques such as the spiral method, which supports the elbow during movement, can provide pain relief and a sense of stability. Ensure proper application to avoid skin irritation or discomfort.
Bracing: Elbow braces can help by reducing pain in the affected area. However, patients should be instructed on their proper use to avoid complications such as nerve compression.Manual therapy: Lateral glides at the elbow can provide pain relief and facilitate exercise progression. These gliding movements stabilize the humerus and apply lateral force to the ulna.Shock wave therapy: There is strong evidence that this is not beneficial for lateral epicondylalgia and may actually worsen outcomes.
Dry needling: Dry needling may have a more favorable profile for pain management. Although the evidence for dry needling is weaker than for other treatment methods, some studies suggest that it may relieve pain in certain patients. The primary goal of dry needling should be pain relief rather than directly stimulating tendon repair.
