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 resulting from overuse of the extensor tendon. This condition can significantly impact a person's ability to perform daily tasks and participate in sports, particularly those involving gripping or extending the wrist. This blog post provides a summary and the latest insights, offering a comprehensive overview for practitioners or people suffering from this condition who want to improve their understanding and management of it.
Risk factors for lateral epicondylalgia: lateral epicondylalgia is a condition that affects many people, particularly those who engage in repetitive arm movements or strenuous activities. Although this condition is often associated with athletes, it can occur in anyone whose daily activities strain 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 the age of 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 is simply much less common in people under 40 and very rare in people in their early 20s or younger.
The role of repetitive strain: repetitive strain is one of the main causes of lateral epicondylalgia. Activities that involve repeated gripping, especially with a straight and pronated wrist, put a lot of pressure on the extensor tendons of the forearm. Over time, this can lead to microtears, strain injuries, and tendon degeneration. Manual laborers, office workers, and recreational athletes are particularly at risk due to the repetitive nature of their tasks. For example: manual laborers often perform tasks that require powerful gripping or lifting, which puts a lot of strain on the tendons. Athletes who play tennis, golf, or squash often make repetitive arm movements, which increases the risk of developing the condition, especially when technique or equipment is not optimal.
Assessment of potential lateral epicondylalgia: the assessment begins with a thorough patient history and understanding of the injury mechanisms and specific pain triggers. After carefully listening to the patient and ruling out any red flags, the assessment usually continues with palpation of the elbow, focusing on the lateral epicondyle and surrounding musculature, including the common extensor tendons.During palpation, clinicians apply pressure to these areas while asking the patient to perform specific movements. This process helps to determine the exact location of the pain and identify any relationship to the tendons involved. In addition, the physical therapist should 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. Understanding how the patient's pain relates to their daily activities is therefore crucial to creating an effective rehabilitation program.
1. Education and load management: understanding and managing load is fundamental to treatment. As a practitioner, you must teach your patients to avoid aggravating activities, such as repeated gripping or stretching the wrist in a pronated position. In addition, it may help to encourage them to use pain as a guide. A general rule is that pain during activities should not exceed 3-4 out of 10 and that pain should disappear within half an hour to an hour after exercise. If pain persists or symptoms worsen, this should indicate that adjustments are needed.
2. Exercise therapy: exercise has been shown to be better than passive treatments, although not by much. Still, this treatment method is better than all the others because it can help the tendon tissue heal and regenerate. Figuring out the right amount of exercise is key, but too much can break down tissue and make symptoms worse. It is important to note that during and after the exercises, you should remain below an NPRS (Numeric Pain Rating Scale) of 3-4 and that the pain should disappear within 24 hours, but ideally within an hour or two.
3. Complementary therapies: various complementary therapies can supplement exercise therapy to optimally relieve pain and support recovery:Taping: Techniques such as the spiral method, which supports the elbow during movement, can provide pain relief and a feeling of stability. Ensure correct application to prevent skin irritation or discomfort.Bracing: Elbow braces can help by reducing pain in the affected area. However, patients should be instructed on how to use them correctly to avoid complications such as nerve compression. Manual therapy: Lateral gliders at the elbow can provide pain relief and facilitate the progression of exercises. These gliding movements stabilize the humerus and apply a lateral force to the ulna.Shock wave therapy: There is strong evidence that this is not beneficial for lateral epicondylalgia and may even worsen the results. Dry needling: Dry needling may have a more favorable profile for pain relief. Although the evidence for dry needling is less strong 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.
