Understanding tennis elbow and how you can be at risk

Lateral epicondylalgia, or “tennis elbow” as it is often called, is one of the most common musculoskeletal injuries related to overuse that therapists see in patients.

The vast majority of these patients don’t play tennis, or sports in general. For many, this problem can quickly become chronic, leading to prolonged pain and disability.

Conservative treatment of tennis elbow focuses on reducing inflammation and pain around the elbow while strengthening the muscles that control wrist extension.

However, for more complex cases, other areas in the body may need to be addressed to lessen pain and disability.

The shoulder

Lateral elbow pain is often caused by an overload of the extensor tendons of the elbow, which are compensating for a weak or fatigued shoulder.

Rotator cuff injuries and poor shoulder blade strength often begin as non-symptomatic problems that manifest as elbow pain when the distal arm attempts to compensate for a poor base of support.

Your physical therapist should examine shoulder function and strength as part of a thorough investigation of the cause of elbow pain and to prevent reoccurrence.

The neck

Neck stiffness and dysfunction can contribute to elbow pain directly, as compensations in movement due to poor neck/shoulder mechanics or problems with the way the peripheral nervous system is communicating can lead to elbow pain.

The radial nerve originates in the mid cervical spine (neck) and branches from the brachial plexus to pass down the arm and across the outside of the elbow. Pain in this nerve can be misdiagnosed as tennis elbow and is sometimes present in conjunction with a tendon injury.

The radial nerve passes through many junction points as it travels from the neck past the elbow and is vulnerable to irritation and compression at each point.

Two or more junction points can be responsible for creating a “double crush” injury in which the cumulative irritation results in elbow symptoms.

Your therapist should consider both your neck function and nerve dynamics when treating lateral elbow pain, especially in chronic cases.

Equipment and technique

Lateral elbow pain is also often the product of poor equipment or technique. Changing grip sizes when playing racquet sports or golf can help reduce the strain on the elbow by relaxing the force required to hold onto the handle.

Small grip size in relation to hand size has also been shown to be a factor in the development of elbow pain. Increasing the grip size by getting equipment that fits properly or adding an overgrip can help resolve an injury.

Technique can also be a major factor in an injury that involves the elbow. Improper swing mechanics where force is generated in the upper body without an optimal contribution of the lower body weight transfer can quickly lead to the arm being overloaded.

Preventing injuries

Talking to a pro and or taking lessons to learn better body mechanics and techniques might be the best way to improve your game, prevent injuries and/or help with injury recovery. Your physical therapist may also want you to bring in your equipment so that you can demonstrate your form.

They may record your mechanics through video and use slow motion to identify errors that may be causing injury.

Elbow pain can be a complex problem for what seems like a straight forward injury. Working with a therapist to determine the source of the injury is key. If you’d like to consult a physiotherapist, check out our Locations page to find a Lifemark clinic near you.