Tennis Elbow, also known as lateral epicondylitis, is a common injury where the tendons surrounding the elbow joint become inflamed or damaged from repetitive use. As a result, this causes tenderness or pain on the outside of the elbow and the forearm or wrist. This injury typically exists for those who are tennis players or those who complete a lot of manual work, where overuse of the extensor carpi radialis brevis (ECRB) muscle leads to inflammation of the common extensor tendon (as this tendon attaches to the lateral side of the elbow joint). As this muscle controls wrist extension or abduction, this pain can be experienced when gripping or completing resisted wrist extension movements. So, what is the best way to treat this injury?
The best way to initially manage this injury or exacerbations of pain is to modify activities that aggravate the affected elbow (such as gripping heavy objects or lifting objects with the palm facing down). It is best at this point to unload the tendon until symptoms and pains reduce. When this occurs, it is ideal to move on to an exercise rehabilitation program.
Exercise plays a crucial role to the treatment of tennis elbow. Now that the tendon inflammation has settled, it is important to introduce the extensor tendon to load and strengthen the (ECRB) muscle group. Exercise treatment for tennis elbow is typically split into different stages.
- Isometrics: In early-stage treatment, isometric exercises (placing a load on the muscles without lengthening or stretching the muscle) slightly loads the tendon and reduces pain by changing the pain pathways to your brain. Examples of isometric exercises can simply be a towel scrunch, suitcase carries or extending the wrist and holding it in place with the supporting arm.
- Eccentric exercise: When pain levels improve and you are ready to progress from isometrics, eccentric exercises are the next step. Eccentric exercises are ideal as now some load needs to be introduced to the common extensor tendon, with the goal of improving tolerance. Eccentric exercises involve lengthening of the muscle and tendons whilst producing a minimal load on the tendon. Exercises can include wrist curls or wrist supinations with a dumbbell. With these exercises it is important to go down slowly in the eccentric phase of the exercise (the lowering phase of the movement).
- Isotonic Exercises: When you are ready for the next stage of your rehab, completing isotonic exercises (exercises that include active shortening and lengthening of the muscle) is a great progression to increasing load and the strength of the tendon and improving the strength of your ECRP muscle. Examples of this can be doing bicep curls, wrist curls or wrist supinations (with increase in intensity and less focus on the eccentric phase), neutral grip bench press and so on.
If you are experiencing this issue and need further guidance on managing this injury, seeing an Accredited Exercise Physiologist would be beneficial as they can develop an individualised exercise program to assist with your rehab and health goals.