Lateral epicondylitis, or “tennis elbow," is the most common elbow condition and affects up to 3% of the population, primarily in their 40s and 50s. It is most commonly seen in the dominant arm since it is usually repetitive in nature. Although -itis typically refers to inflammation, most cases present without inflammation. Especially in a chronic state, meaning lasting longer than 3 months or being recurrent, the issue becomes “tendinosis” which is more of tendon degeneration due to repeated micro-trauma. The most common muscle that is involved is the Extensor Carpi Radialis Brevis.
A lot of times patients are referred to PT with a diagnosis of Lateral Epicondylitis, but this might not be the main contributing factor to their elbow pain. A skilled therapist will be able to rule in or out other issues that may be contributing. Differential diagnosis should include radial tunnel syndrome, cervical radiculopathy, rotator cuff injuries, and/or ligamentous injuries as lateral epicondylitis is often misdiagnosed or other contributing factors are missed in the assessment. These other issues can be ruled in or out through a variety of special tests, strength or range of motion assessments, postural assessments, and palpation.
The diagnosis of tennis elbow can be misleading as most people that get it, have never played tennis before. It seems to be more postural contributions especially with people working on computers, laptops, or tablets. Often, an ergonomic evaluation can be performed by your company but following a few recommendations for sitting posture can be helpful. Sitting with elbows at your side with support, wrist support, and keeping the keyboard and mouse closer to your body are easy ways to start working on decreasing demand for these muscles. If you think about sitting at a keyboard with your wrists cocked into extension for 8-10 hours per day of computer use, the wrist extensor muscles are constantly working.
If you are a tennis player, things that can help with this condition include wider racket grips, elbow braces, stretching, warming up, and working on full-body strengthening and mobility. Although symptoms are in the elbow, often the cause is due to either poor mechanics, lack of mobility, or lack of strength. If your rehab consists so far of icing, resting, taping, and working on forearm or elbow strength, you might be missing the cause of the pain.
During a forehand in tennis, elbow pain is usually felt either at ball contact due to the vibration and/or from the topspin being created, or during the follow through due to the eccentric load going through the tendon and the mobility demands required through the entire body. For example, if you lack lead leg internal rotation, thoracic rotation, or posterior shoulder mobility, there will be more range of motion demands and eccentric tension going through the wrist extensor muscles.
There’s a lot of force being generated through a tennis swing and a lot of moving parts. If you have leg, hip, core, or shoulder strength deficits and you’re not working on that as a part of your rehab program, then you might be setting yourself up for a longer recovery or a recurrent issue.
For examples of exercises to help you work on your internal rotation, mobility, and strengthening for a more efficient and effective tennis training program, check out our Instagram at @rehabunited or by visiting https://www.instagram.com/rehabunited.
Jason Averilla, PT, DPT, FAFS, OCS, CCI, is a Doctor of Physical Therapy from SDSU's inaugural class. He is a Board-Certified Orthopedic Clinical Specialist, Fellow of Applied Functional Sciences, and teaches in the DPT programs at San Diego State University and the University of St. Augustine. He is passionate about teaching and takes multiple students per year. In his free time, he likes to spend time with his family and 1-year-old son, kayak fish, golf, and play sports.