Lateral Epicondylitis (Tennis Elbow)

Lateral epicondylitis (Tennis Elbow) 

What is it

Lateral epicondylitis also known as tennis elbow is a repetitive overuse injury in the forearm and elbow that is caused by inflammation on the proximal attachment of the tendon of the extensor carpi radialis brevis muscle, which is a muscle on the dorsal aspect of your forearm.

Why does it occur

This inflammation is caused by an excessive amount of load which can be done through gripping and wrist extension movements which puts too much load on the tendon therefore causing inflammation and pain. Another reason why tennis elbow or lateral epicondylitis may occur is due to poor mechanics of the hand and wrist, elbow or even the shoulder which can cause compensatory patterns therefore causing more stress and load on the extensor carpi radialis brevis tendon.

Signs and symptoms

The signs and symptoms of lateral epicondylitis/ tennis elbow are:

–           Pain in the elbow with gripping, lifting objects,

–           Any wrist extension that causes pain

–          Pain with a gradual onset

–           Pain at night

–           Weak grip strength / with pain

–           Swelling around the elbow

–           Tenderness and stiffness in the elbow

Management / Treatment options

Ice/ cold therapy: Implementation of cold therapy and ice therapy has been proven to decrease pain in inflammation to the effected tendon. This can be an easy way to reduce pain and swelling in the area.

Exercise prescription:  Strengthening exercises have been shown to increase muscle and tendon strength while also reducing pain levels. The Eccentric load of the muscle and tendon has proven to be beneficial in providing symptom relief.  Some of the results that eccentric strength training has provided include increased functions like grip strength, range of motion before the point of pain, and load capacity in everyday activities. This suggests that strength training focussing on the eccentric part of the movement provided the most effective results for lateral epicondylitis. (Chen & Baker, 2021)

Anti-Inflammatory medication: Can be used to decrease inflammation but is recommended only for a short period of time for up to 5 days. This is not a long-term management strategy. These can be useful for speeding up the healing process.

Bracing / Strapping: Taping and bracing has been shown to increase grip strength and reduce pain intensity and pain with pressure. This can provide support and relief to the tendon reducing load and increase the tendons’ ability to begin to heal. (Rodruigues & Syrivastava, 2021)

Needling: Dry needling has been proven to decrease pain intensity, increase grip strength, and increase functional capabilities.

Corticosteroid injection: Corticosteroid injection is an option for lateral epicondylitis/ tennis elbow as studies have shown that in some cases it can provide pain relief and decreased inflammation therefore allowing patients to complete daily tasks easier. (Saccomani, 2010)

When to consider or go for surgery?

As osteopaths, we advocate for a conservative approach to injury management and treatment before considering surgical intervention. We prioritise non-invasive techniques to promote healing and restore function. However, if pain persists, worsens, or significantly impairs daily activities over an extended period without improvement, surgical options may be considered as a last resort.

How can osteopathy help?

At our clinic, we provide comprehensive care utilising a range of techniques and management strategies to alleviate pain and enhance function. Our treatment approach considers various factors, including workplace and home ergonomics, joint alignment, and activity modifications to reduce strain on the affected area. We aim to facilitate pain relief and promote recovery, we incorporate specialised techniques such as dry needling, taping, soft tissue massage, and targeted interventions for muscles and ligaments in the hand, wrist, elbow, and shoulder. Our goal is to optimise rehabilitation and support long-term musculoskeletal health.

Reference list

Chen, Z., Baker, N, A. (2021). Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis, Science Direct, 34, 1, 18-28. https://doi.org/10.1016/j.jht.2020.02.002

​ Ma, K., & Wang, H. (2020). Management of lateral epicondylitis: A narrative literature review. Pain Research and Management, 2020, Article 6965381. https://doi.org/10.1155/2020/6965381

Özünlü Pekyavaş, N., & Cerezci Duygu, S. (2022). Which cold application is more effective for tennis elbow? Cooling gel vs cold pack. International Journal of Disabilities Sports and Health Sciences, 5(1), 16–21. https://doi.org/10.33438/ijdshs.1039813

Saccomanni, B. (2010). Corticosteroid injection for tennis elbow or lateral epicondylitis: A review of the literature. Current Reviews in Musculoskeletal Medicine, 3(1–4), 38–40. https://doi.org/10.1007/s12178-010-9066-3

Xia, M. B., Yaqin, Q. B., Jinyang, W. M., Anke, X., & Jiteny, R. (2024). Therapeutic effects of dry needling on lateral epicondylitis: An updated systematic review and meta-analysis. Science Direct, 105(11). https://doi.org/10.1016/j.apmr.2024.02.713

Yoon, S. Y., Kim, Y. W., Shin, I. S., Kang, S., Moon, H. I., & Lee, S. C. (2021). The beneficial effects of eccentric exercise in the management of lateral elbow tendinopathy: A systematic review and meta-analysis. Journal of Clinical Medicine, 10(17), 3968. https://doi.org/10.3390/jcm10173968