Lateral Epicondylitis Of The Elbow

Tennis Isn’t Always The Cause Of Tennis Elbow

Lateral epicondylitis, also commonly known as tennis elbow is a relatively prevalent condition.  Particularly prevalent in adults aged between 30 and 50 years old and despite its name, less than 5% of cases are actually linked to the act of playing tennis.

Some Common Causes Of Lateral Epicondylitis Include:

Any activity involving excessive gripping, or wringing activities has the potential to trigger lateral elbow pain. However the action of simply gripping alone is typically not sufficient to cause tennis elbow, an overload to tissues is generally required. This overload may come in the form of a significant jump in stress to the area without time for tissues to adapt, insufficient rest between sessions of stress, subsequently not allowing enough recovery time between loading sessions are both common forms of tissue overload.

• Unaccustomed activity involving the hands such as a concentrated period of DIY painting, carpentry including hammering, using a screwdriver, or sawing…
• Playing musical instruments
• Weight lifting
• Cricket, golf, baseball, hockey and other racquet sports like squash and badminton…
• Excessive typing

Insufficient forearm muscle strength, or conditioning when performing the above (or similar) activities may trigger an episode of lateral elbow pain. Poor technique with any of the above activities and/or as mentioned above overloading tissues by going to heavy too soon, meaning to much load in one sessions, or insufficient recovery time for tissues between successive loading periods can all contribute to tissue stress and potentially lead to the onset of lateral epicondylitis.

Loading Changes Within A Tennis Game That Could Contribute To The Onset Of Tennis Elbow

The above loading risk also applies to tennis and other racquet sports such as squash, badminton, or racquet ball as a potential cause of lateral elbow pain:

• Changing racquet this could include an alteration in racquet weight or size changing the levers on ball contact.
• Changing string tension
• Changing grip size
• Changing grip technique
• Playing on a different surface moving from artificial grass to hard court…
• A change in ball weight which could come from playing tennis in the wet, with heavy saturated tennis balls, or switching from regularly playing with flat lifeless balls to playing with fresh pressurized tennis balls.
• Changing playing partner (playing someone who hits the ball harder and receiving faster high force balls.
• Altering playing frequency, going from playing one a week to a couple of times a week. Or switching from playing doubles to singles and effectively doubling the number of strokes played in each match…
• Changing your stroke technique, such as trying to move from a double handed backhand, to a single handed backhand technique.
• Taking up tennis as a new sport, or returning to playing tennis after an extended hiatus.

Among other things, the above situations in tennis can all play a role in why the sport of tennis is a common cause of lateral epicondylitis and elbow pain.

Acute Verses Chronic Lateral Epicondylitis

Acute lateral epicondylitis resulting from over loading the tissue may be initially associated with inflammation. Swelling and pain can occur in normal healthy tissue that is overloaded though greater forces that the normal healthy tissues can handle. Inflammation in lateral elbow pain can also occur as an acute on chronic problem, where there is a chronic non-inflammatory tennis elbow condition that is overloaded with more force than the tissue (this time tissue of poor health) can cope with, this overload to degenerative tissue sets off a reactive acute inflammation in the area, acute inflammation on top of a chronic tennis elbow complaint.

Unlike an acute lateral epicondylitis, chronic tennis elbow is not actually due to inflammation but is associated with degenerative changes in the tissue around the lateral epicondyle. Hence although lateral epicondylitis is frequently used as the medical term for all tennis elbow conditions this nomenclature refers to there being inflammation of the lateral epicondyle, and is not accurately representing what we now understand is going in the tendon in the majority of tennis elbow complaints. Investigation of individuals suffering with chronic tennis elbow has shown no evidence of the chemicals normally associated with inflammation. Instead, you see degenerative changes in the extensor tendon, where the tendon structure starts to break down. The use of a blanket term “extensor tendinopathy” is commonly used as this can more accurately cover the possibility of there being inflammation, degeneration and/or tears within the tendon tissue.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Lateral Epicondylitis Of The Elbow should consult his or her physiotherapist, sports medicine specialist, orthopedic surgeon or otherwise appropriately skilled practitioner.