Lateral epicondylitis, or tennis elbow, as it is most commonly known, is the term used to describe inflammation and pain on the outer elbow, where tendons are attached to bone.

It is often caused by repetitive movements, usually performed while playing racket sports, thus the name tennis elbow. It may also occur due to other repetitive movements involved in various occupations such as machine operators, manual handlers, people working in the sewing industry and those who spend long hours operating computers. The weight and size of the racket, grip strength and poor ergonomic set-up have also been attributed as possible causes of tennis elbow.

Immediately after sustaining an injury to this area, rest, followed by the application of ice over the elbow, is most important in the first three days. Ice should be applied using a damp cloth for 15 minutes and should be repeated regularly every four hours in the first 48 hours.

A thin film of baby oil applied on the skin helps prevent the possibility of getting an ice burn. Caution must be exerted in the case of diabetics due to the possibility of altered skin sensation.

If the pain experienced around the elbow has been there for some time and comes and goes without any specific pattern, ice application is still useful as it helps in numbing the pain.

It is advisable that, especially in the initial days following elbow injury, one seeks the advice of a physiotherapist. This visit will help identify the cause leading to the development of tennis elbow and treatment can start immediately. Tennis elbow has a tendency to come and go and, more often than not, immediate action is not sought.

Unfortunately, this delay may aggravate the condition and make it worse and harder to treat. Exercise therapy, ice therapy, ultrasound, laser, acupuncture, friction massage, electrotherapy and strapping techniques all form part of a possible physiotherapeutic intervention.

Assessing the mechanism of injury is very important to help in the design of the prescribed treatment and exercise programme.

The muscles that extend the wrist (take the wrist back) are called extensors, while the muscles that flex it (bend the wrist forward) are called flexors.

The extensor muscles are by nature weaker than the flexors. This difference in strength puts a lot of tension on the extensor muscles, which insert in the elbow, and is considered to be an important underlying cause of tennis elbow.

In view of this, it is essential to strengthen the extensor muscles as part of the treatment programme. Ergonomic workstation design must also be analysed to correct potential causes of repetitive strain injuries.

Tennis elbow straps consisting of a belt-like support secured around the elbow are often recommended. These supports decrease the pain by offloading the tension on the damaged tendon, thus allowing one to continue work.

After carrying out a full examination, the physiotherapist will advise on how to use these straps and for how long. These straps are not to be worn at night and should not be worn throughout the whole day.

Non-steroidal anti-inflammatory drugs are often prescribed for pain relief. Topical anti-inflammatory gels are also occasionally used to treat this condition and may provide short-term pain relief.

Diminishing the pain does not imply that healing has occurred or that one may resume activity immediately. The rate of healing depends on various factors and this is where professional advice will help guide people suffering from such injuries.

If all conservative methods of treatment fail, steroid injections may be attempted, with surgical intervention considered as a last resort.

Tennis elbow is considered to be a simple injury. However, in its simplicity, if left untreated, it may be a very annoying injury, hindering one from daily simple tasks.

The appropriate treatment from the start leads to an early recovery, preventing long-term pain and discomfort often observed when tennis elbow is left unseen to.

pacejosef@gmail.com

Josef Pace is a physiotherapist.