Or the less commonly known term, lateral epicondylitis, is an ‘overuse’ injury and a very common one at that. It’s when the ECRB (extensor carpi radialis brevis) tendon of the forearm is overloaded and repeatedly stressed.
Despite the ‘itis’ the tendon isn’t enflamed but in a state of disrepair, so it’s a tendinopathy and doesn’t present with swelling. It’s also not very common among tennis players and is more common than golfers’ elbow, a similar tendinopathy which affects the inside of the elbow.
What does it feel like?
- Pain is felt on the outside and a little below the elbow. The tendon doesn’t like to be stretched or contracted, so lifting, lowering an object and gripping can provoke pain.
- Pain can radiate up and down the forearm and sometimes into the third and fourth fingers.
- It may not be an immediate pain however, tendons react 24-48 hours after an event that involves unaccustomed and prolonged activity of the forearm.
- It may present with reduced grip compared to the other hand.
- If you’ve suddenly increased an activity involving the arm this could also trigger it.
The tendon attaches on the outside of elbow and runs down the forearm to the wrist. Tendons are ‘avascular’ meaning they have a lower blood supply than muscles, so they take longer to regenerate while taking the brunt of the load as we age.
Who does it effect if not predominantly tennis players?
- Office workers, drivers, trades people and athletes that predominantly use their arms in sport.
- It affects those age 35 – 55 most commonly, both sexes and is usually experienced in the dominant arm.
- Manual work, especially involving tools weighing greater than 1kg, repetitive actions and heavy lifting.
- Muscle imbalances and strength deficits within the shoulder are also present upon examination.
Other conditions to rule out.
- Referred neural pain from the neck.
- Rheumatoid arthritis.
- Radial or ulnar radiculopathy.
- Posterior interosseous nerve compression.
- Olecranon bursitis.
How to we treat it?
After a thorough examination and assessment of not only the elbow but the shoulder and neck as well, we can identify where the weakness is. We can target any weakness we find in the shoulder complex, but also progressively load the forearm tendon in a way that deliberately provokes healing of the tendon matrix. I design a rehabilitation programme based on what I find during the assessment.
After an initial reduction in load to the tendon we would then start slowly returning that load so the tendon can adapt to it gradually. Its important to manage expectations, tendons take a while to heal, and it can be 6-12 weeks of doing a targeted rehab programme.
In terms of immediate treatment, I would release the forearm trigger points with myofascial massage, target any range of movement deficits found in the assessment and I personally like to offload the muscles using kinesio tape, having used this myself, I found it very beneficial in reducing pain.