Lateral epicondylitis, or Tennis Elbow

Lateral epicondylitis is a musculoskeletal condition that frequently affects men and women between the ages of 35 and 54 and affects approximately 1 to 3% of the general population. Manual workers and tennis players are at higher risk, hence its common name, tennis elbow. It is described as microtrauma following a repetitive movement in the tendon of the extensor muscles of the wrist, which attaches to the lateral epicondyle of the elbow (the bony prominence outside of the elbow).

Lateral epicondylitis can occur in two ways: as a result of trauma or, more often, as a result of overuse of the muscle. Depending on its level of severity, it can heal in 6 weeks to 12 months. If it persists for more than 12 months despite conservative treatment, we may have to consider surgery.

Usually, pain is primarily felt on the outside of the elbow, on the bony prominence and along the muscles heading towards the wrist. Different signs are characteristic of an epicondylitis, such as an increase of pain:

  • When palpating the elbow externally,
  • When resisting the movement of the wrist going upwards,
  • When squeezing an object with the hand.

It is recommended to avoid the movements causing the pain as much as possible to gradually increase the level of effort required on the tendon. Your physiotherapist can teach you the proper exercise progression, but first of all, he can confirm that this is an epicondylitis. Physiotherapy treatment will be adapted to your condition and will include different approaches like manual therapy, Cyriax frictions, eccentric reinforcement and myofascial stretching to accelerate healing. Strengthening and stretching exercises will also be prescribed. Ice can help reduce the pain. Ergonomic posture at work and taking breaks will help reduce stresses in the forearm muscles.

Depending on your condition, your doctor may prescribe anti-inflammatory drugs (NSAIDs), a corticosteroid injection, a resting orthosis or a tennis elbow bracelet that will reduce tendon pain and overload, or inject platelet-rich plasma (PRP).

If you have the signs and symptoms mentioned above or if there is no improvement within a few days of the onset of pain, consult your physiotherapist quickly, because the longer you wait before consulting, the harder the rehabilitation will be.

Coombes, Brooke K., Bisset, Leanne et Vicenzino, Bill. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. Journal of Orthopaedic and Sports Physical Therapy, Nov 2015, vol 45, num 11.

Knutsen, Elisa J. et al. Factors Associated With Failure of Nonoperative Treatment in Lateral Epicondylitis. American Journal of Sports Medicine, Sept 2015, vol 43, num 9, p.2133-2137.

Chesterton, Linda S., Mallen, Christian D., Hay Elaine M. Management of Tennis Elbow. Open Access Journal of Sports Medicine, Avril 2011, num 2, p. 53-59.