Daily Tips and Advice

Treating Tennis Elbow

Stuart Fossella - Tuesday, August 27, 2013 | Comments (0)
Posted 6 years ago
image highlighting damaged tendon causing tennis elbow

Tennis Elbow, Tendon injury or Tendonitis?

I don’t like to mention it but the nights are definitely getting shorter. At least this summer we have had some decent weather to enjoy, getting outside has been great, and the BBQ has actually seen some action this year.

Last summer we had the Olympics to cheer about and this year we have been massively spoilt again on the sporting front. We have had Andy Murray’s success at Wimbledon, the Lions beat the Aussies on their territory, the English cricket team retained the Ashes by beating the Aussies on our own territory, Chris Froome won the Tour De France and now we have athletics success in the world championships-you cant beat a good ‘Mo-Bot’.

Anyway…this summer has given rise to far more episodes of good old fashioned Tennis elbow than I can remember seeing in a while. We have already posted a blog on the condition, if you want to know more head on over to Tennis Elbow.

Seeing as the condition is so prevalent, I thought I would give you a little extra detail on this dastardly condition and how Physiotherapy can help you to overcome it.

Tennis elbow is a condition that tends to affect the tendons of the muscles that act to extend or lift the wrist joint up (as in a back hand stroke). Check out this diagram for a better understanding of what we are talking about.

Check out the following link for a 3D image of the muscles of the elbow joint, and further information about them below the image Healthline

In order to really understand the problem you first need to understand what a tendon is and what its role is, so…

Tendons are connective tissues formed up of dense bands of parallel fibres of Collagen tissue. The role of a tendon is to provide a mechanical link between itself and the muscles fibres. The fibres are responsible for transmitting tensile forces that are generated by muscle cells (as in the act of lifting or gripping). Put simply, a tendon is the junction between the bulk of a muscle and its attachment to bone.

So now we have a better understanding of what a tendons role is and what they are made of, we can turn our attention to how tennis elbow causes pain.

In the commonly considered continuum model of tendon management as discussed by Professor Jill Cook tendon injuries fall under the categories of either being:


  • Reactive tendonopathy

In which cells of the tendon are irritated and aggravated because of tissue overload. These examples of tennis elbow are those that are brought on because of an ‘abusive’ overload to the tissues.

Most reactive tendon injuries tend to occur because of a single or more episode of abusive overload than the tendon is used to. So a patient probably recalls doing something that caused the pain in the first place. Repeated lifting, grasping, pulling in gardening DIY or sport action are enough to cause aggravation. Is this you?

The role of Physiotherapy management is to settle tendon cell irritation to assist in minimising pain. Moving forward through treatment, we will ask a patient to think back to the episodes that are likely to have caused the irritation in the first place, and to consider the loads that have caused the reactivity…and reduce these. Physiotherapy is not just about settling pain, but helping you the patient to avoid further episodes of pain-we want you to learn to help yourself.

In the ‘one off’ episode of elbow pain treatment is directed at allowing the tendon to settle. Get in contact to Book in.

The second category of tendon irritation is:

  • Degenerative tendonopathy

The degenerative tendon is also known as the ‘grumbly’ tendon. Day to day this probably causes you no problem at all. However…this is the tendon that may cause you problems after if it is overloaded-causing irritation and pain, that will again settle well with Physiotherapy treatment techniques and rest from the irritating activity.

This form of Tennis elbow, patients will likely tell there Physiotherapist that generally day to day they simply don’t have strength or power generating capacity in the tendon-so that would mean a weak grip in activities such as lifting, gripping, carrying, using hand tools or the like. So the ability to perform manual tasks is compromised.

As Physiotherapists we assess for ‘normal’ movement patterns. In reviewing someone with a degenerative tendon we assess for ‘cheat’ movements-or mechanisms to cope with day to day tasks. This is done with ‘unloading strategies’ that help to cope with reduced capacity (loss strength, power or energy strong capacity). Simply high-level activities are not possible because the tendon doesn’t have the muscle strength to perform tasks.

In order to overcome this issue your Physiotherapist will plan a course of rehabilitation to address the tendons loss of strength, power and capacity to store energy. Developing strength, endurance and power and may take some time. Physiotherapy led rehabilitation also aims to improve the tolerance of the tendon to activity.

The third and most common form of tendon pathology that we are seeing at the moment is:

  • Reactive on degenerative Tendonopathy

Whereby the junction between the muscle and the tendon has a reduced capacity to tolerate load and stress/strain.

So consider the normally sedentary person who has become more active after being generally inactive. The person who has an office job and then when the weather changes gardens for all they are worth, or does DIY all bank holiday weekend-this causes a reaction in the healthy part of the tendon that is taking the strain.

So we end up with a reacting tendon, which causes pain because the already degenerative tendon causes a physical risk to the previously ‘normal’ part of the tendon.

Essentially, if the tendon is vulnerable, over-activity has the potential to lead to cause further damage and pain. Physiotherapy treatment aims to settle the reactivity with the appropriate treatments. But then must focus on a reoccurrence of the problem. Again rehabilitation is the main stay of treatment and techniques aim to restore any strength losses and improve the capacity of the tendon to tolerate loads.

Current evidence in the long-term treatment of tendon pathology is a graded programme of exercise rehabilitation. Under the guidance of us you will be advised to perform heavy slow Isometric loading exercises to help ease pain, and heavy slow Isotonic exercises which have been shown to be great for reducing pain and allowing rehab to avoid further reactions.

P.S. its not too late to land yourself a sporting accolade this summer-the world pea throwing champs of 2013 have not taken place yet so if you fancy your chances, get down to my old stomping ground of East Sussex and bag yourself a world title World Pea Throwing Championships 2013.

Book an appointment.


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