Physio Penrith Tennis Elbow Treatment
Treatment of Tennis Elbow at Sydney Muscle & Joint Physio Penrith
What is tennis elbow?
Tennis elbow, lateral epicondylitis or lateral epicondylagia is a significant source of lateral elbow pain and presents as pain and dysfunction in the elbow and forearm region and is the result from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Typically micro-tearing is commonly observed during imaging at the origin of the extensor carpi radialis brevis (ECRB) tendon. The tendon injury is characterised as a degenerative process in which the tendons manifest abundant fibroblastic activity, vascular hyperplasia, and unstructured collagen fibres- rather than an inflammatory response.
What are some common symptoms of tennis elbow?
Patients suffering from tennise elbow will typically report a sensation of burning over the humeral insertion of the common extensor tendons (outside of the elbow when your palm is facing forward), loss of grip strength and pain during such daily activities as grasping objects, turning doorknobs, and shaking hands. Poorer outcomes are seen with manual labor, dominant arm involvement, longer duration of symptoms with high baseline pain levels and poor coping mechanisms.
At Sydney Muscle & Joint Physio Penrith our physiotherapists go a step further for patients with tennis elbow and evaluate your neck and mid back, as well as the nerves that come out from the neck and go down the arm. While it is currently unclear as to what impact the presence of cervical and thoracic impairments have on the condition, exploratory research indicates that neck pain is more common in people with tennis elbow and impairment at C4 to C5 spinal levels has been identified on manual examination in people with localised symptoms of tennis elbow.
Diagnosis of tennis elbow
Diagnosis of tennis elbow or lateral epicondylitis is typically down via pain provoking tests. These include palpating the lateral epicondyle, resisted extension of the wrist, index finger, or middle finger; and having the patient grip an object. Mill's Test and Cozen's test can also be used to diagnose the condition.
Ultrasound is one of the most useful tools to diagnose or rule out tennis elbow or lateral epicondylitis. Structural changes affecting tendons (thickening, thinning, intra-substance degenerative areas and tendon tears for example), bone irregularities or calcific deposits can be detected.
Guideline-based treatment of tennis elbow
Guideline-based treatment of tennis elbow follows that of any tendon injury, tendonitis, tendinosis or tendinopathy. It incorporates settling the tendon down and then building it back up with progressive load. Stretching, taping and dry needling are not supported by evidence and tehrefore not proven to be helpful.
Exercise based therapy
Management of tennis elbow follows the prevailing notion in any tendinopathy management and this requires graded exercise and load management. Our physiotherapists utilise various forms of exercise and this is specific to the patient presentation and irritability of pain. Exercises may include isometric, isokinetic, concentric and eccentric with research showing that eccentric exercises produced greater pain relief and functional improvement in those patients with tennis elbow.
Manual therapy and manipulation
At Sydney Muscle & Joint Physio Penrith our physiotherapists use Mulligan's Mobilisation-with-Movement, manipulation/mobilisation of the elbow and wrist and based on assessment and involved- manipulation/mobilisation of the thoracic and cervical spine. These techniques are applied to specific impairments of elbow/wrist joint stiffness and reduced range of motion and is doing prior to exercise management.
Orthotics and taping
There is conflicting evidence for the effectiveness of orthoses and taping in providing pain relief or improvement in function compared with placebo or no treatment. Compared with a multimodal program of friction massage plus US and exercise, an elbow orthosis alone was inferior in relieving pain and overall satisfaction, but was superior in improving function (ability to perform daily activities) at 6 weeks.
Much of the success of acupuncture/dry needling seems to be immediately after treatment. While there appears to be conflicting evidence, acupuncture/dry needling might be more effective than placebo and more effective than US at relieving pain and improving self-assessed treatment benefit in the short term. As a result Sydney Muscle & Joint Physio Penrith does not use acupuncture/dry needling in the management of tennis elbow.
The conclusions drawn from previous systematic reviews remain unchanged: ultrasound appears to be no more effective than placebo for pain relief or self-perceived global improvement in the short term. As a result Sydney Muscle & Joint Physio Penrith does not use ultrasound in the management of tennis elbow.
Shock wave therapy
A Cochrane review plus one additional study found that compared with placebo, shock wave therapy induced no greater pain relief at 6 weeks. Similarly, the pooled mean difference for pain on resisted wrist extension (Thomsen test) at 4 to 6 weeks follow-up was not significantly different between shock wave therapy and placebo. As a result Sydney Muscle & Joint Physio Penrith does not use shock wave therapy in the management of tennis elbow.
At Sydney Muscle & Joint Physio Penrith our physiotherapists pride themselves on a multimodal approach, which is providing different treatment techniques for a specific injury. Research supports a multimodal program of Mobilisation-with-Movement and exercise is likely superior to wait-and-see and placebo injection in the short term, and superior to corticosteroid injection in the long term.