One of the most common complaints that I see at my clinic is Tennis Elbow, clinically know as ‘Lateral Epicondylitis’. Now don’t be fooled, it is not only tennis players who suffer with this sharp pain on the outside of their elbow, but anyone who is overusing the wrist extensor muscles – overzealous action with the garden shears seems to be as common a cause as the tennis racket these days!
Tennis elbow responds very well to soft tissue treatment but if not treated and if it becomes chronic then sometimes more aggressive treatment may be required. I have briefly outlined three cases of tennis elbow that I have worked on in the last 6 months, to highlight how individual each instance is and how tailored treatment is key to ensure the best possible outcome:
Case 1 – The Recreational Squash Player
The client has recently returned to playing squash after a 12 month hiatus. Four weeks into her return she is experiencing pain on the outside of her elbow. There is no pain when playing squash but following squash the pain is quite severe and the elbow is very tender to touch. No previous history of tennis elbow and the client is keen to resolve the pain as quickly as possible so they can get back to training for the coming season.
Physical Assessment showed that tennis elbow was indicated as suspected by the client. On testing the range of motion in the shoulder joint it was evident that the client had a highly restricted range of motion. The pectoral muscles were shortened and tight meaning that the client was struggling in opening their back swing when preparing to hit the squash shot leading the muscles of the forearm being used to hit the ball and follow through.
We treated the tennis elbow directly using a variety of soft tissue techniques to release the tension on the tendons around the elbow and to reduce the inflammation. In addition we worked on increasing the shoulder range of motion and increasing scapula control. This involved a series of strengthening and stretching exercises for the client to perform as homecare.
Once the tennis elbow started to improve I recommended the client had a number of coaching sessions to correct her swing. This ensured that as her shoulder and elbow issues where being resolved she retrained her body to hit the ball correctly preventing re-injury.
Given the early intervention with soft tissue therapy and with the appropriate homecare the client was back to being pain free and playing lots of squash in 4 weeks. The client continues to do the exercise and stretch routine on a regular basis.
Case 2 – The Overzealous Gardener
The client presented with acute tennis elbow on the left side (client is right handed). Onset of the condition was 1 week ago following a hard day’s work in the garden where the client trimmed the trees in his garden using the garden shears.
On examination tennis elbow was indicated, there was inflammation and tenderness of the tendons surrounding the outside of the elbow and it was still in the acute stage. No restriction in the shoulder, neck or upper body. The client was keen to return to play golf as soon as possible. Given the acute nature of the injury I used Kinesio tape to reduce the swelling and inhibit the wrist flexors taking the pressure of the tendons allowing them to heal. Over the following sessions we started to mobilise and gently stretch the tissues regaining full range of motion. The client was also given some gentle strengthening exercises for the wrist extensors to ensure that next time he pushed himself too hard in the garden the injury would not resurface.
The client did not rest sufficiently and continued to play golf and racketball increasing the healing time required. The clients issues were resolved in about 8 weeks after five sessions.
Case 3 – The Tennis Player with a Twist
The client presented with pain to the lateral aspect of the right elbow and has been playing more tennis than usual given it was the summer. The client wanted treatment of the elbow so as she could play tennis pain free.
On interview it was indicated that the client had a fracture to her collar bone about ten years previous but was sure this had nothing to do with the tennis elbow. On assessment there was scar tissue present around the break point and restrictions to the fascia around the attachment of the pectoral muscles. This restriction was restricting the range of motion in both the shoulder and the elbow and may have been exacerbating the tennis elbow in the client.
We treated the tennis elbow directly but also started to break down the scar tissue and to release the fascia around the collar bone. The friction technique was also performed by the client as part of their homecare along with the necessary strengthening and stretching exercises that I recommended.
After 3-4 weeks and 3 sessions the tennis elbow symptoms had disappeared but we continued to work on improving the range of motion in the shoulder for a further 3 weeks. Although the client continued to play several hours of tennis a week they incorporated regular sports massage sessions into their training plan and the tennis elbow has not returned in the last 5 months.
As you can see not only the treatment but the homecare in each case differed but in all cases the tennis elbow was resolved and the clients are now managing their bodies to minimise the risk of re-injury.
If you are suffering from tennis elbow, get in touch to be fully assessed so as we can pinpoint the root cause. We can then treat your elbow but also work on the cause to help keep you pain free for longer.
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