If you have pain on the outside of your elbow that is worse with activities such as tennis, pickle ball, padel, and/or weightlifting you may be experiencing lateral epicondylitis - otherwise known as tennis elbow.
What is tennis elbow?
Lateral epicondylitis is a condition involving the wrist extensor mass as it attaches to the outside aspect of your elbow. It is characterized by tenderness/pain to the bony prominence on your lateral elbow (lateral epicondyle of the humerus) and the tendon that attaches below it. In addition, you may feel pain above or below the elbow joint where the wrist extensor muscles live. These symptoms may be exacerbated with racket sports, prolonged gripping activities, stretching your wrist, and direct pressure on the elbow joint (such as in a side plank position).
Why is it happening?
Most commonly, tennis elbow is an overload disorder of the extensor tendons. Tendons may become irritated with fast, elastic movements such as swinging a racket. If one is to continue this for many hours per day multiple times per week without adequate recovery or cross training, it is not uncommon to experience these symptoms. Scientifically speaking, your tendons/ligaments in your body are made of collagen. In an overuse disorder, you are breaking down collagen faster than your body can produce it for the tendon to heal. This puts the tendon in a state of dysrepair, if untreated it leads to what is called a "degenerative tendinopathy" - where you may have small micro-tears in the tendon. You may think, "well I'm only playing tennis for 2-4 hours per week. How is that overdoing it?" This may be because the tendon structure itself lacks the resiliency or the ability to elastically deform under load. This can be from a lack of physical preparation prior to the onset of a new sport and factors such as poor nutrition, stress, and lack of sleep.
Dealing with this right now?
Get a 60-minute, one-on-one evaluation and a clear plan - not another generic protocol.
How do we fix it?
In the perfect world, we educate you on load management. Which means, adequate days/rest in between racket sport sessions and/or altering your weightlifting technique. If caught early, we can alter the load put through your lateral elbow, do some initial treatment, and get you back to doing the things you love rapidly. However, most of the time this condition is a process that can take weeks to months to feel back to 100%. This is because we need to structurally adapt the tendon to become more resilient with a protocol that includes four phases of loading. Everyone is different, therefore this protocol isn't black and white but it generally follows these four phases.
Four-phase treatment protocol
- Isometric loading (symptom management and load reduction)
- Isotonic loading (Heavy slow training, load increase)
- Elastic loading
- Return to sport/full function
It's important that you get the proper physical therapy treatment for this condition so it doesn't become a chronic issue. Generally speaking, the longer someone is suffering from a certain impairment the longer it will take to resolve.
Dr. Matt Feder, DPT, CSCS