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Lateral elbow pain, also commonly described as “Tennis Elbow” or lateral epicondylalgia, is described as pain over the lateral elbow associated with gripping and manipulation of the hand. The annual incidence is four to seven per 100 patients in general practice, and 1-3% of the population. It is a common condition which significantly impacts the patient’s functional activities, and is recognized as being challenging to treat secondary to a high rate of recurrence. It more often occurs between the ages of 35-54 years, and affects the dominent arm more in both men and women. People who work in situations which include manual tasks with a combination of force, repetition, and poor posture are known to also be at a higher risk.
Lateral epicondylalgia typically involves the common extensor tendon of the forearm, where it inserts on the lateral portion of the upper arm bone, the humerus. Most commonly, the affected muscle is the extensor carpi radialis brevis, which acts to extend the wrist and radially deviate the wrist, as it attaches to the back of the hand near the middle finger.
Diagnosis of lateral epicondylalgia includes a detailed evaluation of the elbow, wrist and hand, as well as the shoulder and the cervical spine (neck). Being able to reproduce the pain through stretch, muscle contraction, and palpation helps to rule in the elbow as the source of the pain. Screening the neck helps clear the neck as a cause of the symptoms, as the mid-to-lower neck commonly refers pain to the lateral elbow and mimics symptoms of tennis elbow. Not only does the physical therapist want to reproduce the pain, but he/she wants to also figure out ‘why’ the problem happened in the first place. A thorough subjective evaluation helps identify reasons why the pain would occur in the elbow, and looking at other areas besides the elbow can help determine if other areas are contributing to the onset of symptoms occurring at the elbow.
Treating tennis elbow can include a combination of strategies, which include manual therapy (joint mobilizations, manipulation, deep tissue mobilization (cross-friction mobilization)), stretching, progressive strengthening exercises, and treatment of other areas as determined by the initial evaluation which are directly impacting the lateral elbow pain (including posture work, neck and thoracic mobilizations and/or manipulation, scapular and shoulder strengthening exercises, and ergonomic (work) changes).
The key to successful treatment of lateral elbow pain is a good evaluation. If you are experiencing lateral elbow pain, contact your physical therapist. Having an evaluation prior to the symptoms becoming chronic helps quicken the amount of time it will take for the symptoms to resolve, and decreases the likelihood of chronic adaptations and compensation strategies to occur which further affects the ability for the elbow to properly heal.