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Tennis Elbow: Understanding, Diagnosing, and Treating Lateral Epicondylalgia

Tennis elbow, or lateral epicondylalgia, causes pain on the outer elbow due to overuse of forearm muscles. While often linked to tendon strain, recent research shows the nervous system may also play a role in how pain is felt. This guide covers tennis elbow’s causes, other possible conditions, and treatment options to help you find effective relief.

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What is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylalgia, is a condition that causes pain around the outer part of the elbow. It commonly results from repetitive use or overloading of the forearm muscles and tendons, leading to pain.

Tennis elbow, or lateral epicondylalgia, is a characterised by pain on the outer part of the elbow, often resulting from repetitive activity and overload of the forearm muscles. Recent studies suggest that tennis elbow may be due to tendon changes (tendinopathy), where the tendon cells are weakened, reducing their capacity to handle load and potentially causing pain.

Studies also suggest this condition may involve changes in the central nervous system's processing of pain. so rather than being solely due to local tissue damage there is evidence to suggest that some individuals with tennis elbow exhibit altered changes in the sensation is processed in the nervous system - which includes the brain. IASP Pain at a simple level central sensitisation is the concept that pain can arise from altered nervous system activity without clear evidence of tissue damage, highlighting the need for comprehensive assessment and management. It can mean stimulus that i snot usually painful or harmful is experience as pain. The presence of central sensitisation can impact on recovery time, but itis important to state that it is not a major feature in most presentations of tennis elbow.

Differential Diagnosis: Other Conditions to Consider

Because elbow pain can be caused by various issues, it’s essential to rule out other conditions. some other conditions to consider include:

  • Golfer’s Elbow (Medial Epicondylalgia): Pain occurs on the inner side of the elbow.
  • Radial Tunnel Syndrome: This involves compression of the radial nerve, often mistaken for tennis elbow due to similar pain patterns.
  • Osteoarthritis of the Elbow: Joint changes can cause pain and stiffness, though typically with noticeable swelling.
  • Cervical Radiculopathy: Nerve irritation in the neck can cause radiating pain down the arm, sometimes mimicking tennis elbow.

When to Seek Help

If your elbow pain persists for more than a few weeks, affects daily activities, or progressively worsens, it’s advisable to consult a doctor or musculoskeletal physiotherapist.

Treatment Options Based on Current Evidence

Because each circumstance is different a tailored approach should be taken. it is likely you will combine more than 1 of the following options:

  1. Rest and Activity Modification: Reducing or modifying activities that load the forearm muscles (like lifting or gripping) can alleviate strain on the tendons, offering the tendons a chance to recover.
  2. Physiotherapy: Evidence strongly supports specific exercises to manage tennis elbow, focusing on progressive loading of the forearm muscles. Eccentric exercises (controlled lengthening under tension) and isometric exercises (static holds) have been shown to enhance tendon strength and pain tolerance.
  3. Manual Therapy: Some studies suggest that soft tissue mobilisation and joint mobilisation around the elbow and wrist can offer temporary pain relief and improve function. However, these are often used in conjunction with exercises rather than as standalone treatments.
  4. Shockwave Therapy: For cases not responding to standard treatments, shockwave therapy has been shown to reduce pain and improve function, though it’s typically recommended after other interventions have been trialled.
  5. Bracing and Supports: Wearing an elbow brace may help manage symptoms by offloading stress on the tendon during activity. While bracing can reduce pain, recent evidence suggests that long-term relief is best achieved with a structured exercise programme.
  6. Injection Therapy: Corticosteroid injections have historically been used to manage pain, though recent research indicates they may not provide long-term relief and could be detrimental to tendon healing. In contrast, newer treatments like platelet-rich plasma (PRP) injections are being explored but require further research for efficacy.

Take the Next Step

If you’re experiencing elbow pain, our team at Dr Dropin Fulham offers evidence-based physiotherapy treatments tailored to your needs. We can guide you through a personalised programme focused on strengthening and restoring function.

Book an appointment today to take control of your recovery journey!