Healthy Life: Tennis Elbow – Causes and Symptoms (524)

Healthy Life: Tennis Elbow – Causes and Symptoms

蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

Tennis elbow (Lateral Epicondylitis) is one of the commonest problems in the forearm. The reasons are that the muscles on the dorsal side (extensors) of the forearms are much fewer than the palmer side (flexors), yet many daily activities require the use of the muscles on the dorsal side because dorsal movements are more natural. One of the few movements that are less natural is the backhand stroke in tennis. Also, it is weaker than the forehand stroke simply because of small muscle bulk. That is why in the modern tennis game, a lot of players use double-handed backhand to increase the power of backhand stroke using the power in their body torso.

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In clinical findings, 90% of patients with tennis elbow do not play tennis. They have such problems because: (1) many daily activities or tasks require a lot of repetitive movements of the weaker extensors in forearm; (2) in many instances, when both of our hands are full of shopping, the back of the elbow is the most natural part of the body that we use to open doors. Moreover, this is the part of the arm that bumps into obstacles such as doors, door knobs and shelves…etc. Once the elbow joint (lateral epicondyle and its related extensor muscles) is injured, the normal pressure of daily activities will become abnormal for the abnormal joint and tissues e.g. typing, using a mouse, cutting vegetables, frying and carrying heavy frying pans. Other activities such as wringing towels, opening caps and taps, carrying heavy books and files, even turning keys or driving can be painful.

The key is to have early intervention because if it is left untreated, the continuation of painful activities will turn it into chronic problem and can cause related pain in the shoulder and wrist due to abnormal mechanical compensation in these joints above and below the elbow. During the treatment, it is advisable to avoid any activities that can cause pain. The golden rule is : “The first thing to getting better is not to make it worse.”

In my clinical experience, the annular ligament is the culprit and muscle attachments at the lateral epicondyle is second in line. These ligament and musculoskeletal junctions are scarce of blood supply and recovery is generally harder. Posteroanterior pressure on the annular ligament seems to be most effective followed by extension adduction mobilisation. Ultrasound and interferential therapy to these areas and related muscle areas will promote faster healing. Squeezing exercises and flexion and extension exercises need to be done to keep a full range of elbow movements. Many patients with chronic tennis elbow pain tend to have weaker grip strength and loss of full extension. However, we can do 90% of our daily activities with only 60-70% of elbow joint range. Finally, early intervention is the key to all muscle and joint problems.