Tennis Elbow

What is it?

Lateral Epicondylitis, or as it’s commonly known, ‘Tennis Elbow’ refers to an overuse injury involving the extensor muscles that share the bony origin on the lateral epicondyle of the distal humerus (the outer boniest bit!). Repetitive and forceful activities usually involving wrist extension and/or forearm supination can create a low-grade inflammation in the common tendon origin. The body reacts to the inflammation by protectively contracting the muscles in that region, which rapidly fatigue from the accumulation of lactic acid. Scar tissue between the tendon and bone accumulates over time, increasing pain, decreasing flexibility and further reducing the overall function of the elbow.

Who gets it?

Despite being linked to tennis players (50% are believed to have suffered it), tennis elbow is the most common overuse injury in today’s society. Any activities involving wrist extension and abduction can eventually lead to tennis elbow. With respect to tennis, players who are over the age of 40 and play more than 2 hours a week are at greatest risk, whilst work-related incidence is highest in the following 3 scenarios:

1.     Handling loads heavier than 20kgs at least 10 times a day;

2.     Repetitive movements for more than 2 hours per day and;

3.     Handling tools heavier than 1kg.

Management

The large majority of cases (95%) can respond well to conservative treatment including Physiotherapy, electrotherapy and specific exercises. Persistent cases may be offered a cortisone injection (no more than 3 in one area is recommended) prior to the rare possibility of surgery. But, as with any ailment, if only the symptoms are treated, the problem is likely to reoccur. Identifying and correcting the cause of the client’s tennis elbow is far more effective in the long term. And with the use of Pilates, good results can be achieved even quicker!

How can Pilates help?

As outlined above, sufferers of tennis elbow share a similar history of overused wrist extensors and forearm rotators and predominantly work in environments that favour these actions. For example, consider a welder who grips a blow torch at the end of an outstretched arm and in an awkward trunk position OR better still, try reaching your own arm out and making a fist as tight as you can then imagine maintaining this for the majority of a working day!

As Pilates teachers we are taught to assess our client’s posture and with tennis elbow sufferers make no exceptions, this can often highlight the cause of their symptoms and help identify where Pilates will help. The following tips may be of help:

1.  Check the orientation of the glenohumeral joint on the affected side.

2.  Make a note as to whether their glenohumeral joint is medially rotated and tight anteriorly.

3.  Don’t forget the entire body and specifically the upper trunk

4.  Is there evidence of increased thoracic kyphosis?

5.  What is their cervical spine range of motion like?

By correcting what you see, aiming to restore a better alignment throughout the entire trunk, the strain experienced on the lateral epicondyle will be significantly reduced.

Yes ....

If you prescribe stretches for the wrist extensors it can help to break down the scar tissue and restore some flexibility ...

Strengthening the wrist flexors on the opposing side can induce an active assisted stretch to the extensors and further reduce the loading that causes the problem ...

Educating the client on a better alignment in their affected side during the causative action can also help ...

BUT ... This is still dealing with the symptoms and not the overall cause. I would encourage you to look at the entire posture as it presents and as with all Pilates tuition, return to the centre. If you work from the inside out, you are more likely to have a positive effect on the cause thereby offering a long-term reduction in your client’s pain and overall improved function.

Remember ... address the cause and the symptoms will not only reduce but inevitably not return.

(By Robert White MSc MCSP, Nov 2009)

PLEASE NOTE: The content of this article is written merely as an opinion by the author and is by no means to be received as a clinical guideline. Opinions written are solely those of the author and as such Pilates Union UK does not accept any responsibility for actions taken as a result of reading this content.