No Love for Tennis Elbow

If the topic of elbow pain comes up, the majority of people are going to have some idea of tennis elbow.  Tennis elbow, otherwise known as lateral epicondylalgia or epicondylitis, is the most common complaint when it comes to pain in the elbow.  While tennis players are notorious for getting tennis elbow, hence its name, it’s common with a ton of different activities. Any job that requires repetitive movements of the arm, especially while gripping an object or tool, is likely to have some risk of developing tennis elbow.

The phrase “tennis elbow” itself is a loose way of describing pain along the outside part of the elbow.  It will usually involve pain in the tendons of the wrist extensors, which are the muscles that help you bend your wrist upward.  These muscles are highly involved in gripping activities as they help put your hand in a neutral position, which is the strongest position for gripping something.  To show how the wrist extensors help with grip, try bending your wrist down as much as possible and then try to make a fist. Then try the same thing with your wrist bent all the way back.  How strong do these positions feel? Compare that to just making a fist normally, and you’ll see the difference.

Long story short, the wrist extensors are important.  With something like tennis, as you swing the racket your arm eventually ends up in a lengthened positioned with your wrist flexed.  This puts a lot of stress on the wrist extensors, especially when you combine that with the fact that you (probably) don’t want to let go of the racket.  This leads to the wrist extensors being forcefully stretched while under load at high speeds. Sounds like a recipe for some pain if those tissues aren’t strong.  So what do you do?

Wrist eccentrics (pictured here) are considered the gold standard of treatment for tennis elbow.  The way eccentrics work is by placing the tendon under load and stretch, similar to what is happening with most movements that will aggravate a tendon.  It seems counter intuitive, but the entire purpose of eccentrics is to make the tendon thicker and more dense so that it can handle the forces it is taking during activity.  Dosage for eccentrics is variable, but there are some guidelines you can follow to help make them more effective.

  • Pain is fine, to a point.  Your pain while doing eccentrics should not exceed 2-3/10 more than where you started.  The pain should also not exceed a 7/10 under any circumstances. The pain should also settle down within the next hour.
  • Volume is important.  The typical rep scheme is going to be somewhere around 2-4 sets of 15 reps, and is typically repeated 1-3 times a day.  As with dosage of any exercise, it is important to find the volume that works for you though, so listen to what your body is telling you.
  • Resistance matters.  You should pick a weight/resistance that makes those 15 reps challenging.  By the time you finish your 2-4 sets, you should feel like that 15th rep is the last one or just about the last one you can do.

If the issue is truly just a tendon issue, these should make a big difference.  Looking at other potential contributors like range of motion and strength in the neck, shoulder, wrist, and thoracic spine can also be important factors.  If you’re not making any progress get help! Physical therapists and occupational therapists can make a huge difference in treating tennis elbow.

Got questions?  Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR can show you how to discover your future without limits.

***The above information, including text, images, and all other materials, is provided for educational purposes only, and not as a replacement or supplement to professional medical advice.  Please contact a certified healthcare professional or your primary physician for any personal concerns.

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