The most common overuse injury in the general population is tennis elbow. Medically referred to as Lateral Epicondylitis, this condition comes as a result of overuse of the wrist extensors, particularly Extensor Carpi Radialis Brevis (though Extensor Digitorum and Extensor Carpi Ulnaris can also be the source of pain). The name however is a little confusing as inflammation is not always present. Rather, the condition is due to degeneration of the collagenous fibres when, during overuse, the region becomes hypovascular. This leads of an area of poor blood supply, leading to degeneration and brittleness of the tendons.
The name tennis elbow comes due to the high frequency of tennis players that suffer the injury, largely due to improper technique during a backhand. Participation in racquet sports in general however increases the risk of incidence. When executing the backhand, improper technique implies adding force through the wrist, as opposed to rotating fully through the shoulder and torso.
Away from sports however, occupations that are at higher risk of developing lateral epicondylitis include:
- Carpenters (sawing and screwdriver use)
- Musicians (particularly pianists and drummers)
- Office workers (especially those spending large amounts of time typing on the computer or using the mouse).
Symptoms typically present 24-72 hours following a particularly stressful and repetitive use of the arm with no trauma required to cause onset. Symptoms vary from mild tenderness at the lateral epicondyle (outside of elbow) when pressure is applied, to excruciating pain when lifting a coffee cup. Attempting to lift the wrist against resistance or strongly shaking hands will also worsen the pain and is further indication of tennis elbow.
For severe episodes of tennis elbow, scientific evidence favours the use of corticosteroid injections topically to relieve symptoms (4 out of 5 patients showed improvement). The injections alone however cannot completely get rid of the pain and is only considered a short term fix.
In order for the symptoms to full be relieved a course of physiotherapy consisting of strength training, stretching and electrotherapy modalities.
Patient tailored exercise programs are agreed upon between the patient and the therapist and the exercises are done under supervision initially. The exercise program is continued at home by the patient for the duration of the course.
In addition, electrotherapy modalities such as ultrasound and laser therapy have been shown to have an analgesic effect on lateral epicondylitis and its persistent painful symptoms.
Further techniques used by the physiotherapist include myofascial release, friction massage at the tendon insertion, heat and cold interchanges and kinesiology taping.