What is tennis elbow?
Lateral epicondylalgia (LE), also known as lateral elbow tendinopathy or tennis elbow, affects a wide variety of individuals, including middle-aged desk workers, manual labourers, and, of course, tennis players.1 Regardless of whether or not you play a racquet sport, LE can severely impact your day-to-day function, your ability to work and your ability to participate in recreational activities.1
How long does LE last?
A typical episode of LE can last 6 months to 2 years.2 The good news is that 83-90% of patients experience a significant improvement of symptoms within one year of diagnosis, with or without treatment.1-3
I don’t want to wait a year. What are my treatment options?
There are numerous treatment options for LE, including physiotherapy, pharmacological and medical intervention, and a wait-and-see strategy.
Some evidence suggests that a wait-and-see approach is a good initial strategy for those who have mild pain or disability, with no negative risk factors, and no involvement in repetitive manual tasks or heavy loads. While waiting out the pain, patients should avoid aggravating activities, and may seek advice from a physiotherapist.1 Patients may also take pain medication, as needed.1 If symptoms are not much better after 6-12 weeks of waiting, a multimodal physiotherapy intervention is recommended.1
For those who have moderate-to-severe symptoms or disability, coexisting neck or shoulder pain, or are involved in repetitive manual tasks or heavy loads, it is recommended to initiate a multimodal physiotherapy intervention.1 Self-administered or prescribed medication is also recommended.1
What can I expect from seeing a physiotherapist?
A physiotherapist will guide you through a multimodal intervention, which may include the following:
- manual therapy to improve the mechanics of your joint, muscles, and nerves;
- exercises to help improve the mobility and strength in your arm;
- appropriate education to help get you back to your restricted activities, including work or sport;
- modalities to help address pain; and
- if needed, taping, brace, orthoses, ice, heat.1
Since many people experience a recurrence of their symptoms following the initial episode of LE,1 it is important to address the underlying dysfunction and not just the pain.
General Advice to Prevent Re-injury
- Warm-up thoroughly prior to engaging in any repetitive activities, including using a racquet, gardening tools or heavy machinery
- Take frequent breaks from repetitive activities. A good rule of thumb is to take a 10-minute break for every hour of activity. Some patients may find they need more frequent breaks in order to avoid symptoms.
- When lifting heavy objects, engage your core and use your legs. Avoid lifting heavy objects with just your elbows or wrists.
Hon BScKin, MScPT, MClScMT
Registered Physiotherapist, FCAMPT
- Coombes B, Bisset L, Vicenzino B. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. J Orthop Sports Phys Ther. 2015;45(11):938-949.
- Smidt N, Lewis M, Van Der Windt D, Hay E, Bouter L, Croft P. Lateral epicondylitis in general practice: course and prognostic indicators of outcome. The Journal of Rheumatology. 2016;33(10):2053-2059.
- Knutsen E, Calfee R, Chen R, Goldfarb C, Park K, Osei D. Factors Associated With Failure of Nonoperative Treatment in Lateral Epicondylitis. The American Journal of Sports Medicine. 2015;43(9):2133-2137.