Lateral Epicondylalgia: What Is It and Can You Prevent It?

Scapular Strengthening For Tennis Elbow

Man with Lateral Epicondylalgia Tennis Elbow

Yes, you can get Tennis Elbow even if you’ve never picked up a racquet in your life. In fact, most patients that come and see me with the diagnosis of Tennis Elbow are baffled and assure me that they don’t play tennis. What then, could have led to this nagging elbow pain also known as Lateral Epicondylalgia and why does it last so long?

Let’s explore these questions and also see if there’s a way to potentially prevent this painful disorder from ever starting…

What Is Lateral Epicondylalgia?

Lateral Epicondylalgia refers to pain at the lateral epicondyle (the boney point at the outside of the elbow) of the Humerus bone. This is where the extensor tendons on the back of the forearm all attach.

“Tennis Elbow” is its common name, “Lateral Epicondylitis” is the common diagnosis, “Lateral Epiconylosis is what it becomes over time, while “Lateral Epiconylalgia” is the all-encompassing term.

“-itis” indicates an acute inflammatory disorder, which this can start as, but then becomes an “-osis”, or a chronic degeneration of the tendon1. The term “-algia” indicates pain – so Lateral Epicondylalgia means lateral epicondyle pain – a more broad definition for this disorder – so that’s what I’ll call it from here on out.

Epicondylalgia is very common in occupational environments – with prevalence rates as high as 12.2%2.

What kind of occupational environments?

In particular, Lateral Epicondylalgia mostly affects those in professions that require repetitive, forceful, heavy manual tasks3,4,5, non-neutral wrist positions (like twisting)6, and repetitive gripping,7,8,9,10.

What makes this disorder particularly cruel is that it can last for 4 years and even tends to recur11.

As it turns out, the term “Tennis Elbow” is actually used for a reason – it’s the most common elbow problem in athletes, especially tennis players12,13.

Signs and Symptoms of Lateral Epicondylalgia

The question then becomes: what differentiates tennis players with the disorder from those without?

In 1994, a research study14 using high-speed cameras and EMG of the forearm muscles compared tennis players with Lateral Epicondylalgia to those without. When comparing the backhand stroke, those with the pain had higher levels of electrical activity in the forearm extensor muscles at ball impact than those without pain.

The study also found that, in subjects with pain, the elbow was more “leading”, which made the wrist more extended, and the shoulder was more internally rotated.

It’s not surprising, then, that individuals with Lateral Epicondylalgia tend to have weak rotator cuff muscles, 25-35% weaker, when compared to a control group15.

Plus, more evidence suggests that tennis players with Lateral Epicondylalgia tend to have lower trapezius (scapular) weakness16.

Scapular and rotator cuff weakness both present themselves in non-athletes with this disorder, as well.

In addition to weakness, the main signs of Lateral Epicondylalgia are pain to direct touch over the lateral epicondyle of the elbow and reproduction of pain and weakness with gripping.

Some Treatment Options For Lateral Epiconydylalgia

Most treatments focus their attention at the location of the symptoms – the elbow.

Oftentimes, treatment here will look like stretching and/or strengthening of the wrist extensor muscles, soft tissue manual therapy, ice, and a few other options:

  • Although difficult – and sometimes not even a long-term possibility – rest, avoidance or modification of aggravating activities can eventually lead to a decrease in symptoms17.
  • Eccentric strengthening exercises have been found to be superior to conservative management at six weeks18.
  • Epicondylar counterforce braces work by reducing the level of tension in the forearm extensors. Several studies have shown that these braces can improve pain and grip strength19.
  • Joint Mobilization – at the elbow, wrist, cervical, and thoracic spine can result in changes in pain and the motor system, which can assist in the management of Lateral Epicondylalgia in the short-term (Vicenzino 2007).
  • Anti-inflammatory drugs (NSAIDs) may improve short-term function20.
  • Local injection of corticosteroids have been found to be superior to NSAIDs at four weeks, but no long-term differences were noted between steroid injections and NSAID treatment21.

Unfortunately, like so many other disorders, treating only the area that has symptoms often provides only temporary relief.

These temporary remedies may be beneficial for you if you have a demanding repetitive job that you can’t take time off from, or if you need to take the edge off.

But let’s look at what you can do that might help more long-term…

Scapular Strengthening for Lateral Epicondylalgia

Recently, a study found a significant decrease in scapular muscle strength and endurance when comparing the arm with elbow pain, to the uninvolved arm22.

The middle and lower trapezius muscles are scapular muscles that help maintain alignment of the scapula (shoulder blade) and the arm23,24 and help coordinate timing of muscle recruitment with reaching25.

By correcting a faulty position of the scapula, the middle and lower trapezius, along with the rhomboids, can improve the position of the arm26.

Another recent study27 found that modifying the position of the scapula into adduction (closer to the spine) in individuals with weak scapular muscles and an abducted scapula (away from the spine) also improves the position of the arm and reduces Lateral Epicondylalgia symptoms.

Plus, the researchers found that this scapular correction often results in improved grip strength.

These studies, among others, find that a full resolution of symptoms and return to full function can be achieved without ever treating the elbow.

This suggests that underlying causes of Lateral Epicondylalgia might not be restricted solely to the elbow region.

Potential Prevention of Lateral Epicondylalgia

The recent evidence of scapular weakness in people with Lateral Epicondylalgia leads us to assume that the weakness was likely there before the pain began.

Since strengthening scapular muscles as a treatment for elbow pain has proven to be beneficial, I’m inclined to believe that strengthening scapular muscles could potentially prevent elbow pain from occurring in the first place.

For more scapular strengthening exercises and info about how to correct the position of your scapula, check out my ebook Why You Have Bad Posture and How To Make It Better.

Here are a couple of scapular strengthening exercises you can incorporate into your workouts:

  1. Quadruped Forward Rocking

2. Prone Lift-Offs

Question: What have you found to be successful in treating Lateral Epicondylalgia? You can leave a comment by clicking here.

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  2. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25:43-57. http:/dx.doi.org/10.1016/j.berh.2011.01.013. ↩︎
  3. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25:43-57. http:// dx.doi.org/10.1016/j.berh.2011.01.013 ↩︎
  4. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164:1065-1074. http://dx.doi. org/10.1093/aje/kwj325 ↩︎
  5. van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford). 2009;48:528-536. http://dx.doi.org/10.1093/ rheumatology/kep013 ↩︎
  6. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164:1065-1074. http://dx.doi. org/10.1093/aje/kwj325 ↩︎
  7. Bhargava AS, Eapen C, Kumar SP. Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis – comparison of involved vs. uninvolved side in athletes and non athletes: a case-control study. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:22. http://dx.doi. org/10.1186/1758-2555-2-22 ↩︎
  8. Vicenzino B, Cleland JA, Bisset L. Joint manipulation in the management of lateral epicondylalgia: a clinical commentary. J Man Manip Ther. 2007;15:50-56. http://dx.doi. org/10.1179/106698107791090132 ↩︎
  9. Vicenzino B, Smith D, Cleland J, Bisset L. Development of a clinical prediction rule to identify initial responders to mobilisation with movement and exercise for lateral epicondylalgia. Man Ther. 2009;14:550-554. http://dx.doi. org/10.1016/j.math.2008.08.004 ↩︎
  10. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford). 2012;51:305-310. http://dx.doi.org/10.1093/ rheumatology/ker228 ↩︎
  11. Murtagh J 1988 Tennis elbow. Australian Family Physician 17: 90,91,94–95 ↩︎
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  13. Eygendaal D, Rahussen FT, Diercks RL. Biomechanics of the elbow joint in tennis players and relation to pathology. Br J Sports Med. 2007;41:820-823. http://dx.doi.org/10.1136/ bjsm.2007.038307 ↩︎
  14. Kelley JD, Lombardo SJ, Pink M, Perry J, Giangarra CE 1994 Electromyographic and cinematographic analysis of elbow function in tennis players with lateral epicondylitis. Amercian Journal of Sports Medicine 22: 359–363 ↩︎
  15. Alizadehkhaiyat O, Fisher AC, Kemp GJ, Vishwanathan K, Frostick SP. Upper limb muscle imbalance in tennis elbow: a functional and electromyographic assessment. J Orthop Res. 2007;25:1651-1657. http://dx.doi.org/10.1002/ jor.20458 ↩︎
  16. Lucado AM, Kolber MJ, Cheng MS, Echternach JL, Sr. Upper extremity strength characteristics in female recreational tennis players with and without lateral epicondylalgia. J Orthop Sports Phys Ther. 2012;42:1025-1031. http://dx.doi. org/10.2519/jospt.2012.4095. ↩︎
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  21. Wolf JM, Ozer K, Scott F, Gordon MJ, Williams AE. Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am 2011;36:1269–1272. ↩︎
  22. Day JM, Bush H, Nitz AJ, Uhl TL. Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy. 2015;45(5):414-424. ↩︎
  23. Graichen H, Hinterwimmer S, von EisenhartRothe R, Vogl T, Englmeier KH, Eckstein F. Effect of abducting and adducting muscle activity on glenohumeral translation, scapular kinematics and subacromial space width in vivo. J Biomech. 2005;38:755-760. http://dx.doi. org/10.1016/j.jbiomech.2004.05.020 ↩︎
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  27. Bhatt JB, Glaser R, Chavez A, Yung E. Middle and Lower Trapezius Strengthening for the Management of Lateral Epicondylalgia: A Case Report. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(11):841-847. ↩︎
  28. Vicenzino B, et al. Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary. J Man Manip Ther. 2007;15(1):50-56.
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