Tennis Elbow: Finding Relief For the Long-Term

Scapular Strengthening For Lateral Epicondylalgia

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 we see with the diagnosis of Tennis Elbow are baffled because they don’t play tennis. What then, could have led to this nagging elbow pain and why does it last so long?

Let’s explore these questions and figure out a plan to help you recover…

What Is Tennis Elbow?

Tennis Elbow refers to pain at the outside of your elbow. This is where a bunch of muscles that help move your wrist all attach.

Tennis Elbow is very common in workplace environments – with rates as high as 12.2%2.  This means that we’ve seen many of these types of cases – and you’re in good hands!

What kind of workplace environments?

In particular, Tennis Elbow mostly affects people 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 Tennis Elbow 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 Tennis Elbow: Do I Have It?

Workers with Tennis Elbow commonly complain of the following symptoms:

  • Sharp pain at the outside of the elbow
  • Pain with gripping or repetitive forceful use of the hand

Does this sound like you?  Then read on…

Some Treatment Options For Tennis Elbow

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 forearm muscles, soft tissue massage, 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 symptoms14.
  • Strengthening exercises have been found helpful after six weeks15.
  • Epicondylar counterforce braces work by reducing the level of tension in the forearm muscles. Several studies have shown that these braces can improve pain and grip strength16.
  • Joint Mobilization – at the elbow, wrist, neck, and thoracic spine can assist in the management of Lateral Epicondylalgia in the short-term (Vicenzino 2007).
  • Anti-inflammatory drugs (NSAIDs) may improve short-term function17.
  • 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 treatment18.

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…

Shoulder Blade Muscle Strengthening for Tennis Elbow

Recently, a study found that people with elbow pain tend to have a significant decrease in shoulder blade (scapular) muscle strength and endurance when comparing the arm with elbow pain to the uninvolved arm19.

The middle and lower trapezius muscles are shoulder blade muscles that help maintain alignment of the shoulder blade and the arm20,21 and help coordinate timing of muscle recruitment with reaching22.

Another recent study23 found that modifying the position of the scapula can improve the position of the arm24 and reduce Tennis Elbow symptoms.

Plus, the researchers found that this shoulder blade 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 Tennis Elbow might not be restricted solely to the elbow region.

Potential Prevention of Tennis Elbow

The recent evidence of scapular weakness in people with Tennis Elbow 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 future.

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

1. Quadruped Forward Rocking

 

2. Prone Lift-Offs

 

Question: What have you found to be helpful in treating Tennis Elbow? You can leave a comment by clicking here.

  1. Verhaar JA. Tennis elbow: anatomical, epidemiological and therapeutic aspects. Int Orthop 1994;18:263–267 ↩︎
  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 ↩︎
  12. Abrams GD, Renstrom PA, Safran MR. Epidemiology of musculoskeletal injury in the tennis player. Br J Sports Med. 2012;46:492-498. http://dx.doi.org/10.1136/bjsports-2012-091164 ↩︎
  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. Ahmad Z, et al. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 2013;95-B:1158-64. ↩︎
  15. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and metaanalysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med 2005;39:411–422. ↩︎
  16. Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sports Phys Ther 2009;39:484–489. ↩︎
  17. Ahmad Z, et al. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 2013;95-B:1158-64. ↩︎
  18. 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. ↩︎
  19. 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. ↩︎
  20. 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 ↩︎
  21. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St Louis, MO: Mosby; 2001. ↩︎
  22. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St Louis, MO: Mosby; 2001. ↩︎
  23. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St Louis, MO: Mosby; 2001. ↩︎
  24. 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. ↩︎
  25. Vicenzino B, et al. Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary. J Man Manip Ther. 2007;15(1):50-56.
Get Your FREE eBook!
Turn Down Your Pain
Plus, I'll send you new articles and products as they become available.