tenniselbow1If you are a tennis player it is definitely that time of year again; time to step up your game. Unfortunately, unless you are careful, some combination of ramping up your activity level too quickly, a lack of preparatory conditioning, or improper stroke mechanics may result in tennis elbow.

Tennis elbow – or lateral epicondylitis – is a common overuse injury amongst recreational tennis players (much less so pros) as well as those suffering from repetitive stress from a myriad of non-athletic causes. It most commonly occurs after age 40. Initially considered a “tendinitis”, or inflammation of the tendon, it is now widely accepted to be a “tendinopathy”, which is a degenerative condition that entails disruption of the tissues – described in greater detail below.

The best way to approach tennis elbow is to avoid getting it in the first place. That means getting fit to play rather than playing to get fit. Developing adequate strength and flexibility of the forearm/wrist musculature helps to avoid overuse, as does attention to form. That applies to tennis of course, but also to any repetitive activity, such as computer keyboarding.

Early recognition of symptoms that may develop is also crucial. As with many conditions, managing epicondylitis when acute is much more successful than once it becomes chronic.

Acute management generally focuses on physical therapy (PT), which incorporates progressive strengthening (with a focus on eccentric training), as well as manual techniques to break up scar tissue and improve mobility and flexibility of the soft tissues.

It is also important for the PT to identify any structural factors or dysfunctional movement patterns that may place excessive stress on the lateral elbow during activity. Assessment of the shoulder, wrist and neck is a part of this process as is a more detailed physical exam of the elbow itself. There are a number of things that can mimic tennis elbow (such as a nerve compression or arthritic changes) or lead to it (elbow joint instability, and even loss of shoulder mobility) that must be differentially diagnosed. Treating the symptoms alone is insufficient. To prevent recurrence, it is crucial to address their cause(s).

Treatment of chronic tennis elbow is another story entirely. Again, because inflammation is no longer considered a significant factor – though some studies again claim it may be a component – it makes sense that many in the medical community have moved away from treating the condition with anti-inflammatory agents, like cortisone injections. In fact, current thinking is that use of cortisone is likely to impair healing and result in the condition recurring. Even when epicondylitis was thought to be primarily an inflammatory problem, reliance on injection without also restoring strength and flexibility was an unwise approach. Rest and medication are likely to provide only temporary benefits – if that. Once the offending activity is resumed – without adequate rehab – exacerbation is likely.

Chronic tennis elbow is thought to entail more significant tissue disruption that may involve further thinning of the tendon and separated or disorganized collagen. In addition, hyaline (cartilage) degeneration and vascular (blood vessel) proliferation (hyperplasia) has been identified. These microscopic findings typically occur in the region of the Extensor Carpi Radialis Brevis tendon (a wrist extensor) at its attachment (with the common extensor tendon) to the lateral epicondyle on the outer aspect of the elbow.

Part II of this series will focus on current treatment options for chronic lateral epicondylitis.




About the author

Abby serves as the Injury Expert for CBS New York where, since 2010, her Injury Breakdown Blog examines injuries in professional sports. She also blogs on health & fitness as well as sports injuries for Huffington Post, and Recovery Physical, where her blog earned a top ten mention for physical therapy blogs in 2012 @ In a ranking of the Top 30 Healthcare Blogs for 2012, Top Masters in Healthcare also rated Abby’s blog in the top three in Physical Therapy! Abby is the founder of Fit-Screen and she welcomes your comments and questions!