Tennis Elbow – Lateral Epicondylitis: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment

What Is A Tennis Elbow?

Clinically known as lateral epicondylitis, the tennis elbow is a painful condition of the elbow region. It occurs as a result of damage to the extensor carpi radialis brevis muscle due to excessive use and is more common in middle-aged people. Unlike what its name suggests, the condition is not exclusive to tennis players. It is more common in people who are not tennis players. (1).In athletes, it is often precipitated by poor technique, improper equipment, or mechanics of movement. (2)

 Damage to the tendon of extensor carpi radialis brevis muscle occurs secondary to repetitive straining or an excessive amount of overload. While bending or extending the arm, the tendon rubs against the bony prominences of the arm and forearm. This results in pain in the elbow region that may radiate to the forearm and wrist. (3)

What Are The Symptoms Of Tennis Elbow?

Tennis elbow often causes the following symptoms:

●  Pain or burning sensation in the lateral part of the elbow joint and along the lateral part of the arm and forearm.

●  Weakness of the elbow and wrist muscles.

●  Pain on gripping and twisting objects such as turning a doorknob, shaking hands, or holding a cup, etc.

●  Pain produced by resisted wrist extension.

●  Pain induced on passive flexion of the fingers and the wrist joint.

●  Difficulty on the extension of the forearm. (4)

What Are The Causes Of Tennis Elbow?

Tennis elbow is often caused by:

●  Backhand strokes with poor body mechanics and technique.

●  Driving screws

●  Prolonged or repetitive use of the mouse on the computer, or typing.

●  Cutting food.

●  Painting.

●  Certain professions such as plumbing, carpentry. (5)

●  Direct trauma to the muscles of the elbow joint.

●  Not warming up properly before exercising or engaging in any sports-related activity. 

Wat zijn de risicofactoren? 

Common risk factors that may lead to the development of tennis elbow include:

●  Ages 30 to 50 (common in middle-aged population).

●  Sports and athletic activities that employ the use of a racquet, for example, tennis, squash, badminton, etc.

●  Certain occupations involve the use of excessive motion at the wrist and elbow joints, for example, painters, butchers, carpenters, plumbers, heavy-weight lifters, etc.

Pathophysiology – Healing Cycle Of Tennis Elbow

Before moving on to the treatment of the tennis elbow, we need to understand what is really happening in the processes that lead to this pain.

If the tension applied to a muscle tendon exceeds its capability of bearing load or stretch, microtears may occur in the muscle. These micro-injuries cause degeneration of the muscle tissue. (6)

Our body’s normal response to injury involves the following phases:

1.     Ontsteking: As a result of injury to the tissue, our immune system recruits a number of cells to the site of damage. This initial phase causes the release of pro-inflammatory cytokines that lead to the development of pain, redness, and swelling in the area, as well as cause a local rise in temperature. (7)

2.     Proliferatie: In response to the injury and inflammation, our body attempts to heal the wound by producing collagen, blood supply, and other components of the extracellular matrix. This results in the production of scar tissue, muscle spasms, and trigger points at the site of injury. (8)

3.     Rijping: This is the final stage of wound healing in which the body removes excess and preliminary scar tissue and fibrosis. This involves the return of the injured tissue to more or less its original form. (9)

If the injury becomes repetitive or extensive, the body produces an excessive amount of scar tissue that does not get removed as quickly as it needs to. This results in fibrosis and the formation of adhesions between the various layers of the fascia.

This is what happens in tennis elbow. Fibrosis causes restriction of the stretching ability of the muscle. Therefore, too much scar tissue limits the range of motion and causes pain in the movement of the upper limb.

Treatments That Do Not Work:

●  Warmte en ijs: These may provide temporary relief to pain in the elbow, but the sensation returns as soon as heat or ice is removed. Additionally, ice can causes further inflammation in the region. This will worsen the pain in the long run.

●  SCHATTING: Electronic stimulation of the muscle is a physiotherapeutic approach that may help in the improvement of pain temporarily, but does not aid the process of healing of the injured tissue. (10)

●  Foam Roller and Massage: Both of these methods employ the application of pressure to the painful area. Pressure causes temporary inhibition of pain, but it damages the injured area more by compressing it, thus aggravating the inflammatory process.

●  Stretching and Strength Exercises: These are necessary for regaining the range of motion and movement at the joint, but must be done at an appropriate time. Undue stretching and movement can cause further injury if it is done during the inflammatory or proliferation phase of healing.

Treatments That Do Work: 

To achieve long-term improvement and healing of the tennis elbow, we need to individually and often simultaneously target the different phases involved in its pathogenesis.

Inflammatory Phase:

●  Rest well and take it easy. Excessive motion can cause and aggravate the pain of the tennis elbow.

●  Magna Heal is a tool that is used to apply a magnetic field penetrating 3 inches into the tissue. It helps to break the adhesions formed and regain motility.

●  An anti-inflammatory diet, such as that including the likes of ginger and turmeric, is a necessary component required to support and maintain the treatment process.

●  Nutrient deficiency must be treated to aid the process of healing. AskASTR website provides free evaluation and treatment suggestions regarding particular deficiencies.

Proliferation Phase:

●  The A3 and A5 tools help to release scar tissue and trigger points.

●  Adhesions formed between the layers of the fascia can be broken by using the A1 and A5 tools that have been specifically designed for this purpose.

Give yourself a break and let your tennis elbow heal!

 Referenties

1. Burgess RC. Tennis elbow. J Ky Med Assoc [Internet]. 1990 Jul [cited 2021 Sep 24];88(7). Available from: https://pubmed.ncbi.nlm.nih.gov/2373949/

2. Buchanan BK, Varacallo M. Tennis Elbow. In: StatPearls [Internet]. StatPearls Publishing; 2021.

3. The Basics of Tennis Elbow [Internet]. [cited 2021 Sep 24]. Available from: https://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis

4. The Basics of Tennis Elbow [Internet]. [cited 2021 Sep 24]. Available from: https://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis

5. Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Reviews. 2016 Nov;1(11):391.

6. Michael H. Askenase LHS. Stadia van de ontstekingsreactie bij pathologie en weefselherstel na intracerebrale bloeding. Semin Neurol. 2016 juni;36(3):288.

7. de Oliveira Gonzalez AC, Costa TF, de Araújo Andrade Z, Medrado ARA. Wound healing – A literature review. An Bras Dermatol. 2016;91(5):614.

8. Lake DA. Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries. Sports Med [Internet]. 1992 May [cited 2021 Sep 24];13(5). Available from: https://pubmed.ncbi.nlm.nih.gov/1565927/