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Elbow the pain away


CHANCING YOUR ARM?  Painters, bricklayers, plasterers, golfers and typists are most at risk of tennis-elbow pain.

Andrew O'Brien

Some patients’ injuries are a bit like buses, you can go for ages without seeing one, then all of a sudden three arrive in a row. Over the last week, the buses all seem to be coming from Tennis Elbow Central. And none of the passengers have enjoyed their journeys.
Tennis elbow was long been referred to in medical literature as lateral epicondylitis, the ‘-itis’ suggesting an inflammatory condition at the point where the forearm muscles attach above the elbow. In recent years, it has been suggested that a more correct name would be lateral epicondylalgia. The suffix ‘-algia’ means pain. This is a more accurate description in that the condition appears to be more due to a degenerative process within the tendons, rather than an inflammatory process.
What do such semantics matter to the poor soul sitting in front of me who can’t lift a kettle? Probably not a lot, but it does make a difference to how the patient is managed.
Before we worry about how to look after the problem, let’s consider how it comes about.
Tennis elbow can be a painful and quite debilitating injury that tends to affect people between 40 and 50 years of age, and it can last for up to two years. It typically, but not always, affects the dominant arm, where pain starts gradually at the outside of the elbow. Over time, the pain radiates down the forearm and into the wrist, and the arm becomes weaker. In severe cases, pins and needles can be felt into the hand and fingers.

In the past, when tennis players used heavy wooden racquets and tended to play ‘wristy’ one-handed backhands, it was common to develop pain at the elbow. Since the advent of lighter racquets, and with most modern players using two hands on the backhand, the incidence among tennis players is relatively low.
In general, people who perform repetitive tasks with their wrists in an extended position are most likely to develop symptoms. Bricklayers, plasterers and painters are most at risk, but so too are people who spend long hours using a PC.
To get an idea of how the forearm works, rest your left hand on your right forearm, then extend your right wrist back; you will feel the muscles of the forearm contract under your hand. All of those muscles attach to the outside border of your humerus through one common tendon. If this tendon is repetitively overloaded, it thickens and, if not looked after properly, starts to degenerate. For someone with tennis elbow, poking a finger or thumb into the top end of those muscles can be very painful.

Stretch it out
What should you do if you develop pain at the elbow? There are a number of self-help remedies, including trying not to aggravate the pain in the short term – easier said than done if it’s your dominant arm! Using cold gels or ice on the painful site can provide some relief, as can self-massage – try to get into the sore spot and work across it with your fingers. Given that there doesn’t appear to be an inflammatory process involved, anti-inflammatory tablets and gels are unlikely to help.
A good stretch for the forearm is to straighten your elbow, and bend the wrist down, then grab onto the back of the hand and gently pull downwards until you feel a stretch along the top of the forearm. Hold this for a few seconds, then reverse the position, bending your wrist back so that you feel the stretch on the underside of your forearm.

Other factors
Like any overuse injury, there are many other factors that contribute to tennis elbow. The neck needs to be assessed for any nerve impingement, and shoulder stability and strength are important factors. Weakness at the shoulder means the muscles of the forearm need to work harder to get the same power output.
If it is a work-related injury, you should look at your work patterns. How long do you spend doing the same thing each day? Are you in the optimal position to do so?
If you do have problems playing tennis, you will probably need to take some time off from the sport and have a coach look at your technique.
If you don’t get relief quickly from self-management, arrange an appointment with a chartered physiotherapist, who can help with a treatment and exercise programme to get you back on the bus to Normality.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at