Elbow tendon problems
It is likely that you have pain related to small “micro-tears” within the tendons around the elbow. These structure connect your forearm muscles to your elbow allowing you to do activities involving gripping. If your pain is on the outside of your elbow (see left image) this is called “tennis elbow” because it is sometimes caused by repetitive serving and backhand shots in tennis. If the pain is on the inside it is called “golfer’s elbow” because it is aggravated by repetitive hitting a golf ball. Tendinopathies are usually caused by “overloading” the tendon with an increase in activities. Note that these causes of musculoskeletal pain are common in people not playing tennis or golf.
Try pressing on the inside and outside of your elbow, 1-2cm below the bony pointy part. If this is tender the diagnosis is highly likely to be tennis or golfer’s elbow. Pain on firm gripping of objects (eg shaking hands) is also a feature of tennis/golfer’s elbow. For detailed information on tennis elbow see here and golfer’s elbow here, noting that the correct physiotherapy treatment is highly effective in almost all cases (surgery or injections are rarely required).
If your pain is relatively low (less than 4/10 on average) and not having a major impact on your life consider the following effective physiotherapy treatments you can do on your own:
For a short period, stop doing anything (eg forced gripping during daily activities or sport) that significantly increases your pain by more than 2/10 during the activity or that results in more than 2/10 pain for more than 30 minutes after the activity
Read these resources on “pacing” and “more on pacing” to ensure you have the right balance between activity and rest to optimise recovery
A graduated series of exercises (click on the links below to see a video description) to build up the strength of the tendon is a very important strategy. Work your way through the list below step by step. The exercises should be done 2 times a day starting with 2 sets of 5 (no hold) and progressing to 2 x 12 over 3-6 days making sure there is no significant increase in pain (see bullet point above). Once mastered move to the next exercise in the list, starting again at 2 x 5 progressing to 2 x 12 over 3-6 days.
Start with wrist extension for tennis elbow (shown here) or wrist flexion for golfer’s elbow (shown here) with 0-1kg. The exercises should be done with minimal pain during or after (see above)
Progress to wrist extension or flexion with 2-3kg
Progress to wrist extension or flexion with a “catch”
Final progression is wrist extension or flexion with a “catch” and “rebound”
A tennis elbow brace can be helpful to “unload” the tendon and can be purchased at most pharmacies. To use effectively:
Grip an object and note how much pain it produces
Put the brace on with the top edge around 2cm below the bony points of the elbow
Re-test your grip. The pain should be improved. If not, experiment with the position and tightness of the brace
If no significant improved is noted do not use the brace
If there is improvement the brace should be worn only during activities that normally cause pain to prevent further aggravation and flare ups
When you can do wrist extension or flexion with 2-3kg without a significant increase in pain, you should be able to also start grading up your activities by following the principles of rehabilitation described here. Tennis, golf and other high force gripping activities should not be graded up until you can comfortably do 15 wrist extension or flexion exercises with a catch and rebound.
Negotiating the above exercise and rehabilitation program can be complex. Or you may not be noticing any improvement over a two week period. If this is the case why not try a free telehealth consultation with one of our expert practitioners by clicking the button below. Ongoing treatment by telehealth or face to face can also be provided if needed to guide your recovery.