Tennis elbow, also known as lateral epicondylitis usually occurs by repetitive motion of wrist and arm. There is pain and inflammation on the outer part of the elbow. It is an overuse and muscle strain injury. Pain can also spread into the forearm and wrist. It occurs when the forearm muscle i.e. the extensor carpi radialis brevis (ECRB) which is mainly responsible for extension of wrist is damaged. As the name suggests, tennis elbow affects 50% of tennis player, reason being the overuse and repetitive stress weakens the ECRB muscle, thus causing tiny micro tears in the muscle’s tendon at the point where it attaches to the outside of the elbow. These tears are primarily responsible for inflammation and pain.
Despite the name, tennis elbow can also occur with the activities of daily living. Cooks, painters, swimmers, carpenters, gardeners, plumbers and even butchers can develop tennis elbow.
In majority of cases, the patient complains of mild pain but slowly & gradually the pain becomes worse over a month. The patient with tennis elbow usually complains of pain on outer part of the elbow. You might experience pain when you try to:
- Open the lid of pickle jar.
- Twist your wrist to open door.
- Hold any heavy book, water bottle, etc.
- Constant use of mouse.
- Raising your hand in attempt to reach or grab something
- Knitting
Sometimes, night pain might be present.
Tests to confirm tennis elbow – At Home
- For confirmation of pain for tennis elbow, gently press the affected area with the fingers of other hand as shown in the image. Now give the pressure little dip and check for any pain or swelling. Presence of pain on the site will confirm tennis elbow.
- Hold the glass of water or water bottle with your affected hand. In case you feel pain around the elbow while holding it, it confirms for tennis elbow.
- Place your affected hand straight just parallel to the floor with the palm facing downwards. Now put the palm of other hand over the affected hand. Gently move the wrist of affected hand towards you while with the other hand give pressure downwards. Presence of pain means that the test is positive.
- For this test you will need a chair which should be light in weight. With your arms straight and palm facing downwards hold the chair with your index finger, middle finger and thumb.
Treatment protocol of tennis elbow
The basic step for the physiotherapy protocol of tennis elbow is the pain management. TENS and ultrasound are the electrotherapy generally used. But the cryotherapy plays a very vital role in the treatment of tennis elbow.
Cryotherapy
Cryotherapy in simple words is nothing else but the application of ice over the painful area. It is very effective in treating tennis elbow. It not only helps in reducing pain but also reduces the swelling.
It acts as analgesic as the cold applied to the painful area makes the soft tissues numb. Nerve cells in the chilled area cause constriction of nearby blood vessel (scientifically known as vasoconstriction) which leads to reduction in blood flow at the injury site.
The use of ice gel packs preferred in cryotherapy by the physiotherapists. But no need to worry, there are other alternatives which can be done at home. Some of them are:
- One can use ice cubes wrapped in cloth or towel and can can apply it over the painful area around elbow.
- Small ice cubes can also be rubbed gently in circular motion for few minutes.
- Ice spray can be used.
- One can also immerse the painful area in chilled water.
Once inflammation subsides, stretching and strengthening exercise program can be further aided to strengthen the muscle.
Stretches for Home Care
- Keep your affected arm straight parallel to the floor. Place the other hand over the palm of affected hand. Gently push the palm of affected hand with your other hand towards you. Hold for 15 seconds. Repeat it 3 times.
- For this stretch also, keep your affected arm straight parallel to the ground . But this time keep your other hand should be on the outer surface of palm ( dorsal surface). Now push the palm of your affected hand away from you i.e. towards the floor. Hold it for 15 seconds and repeat it 3 times.
Exercises to strengthen your muscle At Home
- Hold a half kg dumbbell or a water bottle filled with water ( make sure it is light ). Place your hand on a table in resting position with your palm facing downwards. Your wrist should be on the edge of table. Now slowly move your wrist upwards. Do this exercise 10 times.
- Again hold a half kg dumbbell or a water bottle filled with water (sould be light in weight). Place your hand on a table in a resting position with your palm facing upwards. Note that your wrist should be on the edge of table. Now slowly move your wrist in upward direction. Repeat this 10 times daily.
- Hold a small ball in your hand or a towel roll and try to squeeze it gently. Do this also 10 times in a day.
- Take a loose rubber band and put it around your fingers as shown in image. Now try to open your fingers and thumb slowly. Repeat it 10 times.
These are the exercises which can be performed easily at home by anyone to cure tennis elbow. If you still face any problem you can consult your doctor or physiotherapist.
By Dr. Preeti Sharma (Physiotherapist)
