Lateral epicondylitis or tennis elbow is one of the most common overuse syndromes. It can be quite debilitating and is most often reported in the industrial athlete. The injury is most often observed in patients 30-60 years of age who perform some type of repetitive motion with their upper extremities. This condition also has been estimated to occur in approximately 60 per 10,000 industrial workers. (eMedicine, by Vincent Disabella, DO)

The muscles of the forearm, especially the extensor carpi radialis brevis, are involved in a tendinopathy at the lateral epicondyle. This micro trauma can be caused by any activity that involves repetitive wrist extension, supination, or repetitive heavy lifting. Tennis elbow may also result from faulty body mechanics involving sitting at a desk with the keyboard elevated too high for the elbow and wrist.

During an evaluation the physical therapist will assess range of motion, strength and mechanics of the elbow. The neck, shoulder, and upper back may also be contributing factors to lateral elbow pain and are therefore assessed. After the evaluation a treatment plan is constructed to promote healing of the tendonitis. In the treatment plan modalities may be utilized such as: ultrasound, electrical stimulation, iontophoresis and cryotherapy. Friction massage, stretching, and strengthening help reduce pain and aid to facilitate the healing process. The friction massage will help strengthen the musculotendon junction which can help increase one’s tolerance for excessive force on the forearm region. A work evaluation may also be performed by the therapist in which the patient’s job site is assessed and recommendations are made to help correct or improve faulty body mechanics.

Patients with lateral epicondylitis are frequently treated with a corticosteroid injection, in order to relieve pain and diminish disability. Thirteen studies consisting of 15 comparisons were included in our review. These evaluated the effects of corticosteroid injections compared to placebo injection (n=2), injection with local anesthetic (n=5), another conservative treatment (n=5), or another corticosteroid injection (n=3). Statistically significant and clinically relevant differences were found on pain, global improvement and grip strength for corticosteroid injection compared to placebo, local anesthetic and conservative treatments. However, for intermediate (6 weeks-6 months) and long-term outcomes (>or=6months), no statistically significant or clinically relevant results in favor of corticosteroid injections were found. (PubMed Pain 2002 Mar;96(1-2):23-40)

We believe physical therapy is an effective tool because it addresses the root causes of lateral epicondylitis. This may include imbalances in muscle strength, poor posture, and faulty ergonomics at work. In a research study comparing eccentric training versus stretching 38 patients were randomly placed into two groups. Reduced pain and increased grip strength were seen in both treatment groups but 12 out of 17 patients (71%) in group E rated themselves as completely recovered as compared to 7 out of 18 (39%) in group S, and in group E the increase in grip strength after 6 months was significantly larger than in group S. (PubMed Scand J Med Sci Sports 2001 Dec;11(6);328-34