Tennis Elbow – Vancouver

By Lindsay Farr, Physiotherapist

Lateral epicondylalgia (LE), more commonly referred to as tennis elbow, refers to pain on the outer side of your elbow.

This pain is usually worsened with gripping and repetitive activities such as typing, mousing, lifting objects with an outstretched arm, and opening doors. It is typically considered a tendinopathy of the extensor carpi radialis brevis muscle, however evidence shows a relationship between the neck, the radial nerve, and LE. Historically this condition was treated with non-steroidal anti-inflammatories (NSAIDs), ice, and rest.

Current evidence suggests there may not actually be an inflammatory component to this condition and studies have shown that physiotherapy combined with a home exercise program is more effective than ice or NSAIDs.

Studies have started to investigate the role of posture and the nervous system in the development of LE and have shown positive correlations. There is a greater prevalence of neck pain in patients with LE versus age matched controls (Berglund, Persson & Denison, 2013) and individuals suffering lateral elbow pain are more likely to test positive for radial nerve sensitivity (Coombes et al., 2013). Sitting at a desk for prolonged periods of time can lead to a chronic “head forward posture,” as pictured below.

Tennis Elbow 1

This position compresses the joints in our neck and narrows the space through which our nerves pass. Chronic poor postures can lead to compression of nerves, such as the radial nerve, which supplies muscles in our lateral elbow. When our nerves are compressed information moving through those nerves is restricted and slowed and this puts structures innervated by those nerves at risk for injury. Where our muscles would normally be able to withstand the repetitive daily tasks such as gripping and opening doors, nerve compression and irritation has limited their tolerance and so they breakdown sooner and start emitting pain signals. This is when we feel “tennis elbow.”

Here are some helpful tips for those of you who are “9-5 desk sitters,” or anybody struggling with lateral elbow pain:
Adjust your desk station: try to attain posture as shown in this image. If you are unable to adjust your station yourself, speak with your manager and ask to have an ergonomic assessment of your desk station

Tennis Elbow 2

Move: set a timer for 45 minutes. Whenever that timer goes off adjust your position. Lean back over your chair to stretch your chest muscles, stand up and walk to the printer/cooler, twist left and right in your chair.

Tennis Elbow 3

Stretch: use these basic neck and arm stretches daily to avoid tight muscles and relieve pressure on the nerves

Tennis Elbow 4

Posture: try to maintain a posture where your head rests over your body. Shoulders should be slightly back, lengthen the back of your neck and gently nod your chin “yes”. Your ears should nearly align with your shoulders when viewed from the side.

Tennis Elbow 5
See a Physiotherapist: if your symptoms persist and are becoming limiting to simple daily activities you should seek medical advice from a physiotherapist who can instruct you on more specific treatment methods and exercises.