Tennis elbow

Although the condition is called the tennis elbow, it has nothing to do with tennis. A classic tennis elbow is a wrist extensor muscle enthesopathy, or in other words – strain changes to the tendon attachments to bones. These changes occur as a result of overlapping micro-injuries.

Tennis elbow – causes

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There are many ways in which micro-injuries may occur. It can be specific movements of the forearm and wrist which recur in the long period of time, e.g. assembling furniture for many hours. This being the case, wrist extensors are subject to long-term contraction and do not have time for regeneration. The problem is related to local structure overstrain. The tennis elbow may also be sustained when we work at the computer for a long time, when wrists lean against the desk while palms are slightly lifted. This unfavorable position may lead to inflammation. Another way we can sustain micro-injuries is when our movement biomechanics is wrong. The example may be a wrong technique we adopt when playing squash. A player who wrongly uses his/her torso, shoulder girdle and legs is likely to compensate movements via wrist extensors. With time this situation may lead to enthesopathy.

Professional groups highly exposed to wrist extensor muscle stress:

  • mechanics
  • needlewomen
  • office workers
  • sportspersons (tennis, squash)
  • musicians


Tennis elbow – symptoms

The main symptom of the tennis elbow is pain identified on the external side of the elbow joint. It may radiate to forearm and wrist. Sometimes it intensifies when moving a hand or when trying to clench one’s fist. It may hinder everyday activities, such as opening the door or lifting a mug. During palpation, a clear tissue tenderness can be sensed.

Tennis elbow – diagnostics

Pain on the side of the elbow does not necessarily mean it must be a tennis elbow. There can be many causes of pain which imitates this condition. Their origins may be related to neck section and breast section of the spine or upper hole of the chest. Elbow pain may also radiate from other soft structures (muscles, fascia). To be able to treat the tennis elbow effectively, we must be sure where the source of the problem is. To do so, an orthopedist or physiotherapist must take a medical history and perform a physical examination. On this basis the orthopedist may decide to refer the patient for ultrasound scanning to confirm the diagnosis and specify the extent of damage. If not, the patient may be referred to a physiotherapist for further examination. The physiotherapist in turn may decide to consult the orthopedist or carry out the examination of the spine neck section, upper hole of the chest, and examine myofascial structures as well as assess the movement biomechanics.

Tennis elbow – treatment

Depending on the cause of the pain, various treatments may be adopted. The first and basic principle in the process of treating is relaxation and regeneration of the damaged tissue. If stress occurs when taking physical activities or when working, these activities must surely be modified or a break must be taken so that the damaged tissue is able to heal. The method which forces the cells of the damaged tendon to regenerate in a short time is platelet-rich plasma injection which contains growth factors (PRP). The treatment requires precision and must be performed by an experienced orthopedist.

In the rehabilitation process the physiotherapist may deal with myofascial structures related directly to the elbow as well as distant places from the pain. In his/her work, the physiotherapist frequently uses myofascial methods. If pain is a result of a wrong movement biomechanics, it is important that the movement technique is improved, weak muscles are strengthened and highly tensed muscles in the torso, shoulder girdle and upper limb are toned. As you can see, we need to take into consideration a number of methods when dealing with tennis elbow. It seems that a proper diagnosis is the most important as it lets us identify the source of the problem.

Tennis elbow – exercises

Presented by MA Natalia Reke:

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Concentric phase of the exercise for strengthening wrist and fingers extensors muscles







Łokieć tenisisty ćwiczenie 2Eccentric phase of the exercise for strengthening wrist and fingers extensors muscles







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Exercises for strengthening wrist and fingers extensors muscles with the use of FlexBar







Łokieć tenisisty ćwiczenie 4Stretching wrist and fingers extensors muscles







Łokieć tenisisty ćwiczenie 5Stretching wrist and fingers flexors muscles







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Shoulder blade lower stabilizer activating exercises (lifting a 1-2kg ball up and down)







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The video shows advanced strengthening exercises used in the tennis elbow rehabilitation. The training which engages upper limb muscles with regard to concentric and eccentric phase of the muscles.

Tennis elbow – regaining physical fitness

As a rule the results of the nonsurgical treatment are very good. Most patients cease to suffer from pain and are ready to regain previous physical fitness. It is crucial that they increase their training time and loads gradually.

MA Zuzanna Kulczyńska – Rehasport Clinic physiotherapist