Are you fed up with having pain in the elbow every time you pick something up, hit a tennis or golf ball or if you knock the outside of the elbow?
Is your experience of physiotherapy being given a few exercises that have not helped or make your pain worse?
Have you been told there is nothing you can do for tennis elbow other than rest and stretch it?
If the answer is ‘yes’ to any of these questions then read on and find the solution for your tennis elbow today!
Read Steve’s story:
“I had been suffering with tennis elbow for 8 months before contacting Complete Physio. I am a keen golfer but was getting agonising pain with every stroke. I was quite frankly fed up. I had rested, tried stretching and used a brace – no help at all. I saw the team at Complete and with three sessions of shockwave and a comprehensive exercise programmed. I was pain-free and back on the golf course in under 6 weeks. I wish I had contacted Complete earlier!”
Steve, 48 from Winchmore Hill
What is tennis elbow and who gets it?
Tennis elbow, is a condition that affects the outside (lateral aspect) of the elbow and is one of the most common causes of long standing elbow pain.
Tennis elbow affects about 1-3% of the population (about 4 to 7 cases per 1000) every year. Women and men are affected equally, mostly between the ages of 35-54.
It has been reported that around 50% of tennis players will experience at least one episode of tennis elbow in their career. However, tennis elbow is not limited to just tennis players, it also affects those who play golf and squash and manual workers who perform repetitive tasks such as painters, electricians and gardeners. The pain is aggravated by simple everyday tasks such as gripping, driving, turning a key in a door or opening a jar.
Tennis elbow is an overuse injury of the tendons that attach to one of the bones (the humerus/upper arm bone) that make up the elbow joint. The main tendon involved in tennis elbow, is the extensor carpi radialis brevis (ECRB), this muscle and tendon unit generates significant force to produce wrist extension (cocking the wrist back) and gripping.
Does tennis elbow ever get better?
The simple answer is yes. But, because tennis elbow involves the tendon and tendons have a relatively poor blood supply (compared to muscles for example), recovery can be slow.
The good news is tennis elbow generally improves over 6 months to one year. The bad news is approximately 10-20% last longer than one year, particularly if not treated correctly.
More good news…with the correct treatment we would expect significant improvement in your pain in 1-3 weeks. This will depend on your levels of pain and activity. We would expect complete resolution of symptoms from 6-12 weeks.
Start Treatment Today
Are you experiencing tennis elbow? Complete Physio can help. Get in touch with us today to begin your recovery.
You can also schedule an appointment right now, online (link to online booking), or email info@complete-physio.co.uk or call 020 7482 3875.
So why is your tennis elbow not getting better?
1. You have the wrong diagnosis? You do not have tennis elbow at all!?
Not all elbow pain on the outside of the elbow is tennis elbow. There are many other conditions that can mimic tennis elbow.
Having the correct diagnosis is key to ensuring you are following the correct treatment path. If your pain is not improving or getting worse with treatment, the first question you must ask yourself is do you have the right diagnosis or is it something else?
To gain an accurate diagnosis of tennis elbow requires an expert assessment. All of our physiotherapists at Complete Physio are highly specialised physiotherapists with extensive experience in the assessment and treatment of tennis elbow.
If we are ever unsure of your diagnosis, an ultrasound scan can be performed by one of our clinical specialists to confirm the diagnosis and assess the severity of the issue.
Diagnostic ultrasound is the best imaging option for the tendons on the outside of the elbow – better than MRI. If you would like to discuss whether an ultrasound scan is required for you, then please email info@complete-physio.co.uk or call 020 7482 3875 and one of our clinical specialists will contact you.
There are several conditions that mimic tennis elbow giving pain on the outside of the elbow. Other reasons for pain on the outside of the elbow are:
1/ Elbow joint osteoarthritis (“wear and tear arthritis”)
This is “wear and tear” of the elbow joint itself. It can be as a result of a previous injury or age-related changes. It is usually associated with pain and restricted movement of the elbow i.e., a stiff elbow when bending and straightening, particularly in the mornings.
2/ Nerve impingement (“pinching of a nerve’) at the elbow.
More specifically this is known as posterior interosseous nerve (PIN) entrapment. It can occur as a result of repetitive tasks. It can cause pain on the outside of the elbow and is often associated with weakness further down the arm into the fingers.
3/ Pain referred from the neck (called medically “cervical radiculopathy “).
Pain referred from the neck as a result of pressure on the nerve as it leaves the spine, this can give pain at the elbow joint and may be associated with weakness, numbness or pins and needles in the arm and hand.
4/ Distal biceps tendinopathy or tear.
The biceps tendon attached just past the elbow joint near the ‘tennis elbow’ tendons. However, the pain is located more in the middle and front of the elbow joint and is aggravated by bending the elbow e.g., a biceps curl in the gym picking a bag up off the floor.
A thorough assessment from one of our physiotherapists will be able to determine what is the cause of your pain.
2. You have rested too much!? Tendons do not want rest!
Complete rest is often not the answer for tendon complaints including tennis elbow. Tendons are like springs. If you rest a spring it gets less ‘springy’ and is not able to perform its function. Rest often reduces your pain but as soon as you return to the activities that were causing pain such as tennis, the pain just returns!
Previously the medical term for ‘tennis elbow’ was ‘lateral epicondylitis’ or ‘’tendonitis” with ‘itis’ meaning inflammation. The ‘itis’ has now been replaced by the term ‘tendinopathy.
It has been shown that ‘tennis elbow’ and many other tendon complaints such as ‘Achilles tendinitis’ do not involve acute inflammation and so do not require complete ‘rest’. Many tendon issues are as a result of tendon degeneration. Degeneration means it is more of a ‘chronic overload issue”. A degenerate tendon can become painful when overused.
This is the reason anti-inflammatory medication and rest often have very little or only a short-term effect on tendon pain. It is well known that tendons do not respond positively to rest. Avoiding the specific movements that aggravate the tendon are effective at reducing pain in the short term but too much rest will reduce the tolerance of the tendon to load/exercise, making it less able to deal with the demands of tennis.
At Complete, our physiotherapists are experts in the rehabilitation of tennis elbow and will be able to gauge when a tendon requires rest and modification of activity and when it is time to push on and progress the exercises and load on the tendon.
If you have Tennis Elbow and would like to see a specialist, call now or book online.
Start Treatment Today
Are you experiencing tennis elbow? Complete Physio can help. Get in touch with us today to begin your recovery.
You can also schedule an appointment right now, online (link to online booking), or email info@complete-physio.co.uk or call 020 7482 3875.
3. You have stretched the tendon but not strengthened it? You need to strengthen it!
As with rest, stretching is often prescribed for tendon complaints such as tennis elbow and can be beneficial in the short term by improving the flexibility of the muscle. But as with rest, this does nothing to improve the tolerance of the tendon to withstand load and force. In some cases, stretching will actually increase the compression of the tendon at the irritation point and worsen the pain.
Strengthening of the tendons need to be carried out slowly and progressively with significant weight. It is important to start at a suitable level and progressing appropriately to the level that tennis demands. This can be guided by one of our expert physiotherapists who have significant experience in treating tendon complaints and will prescribe you the best exercises to get you better as soon as possible.
4. Maybe you have not carried out your rehab exercises long enough? Tendons can take 3 months to get better!
If you have been steadily strengthening the elbow and moderating your activities and sports and still feel you are not making the progress you expect, sometimes a little bit more time is needed!
The changes within the tendon have probably been there for many years (even before the pain began).
Tendons are designed to function with relatively poor blood supply. This means healing takes quite long and many tendon complaints, including tennis elbow, can take three months to improve.
Rehabilitation requires a concerted effort of tendon rehabilitation alongside moderation of activities. It is not essential to be 100% pain free before returning to tennis, but it is important to keep the pain at a very low, manageable level. Our expert physiotherapists will be able to guide you through from the beginning tom the end of your rehabilitation.
5/ You have done all this, and it is still not better! What’s next!
If you have tried all the above and still feel you have reached plateau there are further options available – these include shockwave therapy, steroid injection, platelet rich plasma (PRP) and tendon fenestration.
Shockwave therapy is a non-invasive, safe treatment for tennis elbow pain. It requires 3 sessions to reduce your pain and stimulate a new healing response. Clinical trials have shown positive results for shockwave therapy in the management of many common tenso complaints including tennis elbow.
Steroid injectionscan be beneficial if there is long term, high levels of pain such as keeping you awake or being unable to carry out your work. It is only a short-term option and repeat steroid injections are not advised. Read here for more information about steroid injections.
Hyaluronic acid injections are an alternative to steroid injections. Hyaluronic acid is a naturally occurring substance with very few side effects. Hyaluronic acid injections can improve the mobility of the tendon on the surrounding structures. It can also have an anti- inflammatory effect on the tendon. Read more here.
PRP (platelet rich plasma) and shockwave are all pro-inflammatory treatments. As tendons have poor blood supply, the goal of these treatments is to’ kick start’ a new healing response in the tendon.
For more information click the links before:
Read Sonia’s story:
“I had had pain in my elbow for 6 months before I found Complete Physio. I had pained every time I picked up a cup of tea and it was even waking me up at night. I had seen an NHS physio but if anything, the pain was getting worse. The team taped my elbow which helped immediately with my pain, prescribed some simple exercises I could do whenever I wanted and carried out acupuncture and massage. Within 5 weeks I was pain free and I could not be happier! The team at Complete are the best and the treatment I received was exactly what I needed. Thankyou!
Sonia, 43 from Chelsea
Why choose Complete Physio?
If your experience of physiotherapy so far has been limited to being given 2-3 exercises to try at home that haven’t worked for you and you have not had any hands-on treatment, acupuncture, shockwave therapy or strengthening exercises, then contact us today and start your recovery!
At Complete Physio we provide a one stop clinic for tennis elbow and have vast experience of successfully treating tennis elbow pain, in fact it is one of the most common conditions we see at the clinic. We are experts in tennis elbow and have a variety of treatment options to get you out of pain and back to full function.
To make an appointment with one of our tennis elbow experts please call 020 7482 3875 or email info@complete-physio.co.uk.
Don’t let pain hold you back, book now!
