Tennis elbow (also known as lateral epicondylitis) is a common overuse injury causing pain into the outer (lateral) side of the elbow.

Although the name suggests the cause of this pain to be as a result of playing tennis, less than 5% of cases are as a result of this. More common causes include repetitive activities like computer use, heavy lifting and activities requiring repeated twisting at the wrist (common for electricians, carpenters and gardeners). These repetitive activities result in an excessive amount of strain through the tendons and muscles of the outer forearm. This overuse causes degenerative changes to occur at a cellular level in the tendon leading to a reduction in the tendon’s ability to tolerate load.

Common symptoms are tenderness over the bony prominence of the lateral elbow (lateral epicondyle), and pain that radiates up the arm or down the outside of the forearm. Individuals may also experience pain and reduced strength with activities such as lifting or carrying in the affected arm, and with gripping activities, for example, opening jars and opening doors. Pain may also be provoked with activities involving twisting at the wrist or positions where the palm is turned face down, such as using a screwdriver or typing at a computer.

A common indicator of tennis elbow is that, initially, pain will begin after the provoking activity, and then slowly progress to pain during the aggravating activity, to then having pain constantly (in the later stages of the injury) which will limit you from being able to complete other activities beside the initially aggravating one.

Physiotherapy treatment usually involves an initial focus on reducing pain and irritation with a combination of manual therapy techniques such as soft tissue massage, ultrasound and exercises to gently stretch the muscles of the forearm.

The focus of treatment in the management of tennis elbow is to reduce the excessive loading through the tendon and progressively rebuild the tendon’s tolerance to load. This is achieved through a graduated loading program which your physiotherapist will prescribe for you.

Use of a tennis elbow brace can sometimes be extremely effective in managing the load through the tendons of the lateral elbow, especially in individuals who are unable or have difficulty reducing aggravating activities. Our physiotherapists are experienced in fitting these and will advise you as to whether a brace would be beneficial, and if so, how and when to wear it.

Physiotherapy management for tennis elbow is successful in most cases. Certain cases that do not respond to initial treatment may require further investigation, and possibly medical intervention if it is indicated.

All our physiotherapists are skilled in the diagnosis and management of tennis elbow. Should you need some help in this area, don’t hesitate to contact either our Berwick or Pakenham Lakeside Physiotherapy clinic to book in your appointment.

ACHILLES PAIN STOPPING YOU EXERCISING? Started really increasing your running load during this time of COVID-19 shutdown, but have been plagued by an unusual pain in the back of your lower leg? You are not alone!…Click here to find out more…

As the world adjusts to this world of closed gyms and reduced access to equipment, many people are lacing up their runners and hitting the pavement. This is a great thing! I love running, and have a special interest in the management of runners’ injuries.

As this has increased, however, we have seen an increase of people in the clinic with classic runners-based injuries, such as anterior knee pain, and Achilles tendiopathy.

Your Achilles Tendon is the large, strong band of tissue that attaches the bottom of your calf muscle to your calcaneus (heel bone). It is critical in running, as it helps absorb force as we land, and then helps propel us forward as we go up onto our toes to move onto our next stride.

Achilles Tendinopathy, previously (and still commonly) known as Achilles Tendinitis, is a condition where the tendon suffers a failed healing response to load, and the collagen fibres which make up the majority of the tendon are disrupted [1]. This change in the makeup of the tendon can leave it more susceptible to pain and damage. It is not, as previously thought, a purely inflammatory condition.

The question is how to prevent it, and then treat it once it’s here? As someone who suffered from AT throughout my footballing career and had it occasionally pop back up since I started running, I can say the ability to correctly manage your load (the distance, intensity and time you run for) is paramount in correctly dealing with AT. Our physios are experts at developing and personalising loading programs, and can help you through this process.

Secondly, it is absolutely vital that anyone who is running has a resistance training program that compliments it. One of the primary clinical risk factors of developing AT is a lack of strength in our calves, which makes sense as it’s the muscle that the Achilles originates from! [2] This doesn’t mean pounding massive weights and complicated exercises! Effective resistance exercises for runners can be done easily with body weight or extremely minimal equipment, and we are expertly placed to help you with this. A structured strengthening program that progressively loads the tendon is an effective treatment strategy at both reducing pain and increasing function in individuals with AT [3].

Finally, as with any running injury, ensuring that you have correct footwear that is appropriate for your individual needs is critical. Poor foot mechanics can put forces on the tendon that it cannot handle easily, which can increase the likelihood of developing the condition.

So, if you plan on hitting the pavement again and unsure about how to go about it, or are experiencing some Achilles pain, come on down to our Berwick or Pakenham Lakeside clinics, and let us keep you enjoying your running pain-free!