Physico on tennis elbow. And you don’t get it just from playing tennis!

Tennis Elbow Pain in Weightlifters

Tennis elbow is a term we hear a lot regarding lateral elbow pain. Its medical term is lateral epicondylitis, also known as shooter’s elbow and archer’s elbow. It is a condition associated with pain over the outer (lateral) part of the elbow. The condition is common with racquet sports such as tennis and weight-training. It is considered as an overuse injury occurring over the common extensor tendon originates from the outer elbow i.e. lateral epicondyle. The true tennis elbow is characterised by inflammation of the tendon caused by e.g. gripping the dumbbell or the bar too hard and the weight is too heavy, hitting the ball with a back hand during tennis, which then progresses onto ‘degeneration’ of the tendon. The injured area has poor blood supply so healing rate is notoriously slow.

In the physio world, the condition is generally treated with eccentric loading exercise to strengthen the tendon, along the same line as treating the chronic Achilles tendinosis i.e. The Alfredson Protocol ( google this if you not familiar!)

The eccentric exercise goes like this:

– rest your forearm over the edge of the table with your wrist dangling at the edge, hold a 3-5 kg weight ( e.g. a full bottle of wine) in your hand and lift the bottle up with both hands and then lower it down with one. Target the eccentric phase which is when you lower the bottle at a much slower/controlled pace.

– Do this for 3 sets of 15 repetitions. Three times a day.

However, lateral elbow pain can also originate from the nerves in the neck region and radial nerve in the arm. This can happen with occupational workers involved in lots of typing and mouse/computer work. It can be caused by poor sitting posture and the pain will sometimes radiate down pass the lateral elbow into the thumb with numbness and tingling. The radial nerve can be irritated at the neck level and produce symptoms at the lateral elbow.

Treatment for this condition will involve correcting the whole seated pelvic posture all the way through to muscle tightness around the scapular. Weak postural muscles need to be addressed e.g. lower trapezius. Ergonomic factors also play an important part in eliminating the problem.

Lateral elbow pain frequently happens with weightlifters due to the fact that most weight lifting movements are done in position of full pronation ( i.e. palm facing down) or partial pronation of the forearm. Only two exercises use the forearm in full supination ( i.e. palm facing up) are straight arm curls and underhand grip chin ups. Therefore, the pronator teres muscle gets overworked and exhibits increased tone ( tight and spasmatic). The pain is initially felt on the inside of the forearm and imitates golfer’s elbow. With persistent training, the pronator muscle starts to draw the radius bone forward and upset/displace the radioulnar joint ( joint between the radius and the ulnar) and now pain is felt in the lateral elbow. It then influences the tissues that directly pass over it – the radial nerve and the wrist extensors.

Management of this condition involves managing the tight and hypertonic pronator muscle and correct the imbalance between the pronator and supinator strength ( the muscles that control the turning of the forearm). Regular stretches need to be performed and exercises that maintain the arm in full supination need to be encouraged. E.g.

– Replace seated row with seated row with hands in supination holding a straight bar

– Dumbbell bicep curls replaced by straight bar curls

– Chin ups with underhand grip

In PhysiCo, we are skilled in diagnosing these conditions and target the cause of the problem and give you the best possible treatment/exercise. Feel free to drop us a line.

Written by Ben Lee, sports physiotherapist at PhysiCo. Hyde Park Medical Centre, 175 Liverpool Street, Sydney. NSW 2000. Tel: (02) 9267 3775