Tennis Elbow - diagnosis is critical

Tennis Elbow – True or False

Tennis Elbow aka epicondylitis or epicondylagia is when the tendons (stringy bits that attach muscles to bones) on the outside of the elbow become damaged and irritated, usually caused by overuse.

This translates to pain on the outside of the elbow because you have been doing a particular action repeatedly, common in tennis players but also seen in plasterers, painters, and anyone who’s job or hobby includes a repetitive action (no smirking at the back!).

What can help?

  1. Gentle movement and manual therapy – in this case prolonged rest won’t help as scar tissue could form (making a bad situation worse!), in fact with tennis elbow the motto is “rest and rust”. So while you might not be playing tennis don’t stop moving the elbow completely.
  2. Magnetic Resonance Therapy – repairs and strengthens the tendons as well as reducing the painful bone swelling

Try to avoid braces which restrict movement and can restrict blood supply. Cortisone injections which “rot” the already damaged tendons further are also not recommended. The latest craze is “Shockwave” therapy, while this can help in very specific cases, in the vast majority it is a little like treatment with a jackhammer and doesn’t get the results I would expect.

Anti-inflammatory tablets can help with the initial discomfort but also allow you to move more and potentially do more damage, so use carefully.

BUT what if it’s NOT Tennis Elbow?

There are other things that can cause pain in the outer elbow which AREN’T Tennis Elbow.

Neck problems – the squishy discs in your neck and spine allow the nerves to leave the spinal column. If these discs are compromised the nerves get inflamed and then they aren’t very good at sending and receiving messages. So those messages get confused. So if the nerve for your outer elbow is compromised at the neck, the only message your brain receives is “pain in outer elbow”, because the nerve isn’t working properly. But because the problem isn’t IN the outer elbow, treating it will never make it any better! This phenomenon is called referred pain and happens all over the body.

Shoulder injuries – again shoulders can refer pain down the arm to the elbow because . . . they are attached! So dysfunction in the shoulder can cause nerve or muscle compromise which results in elbow pain.

Injuries to the other arm/shoulder/elbow – if you injure your left arm then you will automatically do more with your right arm. This is great because it gives your left arm time to heal. But what happens when you continue to do all that extra work with the right arm because the left arm isn’t getting better? You get pain in the right arm. But no matter what you do to the right arm it isn’t going to get better because . . . . the left arm is the problem.


So while you might be receiving excellent Tennis Elbow treatment, if you don’t actually have Tennis Elbow it’s not going to be making much difference.

This is a key fact to remember for any treatment – if you aren’t making progress (even small progress) after 6 – 8 treatments then, perhaps, you aren’t treating the actual problem. You can treat the symptoms forever but if you don’t address the true cause then you will be treating them forever. And in my opinion that is a waste of your time and money.

The best advice for resolving Tennis Elbow is to get a good, accurate diagnosis. Make sure that your practitioner assesses not just your elbow but also examines your shoulders (both sides!) and neck function to rule out referred pain. Make sure they also take a full and detailed history of every fall, injury, accident and operation, some of the oddest things can cause pain and problems if they are left undealt with.


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