What is tennis elbow anyway?
Sachin Tendulkar's much-publicised tennis-elbow injury has contributed to a downturn in the India's fortunes, and his continued absence will be a major blow in their bid to overturn Australia on home soil
Nagraj Gollapudi
19-Jul-2005
Sachin Tendulkar's much-publicised tennis-elbow injury has contributed to a downturn in the India's fortunes, and his continued absence will be a major blow in their bid to overturn Australia on home soil. But what is tennis elbow anyway? Nagraj Gollapudi spoke to an expert in the field, Dr Liisa Laakso, a physiotherapist at Griffith University in Queensland
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What is a tennis elbow?
Tennis elbow is a common term used for overuse or misuse injuries to the lateral (outside) elbow. Technically it's called lateral epicondylalgia (lateral elbow pain). Sometimes it occurs due to acute traumatic injury. Local bone and muscle structures are usually involved but the problem can also be attributed to referral of pain by nerves from anatomical structures in the neck (cervical spine). Tennis elbow has a prevalence rate of 3% in the general population, and 15% in high-risk groups. It is said to account for approximately 7 per 1000 patient visits to general medical practitioners.
Tennis elbow is a common term used for overuse or misuse injuries to the lateral (outside) elbow. Technically it's called lateral epicondylalgia (lateral elbow pain). Sometimes it occurs due to acute traumatic injury. Local bone and muscle structures are usually involved but the problem can also be attributed to referral of pain by nerves from anatomical structures in the neck (cervical spine). Tennis elbow has a prevalence rate of 3% in the general population, and 15% in high-risk groups. It is said to account for approximately 7 per 1000 patient visits to general medical practitioners.
What are the symptoms and how is it caused?
Typically the condition is seen in people who are required to do repetitive gripping activities, such as tennis players, carpenters, gardeners, abattoir workers and the like. The condition is characterised by tenderness or pain at the lateral epicondyle (the bone on the outside of the elbow where the extensor muscles of the outside of the forearm attach to the part of the bone called the epicondyle), and pain and weakness with gripping activities. The cause of the condition is not fully understood.
Typically the condition is seen in people who are required to do repetitive gripping activities, such as tennis players, carpenters, gardeners, abattoir workers and the like. The condition is characterised by tenderness or pain at the lateral epicondyle (the bone on the outside of the elbow where the extensor muscles of the outside of the forearm attach to the part of the bone called the epicondyle), and pain and weakness with gripping activities. The cause of the condition is not fully understood.
Does the remedy depend on the speed with which the injury is detected?
As with any injury, the earlier it is diagnosed and managed, the better the outcome is likely to be.
As with any injury, the earlier it is diagnosed and managed, the better the outcome is likely to be.
Can it end a career?
Overuse injuries, if severe enough and not managed appropriately, have been known to end the careers of musicians.
Overuse injuries, if severe enough and not managed appropriately, have been known to end the careers of musicians.
Is the elbow affected by the equipment a player uses?
It appears that the amount of force required to grip a small object (compared to a larger object that fits comfortably in to the hand) over sustained periods or with repetitive activity may contribute to the condition. There is some (largely anecdotal) evidence to suggest that the width of the equipment handle may affect the biomechanical pull of the forearm extensor muscles on the lateral epicondyle at the elbow. In the case of a cricket bat, increasing the circumferential size of the bat handle can be achieved simply by adding more layers of grip to the handle.
It appears that the amount of force required to grip a small object (compared to a larger object that fits comfortably in to the hand) over sustained periods or with repetitive activity may contribute to the condition. There is some (largely anecdotal) evidence to suggest that the width of the equipment handle may affect the biomechanical pull of the forearm extensor muscles on the lateral epicondyle at the elbow. In the case of a cricket bat, increasing the circumferential size of the bat handle can be achieved simply by adding more layers of grip to the handle.
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Could there be any other reason for the cause of the injury?
It appears to occur more frequently in batsmen who are caught in a "cycle of pressure", either through a personal loss of form, or through the need to fend off a high-class bowling attack. A classic example of an "opener-under-pressure" was the Australian batsman Geoff Marsh, who was noted to wear a tennis-elbow strap regularly.
It appears to occur more frequently in batsmen who are caught in a "cycle of pressure", either through a personal loss of form, or through the need to fend off a high-class bowling attack. A classic example of an "opener-under-pressure" was the Australian batsman Geoff Marsh, who was noted to wear a tennis-elbow strap regularly.
Tennis elbow in batsmen most often affects the elbow of the top hand. When the batsman is under pressure for whatever reason, he or she may be advised by the coach, or may naturally start to grip the bat handle more firmly than usual in order to control better the placement of their shots. The key for players addressing a form slump or who want to set themselves to play a long innings is to spend more time playing straight, ie, "in the arc" through mid-on to mid-off.
Players become more circumspect about letting balls go outside off-stump and avoiding cross-bat shots - similar to Sachin Tendulkar's strategy in Australia last summer. By changing the emphasis on how the batsman might ordinarily play, and the amount of force required to grip with the top hand, such a strategy results in a change in the biomechanical load placed on the forearm extensor muscles. The extra load is transmitted to the lateral epicondyle, putting in to place the conditions that can result in tennis elbow.
What are the types of remedies?
Many treatments have been advocated for the condition, but none has been found to be completely effective on its own. Usually a number of treatment strategies are employed to address the problem depending on its initiating factors. For example, if the condition is identified early, the remedy is a combination of modified rest/activity and appropriate strengthening exercises and stretches, anti-inflammatory strategies, and identification of the initiating biomechanical factors.
Many treatments have been advocated for the condition, but none has been found to be completely effective on its own. Usually a number of treatment strategies are employed to address the problem depending on its initiating factors. For example, if the condition is identified early, the remedy is a combination of modified rest/activity and appropriate strengthening exercises and stretches, anti-inflammatory strategies, and identification of the initiating biomechanical factors.
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Other treatment strategies that have been used include elbow bands and splints, acupuncture, ultrasound, laser, shock-wave therapy, deep massage, alterations in sporting technique and combinations of the above therapies. In recent times, special joint-manipulation techniques (called "mobilisation with movement") have been noted to have good results. Pharmacological agents are often prescribed and occasionally steroid injections are used. Surgery is not usually advocated.
How long can the recovery period take?
Recovery may take weeks to years depending on the initiating factors, how effective the management strategy has been and whether the individual continues to use a technique that places continuing strain on the anatomical structures at the lateral elbow.
Recovery may take weeks to years depending on the initiating factors, how effective the management strategy has been and whether the individual continues to use a technique that places continuing strain on the anatomical structures at the lateral elbow.
We have read about shock therapy. What exactly is it and are there any similar kind of treatments?
Extracorporeal shock wave therapy (ESWT) is the external application of single pulsed acoustic (sound) waves. It is a treatment that originated from a method used to treat kidney stones where shockwaves are used to break down calcium deposits. There have been reports that ESWT may be of benefit in the treatment of tendon disorders and it has been used for lateral elbow pain where calcium deposits may have been causing the pain.
Extracorporeal shock wave therapy (ESWT) is the external application of single pulsed acoustic (sound) waves. It is a treatment that originated from a method used to treat kidney stones where shockwaves are used to break down calcium deposits. There have been reports that ESWT may be of benefit in the treatment of tendon disorders and it has been used for lateral elbow pain where calcium deposits may have been causing the pain.
It is a form of therapy used extensively in Europe and the USA. A systematic review of the results of studies that have investigated the effect of ESWT for lateral elbow pain has demonstrated conflicting results to date. More research is needed in this field.
Liisa Laakso is a lecturer at the School of Physiotherapy and Exercise Science at Griffith University (Gold Coast, Australia). She has been a practising physiotherapist for more than 20 years.
Nagraj Gollapudi is sub-editor of Wisden Asia Cricket