More power to your elbow!

Elbow pain is usually fairly straight forward, either occurring on the medial side or the lateral side. Unfortunately, that’s where the simplicity ends. Lateral epicondylitis (LE), also known as tennis elbow, is a chronic condition that plagues racquet sport athletes, archers, and shooters. Today’s feature article, by physiotherapist Trevor Langford, explores the diagnosis and rehabilitation of LE.

The muscles in the forearm that cause pain at the elbow are the extensor carpi radialis brevis (ECRB), and sometimes the extensor carpi radialis longus (ECRL) (see figure 1). Single-handed backhand shots are usually to blame for irritating these muscles. Without additional support from the other hand, the tendons become overloaded. Coaching and teaching proper technique are important in the prevention of this syndrome.

Selecting the proper equipment also protects an athlete from over-loading the tendons. Langford reviews how to select the appropriate racquet grip size. A grip that is neither too big nor too small allows the athlete to better control wrist flexion at the point of contact with the ball.

Figure 1: Extensor mechanism of the lateral elbow

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Diagnoses and treatment

Many tests exist to determine the cause of lateral elbow pain. Langford presents three and reports on the specificity and sensitivity of each. We’ve extensively covered tendinopathy in recent articles, and the treatment of LE follows the same protocol of eccentric exercise and slow, heavy resisted movement. Begin exercise therapy once LE is confirmed. Supporting this approach, a Swedish study found tendon loading, via eccentric exercise, resulted in significant pain relief in subjects with LE¹.

Other therapies often tried with LE include injection therapy, bracing, and taping. Researchers in Ontario reviewed the literature concerning the effectiveness of injection therapy on LE². Concerning treatment using needle tenotomy, autologous whole blood, and platelet rich plasma, the studies contained bias and design flaws. The research also failed to support treatment of LE with corticosteroid injections.

Elbowing in one more study

Kinesio taping has gotten a lot of negative press lately because science hasn’t supported the hype and claims of its manufacturers. Some practitioners aren’t ready to throw in the towel yet, including several at Taipei Medical University. They conducted a randomized, double-blinded, crossover study to test its effectiveness in relieving acute pain in LE³. They found that both the sham and Kinesio tape resulted in pain relief at rest and improved pain-free grip strength. However, the Kinesio tape did provide significantly better pain relieve on resisted wrist extension.

This study, while well designed, consisted of only 15 elbows. Additionally, there was enough evidence of the placebo effect in the parameters measured, that the significant difference should be viewed with skepticism. For the time being, the best approach to treating LE continues to be exercise.

Figure 2: Kinesio tape (a) and sham tape (b) in randomized double-blinded, crossover study (3). Used with permission.

Figure 3: Study design for Kinesio versus sham taping study (3). Used with permission.

References

1. Scand J Med Sci Sports, 2012, 22, 797 – 803
2. J Clin Rheumatol.2018 Aug 3 [Epub ahead of print]
3. BMC Musculoskeletal Dis. 2018;19:193