The so-called tennis elbow (medical term: epicondylitis lateralis humeri) is a painful irritation of the tendon insertions on the outer elbow. Despite the name, the condition does not only affect tennis players – many patients have never held a racket in their hand. It is particularly common in people who regularly perform monotonous hand or arm movements – whether at work, at home or during sport.
But: it doesn’t just affect tennis players
Causes of tennis elbow
The most common cause is overloading of the forearm muscles, which causes the tendon insertions on the elbow to become irritated or even microscopically injured. Typical triggers are
* Repetitive gripping movements (e.g. when typing, screwing, lifting)
* Sports with frequent arm swings
* Working with vibrating tools
* A lack of ergonomics at the workplace
Typical symptoms
* Pain on the outside of the elbow
* Increased pain when lifting or turning the forearm (e.g. when opening a bottle)
* Pressure pain at the elbow
* Sometimes the pain radiates into the forearm
Diagnosis
The diagnosis is usually made through a physical examination. Your doctor will apply targeted pressure and test certain movements. Imaging procedures (e.g. ultrasound, MRI) are only necessary in cases of unclear or protracted progression.
Treatment options
The good news: in most cases, tennis elbow heals conservatively – i.e. without surgery. The most important treatment measures are
Protection & activity adjustment
Avoidance of the triggering stresses
Pauses during repeated movements
Ergonomic adjustments to the workplace
Physiotherapy (stretching exercises and targeted muscle building (eccentric training); manual therapy to relax the muscles; taping or bandages to relieve strain)
Drug therapy
Painkillers or anti-inflammatory medication (e.g. ibuprofen)
Local ointments or injections if required
Shock wave therapy (use of high-energy sound waves to stimulate healing)
This is also an option, especially in chronic cases:
Injections (cortisone*, hyaluronic acid or autologous blood. * Caution: Cortisone can help in the short term, but can weaken the tendon if used frequently).
Surgery (only in exceptional cases, if all conservative measures have been unsuccessful for several months. The aim is to remove degenerative tissue)
What can I do myself?
* Avoid heavy exertion for the time being, but keep moving.
* Do regular stretching exercises for the forearm muscles.
* Cool for acute pain.
* Use a bandage or tape to relieve the strain – especially during physical work.
* Get guidance on how to train your forearm muscles to make them more resistant.
Conclusion
Tennis elbow is unpleasant, but can usually be treated well. It is important to adjust the strain, be patient and seek therapeutic support if necessary. Early treatment can help to prevent chronic complaints.
If you suffer from pain in your elbow, contact us and/or speak to your doctor – the sooner therapy begins, the sooner you can return to pain-free movement.
The Functional Movement Screen (FMS) is a screening tool used in the field of sports medicine and physiotherapy to assess a person’s movement patterns and identify possible imbalances or limitations. It is designed to capture basic movement patterns that are essential for normal daily activities as well as athletic performance.
The FMS consists of a series of seven basic movement tests that assess mobility, stability and symmetry of movement. These tests are:
Deep squat: Assesses bilateral mobility and stability of the hips, knees and ankles as well as core stability.
Hurdle step: Evaluates the bilateral mobility and stability of the hips, knees and ankles during a step movement.
Inline Lunge: Assesses the unilateral mobility and stability of the hips, knees and ankles as well as trunk stability.
Shoulder mobility: Assesses the bilateral mobility and stability of the shoulders and thoracic spine.
Active Straight Leg Raise: Evaluates the mobility of the thigh muscles and hips while maintaining core stability.
Trunk Stability Push-Up: Evaluates trunk stability and upper body strength.
Rotational stability: Evaluates the multiplanar stability and mobility of the trunk and shoulders.
Each test is scored on a scale of 0 to 3, with 3 indicating optimal movement and 0 indicating pain or inability to perform the movement. The results of the individual tests are then combined to give an overall FMS score.
The main purpose of the Functional Movement Screen is to identify movement disorders or imbalances that could increase the risk of injury or impair performance.
It helps professionals such as physiotherapists, athletic trainers and strength and conditioning specialists to develop appropriate training programs and corrective strategies tailored to an individual’s specific needs.
It is worth noting that the FMS is not a diagnostic tool, but a screening tool.
If problems or limitations are identified during the screening, further assessment and evaluation may be required to determine the underlying causes and develop an appropriate treatment plan. We will be happy to refer you if additional medical intervention is required.
Anneke was invited to the winter meeting of the GOTS (Gesellschaft für Orthopädisch-Traumatologische-Sportmedizin) and gave a presentation on physiotherapy treatment options following cartilage surgery. The audience consisted of specialists from various disciplines throughout Switzerland. More information about the event here: GOTS – Society for Orthopaedic-Traumatologic Sports Medicine (gots-schweiz.ch)
Cartilage
Cartilage is a form of connective tissue that is highly resistant to tearing and elastic under pressure. There are three different types of cartilage in our body: hyaline cartilage, elastic cartilage and fibrocartilage. In this article, we are referring to hyaline cartilage, which is found in our joints. It does not contain any vessels of its own, i.e. no blood vessels, lymph vessels or nerves. If it is not supplied with blood, it therefore has no healing potential of its own after an injury. Due to the lack of nerves, the pain we feel does not come from the cartilage but from neighboring, possibly inflamed tissue. Cartilage is nourished by the surrounding synovial fluid and cartilage membrane, which is formed, among other things, through adequate movement, which we supply from the outside. In a joint, the cartilage serves as a support and shock absorber between the bones and joint surfaces.
Treatment – surgery?
Cartilage can be damaged as a result of trauma, for example impact trauma (fall) or twisting, or can also develop as a result of prolonged incorrect or excessive strain. Accompanying injuries can occur, for example a rupture of the cruciate ligament or meniscus in the knee joint. The indication for surgical or conservative treatment of cartilage injuries is discussed with the treating doctor. Many factors must be taken into account: Age, concomitant injuries, location of the cartilage injury, size of the lesion, requirement profile and goals of the injured person, and many more.
Aftercare – Physiotherapy
If the cartilage injury required surgery, direct physiotherapy treatment is essential. A physiotherapist will find out which surgical method was used, which part of the joint and cartilage was affected and which restrictions are recommended by the doctor for the initial period. It can be helpful if these documents are brought to the first physiotherapy appointment.
It may be that the knee joint cannot yet be flexed to its full extent, which is why a splint limits this. You are often given sticks and are not allowed to walk fully for the first few weeks. All these measures can take 2-6 weeks, depending on the operation. We distinguish between three phases in the follow-up treatment:
The first phase, the protection phase, lasts from week 1-6,
the second, functional and active phase, weeks 6-12,
The final phase can last up to over a year and includes the return to sport until the previous performance level has been reached.
Phase 1
The aims of the first phase are to promote wound healing and slightly activate the muscles and joint. The operated area is often swollen and painful at the beginning. As only partial weight-bearing on sticks is permitted at the beginning, physiotherapy checks that the foot is being rolled correctly. A splint is often worn which, depending on the operation, restricts movement so as not to interfere with healing. Early mobilization of the joint, flexion and extension of the knee are very important from day 1 of the operation. The muscles can also be activated without strain and trained as the operation progresses. Less is still more in this phase, but increasing weight-bearing will soon become very important.
Phase 2
The aim of the second phase is to restore full mobility to the joint and enable full weight-bearing without sticks and braces. During the second phase, the difference in strength between the sides (left and right leg) should be as small as possible, which must be achieved through various exercises. The physiotherapist should check the exercises as often as possible, as much as necessary, and instruct constant adjustments. The focus should already be on the patient’s requirements in everyday life, at work and during sport, so that the right choice of exercises is made. It can help to record the exercises with a video so that the patient can see any possible incorrect strain, but also to be able to watch the correct execution again and again at home. Training is becoming increasingly complex and functional and should include the components of strength, coordination, balance, leg axis stability, speed and flexibility .
Phase 3
For many patients, returning to sport and their previous level of performance is the most important long-term goal of the entire rehabilitation process. Both are also possible after cartilage surgery, but can take up to 18 months, or even less than a year depending on the operation. In this case, treatment is always individualized and agreed upon in consultation with the operating doctor, trainer, nutritional therapist, sports psychologist and others. Questionnaires, strength tests and functional test batteries (e.g. the Orthelligent Pro) should help to decide whether the operated leg and the patient are ready to return to sport and later complete the therapy.
Summary and guidance
Physiotherapeutic follow-up treatment following cartilage surgery is important. It may be possible to attend a few physiotherapy sessions before the operation in order to receive important instructions on gait, mobilization and muscle activation and to keep pain and signs of inflammation at an appropriate level. The treatment should be individualized and constantly adapted as the procedure progresses.
Author:
Anneke Penny
Book your appointment for physiotherapy, massage or group courses: here.
References:
1st Anvil 2021
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