Elbow pain certainly is a common reason someone may present into the clinic. Usually the pain has been on-going for many weeks if not months, with the onset of pain being gradual in nature. Due to the gradual onset of symptoms, this typically leads us to believe the injury may be due to the tendinous structures which originate at the elbow. Most commonly the tendon injuries that affect the elbow are lateral epicondylalgia (tennis elbow) & medial epicondylalgia (golfer’s elbow). Additionally, a triceps olecranon tendinopathy is also possible. These tendon injuries are due to overload, where the load placed on the tendons exceeds the tendons capacity.

Although colloquially known as ‘tennis elbow’ and ‘golfer’s elbow’, these injuries are prevalent in occupational workers such as manual labourers and even those desk bound. The symptoms of these injuries are usually quite localised to the elbow and sometimes refer down the forearm muscles. These injuries typically are due to an overload with repetitive wrist movements. For this reason, structured exercise rehabilitation focusing on improving load capacity through the tendons is essential for pain relief and management. The elbow joint like the knee joint can be thought of as a bridge between their adjacent joints. With this in mind it is essential that rehabilitation works on the wrist/hand and shoulder complex. Research has shown how these tendinopathies can result in the function of the entire upper limb being affected.

Lateral epicondylalgia (tennis elbow) has a prevalence of 1-3% of the population. It is also 3-6 times more common then medial epicondylalgia (golfer’s elbow). It is possible to have both tennis and golfer’s elbow at the same time, with a prevalence of 1.2%. Tennis elbow certainly is a burden to the adult population. For individuals who suffer with tennis elbow, 5% will take sick leave. The median time taken off work is 29 days per annum! Tennis elbow like most tendinopathy injuries have a lengthy prognosis. With the duration ranging from 6 to 48 months.

Risk Factors

• Manual workers performing repetitive tasks - Especially those involving repetitive movements of the hand/wrist and gripping

• Smoking (current or previous)

• High BMI

• Poorly managed diabetes

• Medications - Statins and Fluoroquinolones
  

Steroid Injections (corticosteroids)

Steroid injections are certainly not recommended for lateral or medial elbow tendinopathies! Steroid injections are basically a band-aid solution, research for many areas of the body show they are only effective for a very short duration (typically 4-8 weeks). For lateral epicondylalgia in particular, these injections after a period of 12 months increase the chance of recurrence by 10-fold! Furthermore, they lower the chances of treatment success by 5-fold! They are no better then placebo is what the research tells us.

As can be seen, these injuries are common and need appropriate management. At The Reform Lab Osteopathy, we will examine you and prescribe a relevant rehabilitation program in the elite gym Project Reform.