Elbow physiotherapy assessment will typically focus on a few key factors to determine whether the injury is due to Tennis Elbow. Tennis Elbow is a tendon issue, however there are other structures that may cause elbow pain. Although it is a very common injury that we see in elbow physio, it is always important to accurately diagnose the problem to ensure physiotherapy for elbow pain will be effective. Here are the typical tennis elbow symptoms:
1. The pain is always at the outside of the elbow, and can refer down the forearm. It is usually easy to find by pressing on it and can be sharp
2. The pain doesn’t tolerate repetitive or prolonged lifting very well. Activities which are repetitive which require the arm to be in an outstretched position will be typically worse. Many patients report difficulty holding a cup of coffee, holding a pot or saucepan in the air while cooking, lifting weights at the gym and playing racquet sports
3. The pain is typically worse when you wake up, after a period of rest (sitting at the computer for example). This is the usual behaviour of tendon-related issues, which ultimately is the source of pain with tennis elbow
4. Reduced grip strength and general weakness carrying things. Many patients report difficulty holding or gripping objects
5. Pain usually comes on gradually, without there being a single event which caused the injury like for a sprained ankle
6. Recent sudden increase in load. Tendon-related issues such as tennis elbow will usually (but not always) have a recent history of a sudden demand in use. A common example of this is using gardening tools doing a hard full day’s worth of gardening, when it has been many months since using those tools and performing those actions.
Tennis Elbow treatment
Physiotherapy for elbow pain, including tennis elbow, includes 2 aspects:
Treatment to help settle pain
Strengthening to improve physical function
Physiotherapy treatment for Tennis Elbow may involve strategies such as short-term load management. This may involve ensuring the arm is supported as much as possible during daily tasks, and performing less of certain activities if possible. Using a tennis elbow brace temporarily for physical tasks can be particularly useful when needing to perform physical activity that can’t be avoided, especially physical work duties. For some patients, dry needling can be effective in settling the pain and shockwave therapy can be effective in helping healing by promoting tendon cell regeneration.
With elbow physio, strengthening of the tendon will be essential to regain full function again with holding and gripping objects. Tennis elbow exercises can involve using dumbbells, theraband, special resistance bars made for tennis elbow strengthening.
Tennis Elbow strengthening
Recommended rep range
The best rep range for strength gains is 5-6 reps and lower. This means that the best way to get stronger is to pick a load or weight at which failure is achieved with no more than 5 or 6 reps. However with Tennis Elbow physiotherapy management, the tendon may be too painful if performing this exercise with too much weight. In this case, we recommend a rep range of between 8-12, which is still effective for improving strength but with a slightly lighter weight to reduce the chances of flaring up the elbow pain.
Tempo (how fast)
For tendon strength in Tennis Elbow, each rep should be relatively slow and controlled, and go for at least 2 seconds on the way up, and at least 2 seconds on the way down.
Frequency (how often)
This depends on the pain response (if any) with the exercise, whether it has been recommended to achieve failure in each set, and whether there is DOMS (Delayed Onset Muscle Soreness) after doing the exercise. Generally speaking, 3-4 times per week is a good frequency for strengthening in physiotherapy for elbow pain due to tennis elbow.
“Safe” pain during Tennis elbow strengthening
Naturally, exercise rehabilitation of an injured part of the body may occasionally be painful. Pain in the range of 1-3/10 is generally acceptable with physiotherapy rehabilitation of tennis elbow, and will not cause further injury.
Golfer’s elbow treatment and symptoms
Elbow physiotherapy assessment for Golfer’s Elbow is similar to Tennis Elbow, however attention is paid to a different tendon in the elbow. Pain with Golfer’s elbow will be similar in behaviour to Tennis Elbow, except that the pain location is different (see picture below)
Physiotherapy for elbow pain caused by Golfer’s Elbow is similar to Tennis Elbow except the exercises will be different, as the affected tendon in Golfer’s Elbow is different to the affected tendon in Tennis Elbow.
Elbow ligament treatment, symptoms and causes
There are multiple strong ligaments that keep the elbow stable, however during sport excessive stress can be placed upon the ligaments and cause injury. Football (Aussie rules), rugby and weightlifting are common sports for elbow ligament injuries.
The main ligaments are the medial collateral ligament (MCL), lateral collateral ligament (LCL) and annular ligament (AL). Together, these ligaments protect the elbow from forces coming from different directions.
Initial physiotherapy for elbow pain due to a ligament injury focuses on using an elbow brace to protect the injured ligament and improving the range of motion of bending and straightening the elbow. The amount of time needed using the elbow brace depends on the severity of the ligament injury.
Once full elbow movement is achieved, strengthening may begin as long as the pain is acceptably mild. In some cases, clearance from a sports doctor is needed before strengthening is commenced.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!