As I shouted at my TV on Friday willing Heather Watson on at Wimbledon, it reminded me about the conundrum of Tennis Elbow.
Tennis Elbow is officially caused by inflammation of the tendons on the outside of your elbow and is also called lateral epicondylitis. It is classed as an overuse injury and occurs when you do repeated movements and it gets worse if you keep doing the activity that causes the pain. It usually happens on your dominant side. So it is easy to see why it happens in tennis players- as they grip the racquet and then use their arm the tendon that extends the wrist and elbow (called the common extensor tendon) gets inflamed causing pain, swelling and can even make a crunching noise called crepitus.
Tennis elbow often occurs in people who use hand tools for long periods for the same reasons, but why does it happen to people who do none of these activities? For many years Physiotherapists and some Doctors have noticed that Tennis Elbow is a common symptom in people who have neck problems and research in 2010 confirmed that pathology in the neck could cause pain in the area of the Tennis Elbow.
Out of 102 patients involved in the study, all had a confirmed diagnosis of cervical radiculopathy ( damage to a nerve as it exits the neck). Two-thirds also had tennis elbow. The tip-off that it was linked with the cervical radiculopathy (neck) was the fact that the symptoms of elbow pain, weakness, numbness and tingling were present in both arms. MRIs confirmed pathology in the cervical spine (neck). EMGs and nerve conduction studies ruled out local nerve trapping at the elbow.
Interestingly that same spot along the outside of the elbow is where pain can be referred when pressure is placed on the C6/7 nerve root. The C6/7 nerve root leaves the spinal cord in the lower cervical spine and travels from the neck down the arm. When this nerve gets pinched or compressed, neck and arm pain can develop with pain travelling down to the elbow and below.
Diagnosing this for a patient is important because the treatment differs from trauma-induced (overuse) tennis elbow and cervical radiculopathy. Instead of just treating painful elbow symptoms locally (at the elbow), treatment is directed toward the neck as well and unnecessary surgery can even be avoided.
So if you know someone with bilateral tennis elbow, or elbow pain and neck stiffness or discomfort, encourage them to ask for a referral to a Physiotherapist who will assess both their neck and shoulder to make sure that they get the treatment they need! The great news is that Tennis Elbow, whether coming from the neck or the elbow, usually responds well to treatment.
If you want to know more, or if you want to be assessed for this condition or any other pain affecting a muscle, joint or nerve remember that you can book an appointment direct with our Physiotherapists at Physio & Therapies in Todmorden on 01706 819464.