Sports injuries 5

Sports Physiotherapy

Sports injuries 7

Rehabilitation Specialists

Sports injuries 8

Physios to the Premier League

Sports injuries 6

International & Sunday Morning Footballers

Sports injuries 9

Rugby Injuries

Sports injuries 10

Tennis Elbow

Tennis Elbow

Lateral Epicondylitis is one of the most common overuse conditions of the upper limb, affecting up to 3% of the general population (Allander, 1974). It is often referred to as 'Tennis Elbow', so not surprisingly, playing tennis or other racquet sports can cause this condition.

In tennis players, male players are more often affected than female players (Whaley and Baker, 2004) and it is more likely to occur in people 40 years or older (Johnson et al, 2007). It has been estimated that 10% to 50% of people who regularly play these sports will develop this condition at some point during their lives (Nirschl, 1992).

Common tennis related injuries include the back, shoulder, wrist, hand and knees, often because people become de-conditioned over the winter months and return to sport too quickly without adequate training.


Patients with Tennis Elbow tend to present with pain over or just below the outside of the elbow joint, often radiating down the forearm. There is usually a history of repetitive movements, for example racquet sports (Whaley and Baker, 2004). One of the main causes of this problem is overuse of the forearm muscles and tendons, often resulting in reduced grip strength, pain and irritation of these tendons, which may not be strong enough to withstand these repetitive strains (Wilson and Best, 2005).

Research suggests that the contractions of the forearm and wrist muscles during backhand tennis swings, especially in novice players, are the likely reason for repetitive trauma that can cause small tears in the tendon resulting in Tennis Elbow (Riek et al, 1999). Other studies suggest that the tendons attaching to the outside of the elbow joint fail to heal fully due to poor blood supply and lack of nutrients to the area, especially post trauma resulting in long-standing problems that may not fully resolve (Schneeberger and Masquelet, 2002).

Physiotherapists, Osteopaths and Chiropractors are able to offer conservative treatment for this condition. The success rate of conservative treatment can be up to 90% (Whalley and Baker, 2004). Research suggests that Acupuncture may be beneficial for pain relief, as well as other manual therapy techniques including joint mobilisations and soft tissue work and prescription of braces to offload the tendon. In up to 5% of patients who have Tennis Elbow, radial nerve irritation may occur causing pain at the elbow, so this needs to be assessed as well (Gabel and Morrey, 1998).

Physical Therapists can also give advice on activity modification, and prescribe a specific exercise programme; this may include strength and functional training, stretching and correction of any biomechanical dysfunction including muscle imbalances. This in combination with manual therapy will hopefully aid recovery and enable return to sport as quickly as possible (Dlabach and Baker, 2001).

If needed, one of our Musculoskeletal Physicians or Extended Scope Practitioners can administer a local corticosteroid injection for Tennis Elbow. These injections have been suggested to reduce pain and improve grip strength (Assendelft et al, 2004 and Smidt, 2002), both important aspects which need to be addressed before returning to sport. This may then allow you to initiate or continue with appropriate treatment and rehabilitation with one of our Physical Therapists.

In recent years our Musculoskeletal and Sports Physicians have been using Autologous Blood injections (a small injection of blood taken from the patient) injected into the problem area. This relatively new treatment has been shown in trials to be effective and seems to produce a longer or more permanent benefit than steroid injection.

If you are experiencing symptoms similar to those described, then feel free to contact one of our Physical Therapists at the Blackberry Clinic. We will perform an individual assessment and devise a personalised treatment plan for you, promoting optimum recovery from your injury. Stretching and strengthening of both the upper back, shoulder and arm is important, as well as adopting the correct technique when playing tennis. So you may wish to book a few lessons with your local tennis coach!

If left untreated, Tennis Elbow can persist for an average of 6-24 months, and in some cases longer (Hudak et al, 1996). Symptoms may persist for over 1 year in up to 20% of people, thus becoming a chronic condition (Bisset et al, 2011). Therefore it may be best to address Tennis Elbow and to seek medical advice and/or treatment as quickly as possible, to ensure that you do not any cause further damage or irritation.

by Madeleine Nazareth, Physiotherapist