Do you have ongoing tennis elbow issues? Do you reduce your activity to settle it? Do you strap it or wear a brace? Or do you have repeatead cortisone injections? It sounds like you're not really getting to the bottom of the issue.

Lateral epicondylitis, commonly known as tennis elbow, is a condition characterised by pain and inflammation in the tendons that attach to the bony prominence on the outer side of the elbow called the lateral epicondyle. Despite its name, tennis elbow is not limited to tennis players and can affect anyone who repeatedly performs gripping or wrist extension activities.

The primary cause of lateral epicondylitis is repetitive stress or overuse of the forearm muscles and tendons. This can occur from activities such as tennis, golf, painting, typing, or any other repetitive motion involving the wrist and forearm. The repeated stress causes micro-tears in the tendons, leading to inflammation, pain, and difficulty with gripping or lifting objects.

Symptoms of lateral epicondylitis include:

1. Pain and tenderness on the outer side of the elbow, which may radiate down the forearm.
2. Weak grip strength and difficulty in holding objects.
3. Pain worsens with activities that involve wrist movement or gripping.
4. Stiffness and limited range of motion in the elbow.

The diagnosis of lateral epicondylitis is usually made based on a physical examination and a discussion of the individual's symptoms and activities. Imaging tests like X-rays or MRI scans are generally not necessary unless there is suspicion of an alternative diagnosis or if conservative treatment fails.

Treatment for lateral epicondylitis typically involves biomechanical optimisation of the arm and shoulder girdle in the form of joint centration.

Joint centration plays a key role in managing lateral epicondylitis by promoting optimal alignment, stability, and load distribution within the affected joint, which can help alleviate symptoms and support the healing process.

To understand the significance of joint centration, let's consider an analogy: a car's wheel alignment. Imagine a car with misaligned wheels. When driving, the tires experience uneven wear, and the vehicle tends to pull to one side. Over time, this misalignment can lead to excessive strain on certain parts of the tires and suspension, causing discomfort and potential damage.

Similarly, in lateral epicondylitis, the misalignment or lack of joint centration in the elbow joint can result in abnormal stresses on the tendons attaching to the lateral epicondyle. This can lead to micro-tears, inflammation, and pain in the tendons, characteristic of lateral epicondylitis.

By retraining joint centration, the aim is to restore proper alignment and stability within the elbow joint. This involves addressing muscle imbalances, optimizing proprioception (awareness of joint position), and improving neuromuscular control.

Just as aligning the wheels of a car promotes even wear and optimal performance, optimising joint centration in the elbow helps distribute forces more evenly across the tendons, reducing strain and allowing for more efficient load transmission. This, in turn, reduces the risk of excessive stress on the affected tendons and facilitates the healing process.

Joint centration retraining may involve various interventions, including manual therapy techniques, therapeutic exercises, and modalities to restore alignment, improve stability, and enhance neuromuscular control. These interventions help ensure that the joint surfaces are congruent, the surrounding muscles provide balanced support, and the forces generated during activities are appropriately distributed throughout the elbow joint.

Treatment of Tennis Elbow via activity reduction and strengthening alone may bring about a decrease in symptoms. However, if we don't address the underlying cause of why the inflammation has occurred or correct the biomechanics of the arm through common movement patterns, you may find the Tennis Elbow becomes reoccurring and never truly goes away.

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