Understanding Epicondyle Tendinitis: Causes and Eccentric Loading for Recovery

Epicondyle tendinitis, commonly known as “tennis elbow” (lateral epicondylitis) or “golfer’s elbow” (medial epicondylitis), is a condition characterized by inflammation and degeneration of the tendons that attach to the bony prominences on the outer or inner elbow. While this condition is frequently associated with athletes, it can affect anyone who engages in repetitive wrist and forearm movements, such as typing, painting, or heavy lifting.

What Causes Epicondyle Tendinitis?

Epicondyle tendinitis occurs when repetitive stress causes microtears in the tendons surrounding the elbow joint. These microtears lead to pain, tenderness, and sometimes weakness in the affected arm. Lateral epicondylitis typically results from overuse of the extensor muscles on the outer elbow, while medial epicondylitis involves the flexor muscles on the inner elbow. Risk factors include poor ergonomics, improper lifting technique, or a sudden increase in activity intensity.

Over time, chronic cases can develop into tendinosis, a degenerative condition where the tendon fibers weaken without significant inflammation. Treating these cases requires not just symptom management but also a structured plan to rebuild tendon strength and function.

The Role of Eccentric Loading in Recovery

One of the most effective treatments for epicondyle tendinitis is eccentric loading exercises. Eccentric contractions occur when a muscle lengthens under tension, such as lowering a weight slowly after lifting it. Research suggests that eccentric training can promote tendon remodeling by increasing collagen synthesis and improving tendon stiffness, aiding recovery from tendinopathy.

For lateral epicondylitis, a common eccentric exercise involves using a lightweight or resistance band to perform wrist extensions. The patient lifts their wrist with assistance and lowers it slowly against resistance, focusing on controlled, slow movements. Similarly, for medial epicondylitis, exercises target the flexor tendons. Incorporating these exercises into a rehabilitation program, under the guidance of a sports medicine professional, can significantly enhance outcomes.

Strengthening and balancing the muscles around the elbow can alleviate pain and prevent recurrence. Here's how you can approach it:

1. Identify and Address Muscle Imbalances

• Forearm extensors vs. flexors: Weak extensors (top of the forearm) relative to stronger flexors (bottom of the forearm) can contribute to lateral epicondylitis.

• Grip strength: Weak grip can overload the elbow tendons.

• Shoulder and upper back strength: Poor shoulder stability or posture can shift strain to the elbow.

2. Initial Phase: Pain Reduction and Recovery

• Rest and reduce load: Avoid activities that aggravate pain.

• Contrast therapy: Apply heat, then ice in 1 minute intervals for 10-15 mins to increase blood flow.

• Stretching:

  • For lateral epicondylitis: Extend your arm, palm down, and gently pull the fingers toward you.

  • For medial epicondylitis: Extend your arm, palm up, and pull the fingers toward you.

• Eccentric exercises: Begin slow eccentric loading once pain subsides.

3. Strengthening Exercises to Balance Muscles

Progress these exercises as tolerated. Start with body weight or light resistance and gradually increase.

For Lateral Epicondylitis

• Wrist Extensor Strengthening:

  • Hold a light dumbbell (1–3 lbs), palm facing down.

  • Slowly lift your wrist and lower it back down (eccentric focus).

• Reverse Curls:

  • Use a light barbell or resistance band with palms facing down.

  • Curl up and lower slowly.

• Finger Extensions:

  • Wrap a rubber band around your fingers and open your hand against the resistance.

For Medial Epicondylitis

Wrist Flexor Strengthening:

• Hold a dumbbell, palm facing up.

• Slowly curl the wrist upward and lower it back down.
  Finger Squeezes:

• Use a stress ball or putty to build grip strength.

Pronation/Supination:

• Hold a light dumbbell or hammer with your forearm supported.

• Rotate your forearm to turn your palm up and down slowly.

4. Address Upper Body Weakness

Strengthen surrounding muscle groups for better joint mechanics and to offload strain:

• Shoulder stability:

  • Perform exercises like wall slides, scapular retractions, and face pulls.

• Rotator cuff strengthening:

  • Use resistance bands for internal and external rotation.

• Posture-focused work:

  • Include rows and reverse flys to improve posture and reduce elbow strain.

5. Mobility and Stretching

• Daily forearm stretches: Maintain flexibility in the wrist and elbow.

• Soft tissue work:

  • Foam roll or massage the forearm muscles to relieve tension.

6. Functional Progression

Once pain decreases and strength improves:

• Reintroduce activities gradually.

• Use proper biomechanics to avoid excessive strain.

• Incorporate grip-strengthening tools (like a hand gripper) to ensure the balance between flexors and extensors.

Rest and Recovery

Epicondyle tendinitis is a challenging condition caused by repetitive stress and overuse of the elbow tendons. However, a combination of rest, proper ergonomics, and targeted eccentric loading exercises can effectively address the underlying damage and restore function. For those dealing with persistent symptoms, seeking professional guidance and sticking to a structured rehabilitation program is key.

Sources:

1. Coombes, B. K., et al. “Efficacy and Mechanisms of Eccentric Exercise in Tendinopathy Rehabilitation.” Sports Medicine, 2015.

2. Cook, J. L., & Purdam, C. R. “Is Tendon Pathology a Continuum?” British Journal of Sports Medicine, 2009.

3. Rio, E., et al. “Eccentric Loading and Tendon Rehabilitation: Basic Science and Clinical Application.” Journal of Orthopaedic Research, 2017.