Tennis elbow (lateral epicondylitis) causes pain on the outside of the elbow due to inflammation of tendons. It often occurs with repeated or strenuous overuse of the forearm muscles and tendons. Lifting, gripping or twisting movements like turning a door handle or opening a jar may be painful, although pain can sometimes be constant. Despite the name, playing tennis is a relatively uncommon cause. Investigations are not usually needed.
Tennis elbow is usually self-limiting. Resting from exacerbating activities is the first thing to do. Try an ice-pack (such as a bag of frozen peas wrapped in a tea towel) twice a day for ten minutes. Anti-inflammatory painkillers such as ibuprofen may help; try the gel form rubbed over the tender area.
If the pain is severe or you have difficulty using your arm, a steroid injection may help but is not thought to confer additional long-term benefits. Physiotherapy exercises and elbow supports may help. Rarely, if very troublesome symptoms persist despite all of the above, a specialist may advise an operation.
A bike seat that is too high will put extra pressure on your arms and shoulders. Consider dropping the saddle and moving it forwards slightly, or raise the handlebars. Your shoulders and arms should be relaxed with your elbows bent and your handlebar grip not too tight. Changing handlebar positions can help but I see you’ve tried this already and are considering different bars; it’s difficult to know in advance whether this will help. Padded gloves or handlebar taping may help as an additional shock absorber. For prevention, try some forearm stretching and strengthening exercises – these can be found online.
Finally, it may worth considering whether something else you are doing off the bike is perpetuating the tennis elbow and, if necessary, reducing these activities.
Dr Matt Brooks
This was first published in the June / July 2012 edition of CTC's Cycle magazine.