Lateral Epicondylalgia (Tennis Elbow)

If you’re experiencing pain on the outside of your elbow with gripping, lifting, typing or playing sport, you may have tennis elbow, professionally known as lateral epicondylalgia. Tennis elbow  is a tendon pathology which affects the common extensor tendon of the forearm. Despite its name, it commonly affects people who do not play tennis. 

What causes Lateral Epicondylalgia (Tennis Elbow)?

Tennis elbow occurs when the tendons on the outside of your elbow are overloaded. This may be due to a sudden increase in lifting load, weakness or repetitive movements. Common factors that contribute to tennis elbow are: 

• Repetitive gripping or lifting 

• Manual/laborious work - commonly affects people that work in trades

• Weight training 

• Prolonged time spent on the computer - typing and mouse work. 

• Sudden increase in upper limb activity/load

What are the symptoms?

Lateral Epicondylalgia is a condition that generally progresses over a period of time. It commonly presents with the following signs/symptoms:

• Tenderness over the outside of the elbow, particularly when touching it 

• Pain with gripping and reduced strength with gripping 

• Pain with lifting or carrying objects 

• Discomfort during desk work, sport or everyday tasks 

• Reduced and painful wrist extension 

When to see a Physiotherapist and what they can do to help?

You should seek the advice of a Physiotherapist if your pain doesn’t subside within the space of a week or two. It is also recommended if the pain is significantly impacting sport, work or general activities of daily living. 

A physiotherapist will help assist you with activity modification and load management strategies to keep you doing the things you love, at a reduced load. Your physiotherapist may treat with manual therapy techniques or soft tissue massage. Shockwave Therapy is also a highly effective form of treatment, specifically targeting the tendon and reducing pain. Your Physiotherapist can also assist with prescribing an exercise program to assist with improving grip strength, forearm strength and tendon capacity.

Strength Training for Runners: What Matters Most?

Strength training is quite often an afterthought for most runners and usually is only added into a routine when injury occurs. Incorporating strength training around your running schedule can help with running biomechanics, injury prevention, force production and energy efficiency. 

Why should runners strength train?

Running is a single leg sport and the movement is a series of repetitive forward single leg hopping. In one run, a runner's legs can turn over thousands of times. Strength training helps improve running performance by 

• Improved efficiency with force absorption

• Helps maintain good running mechanics

• Improved power

• Tolerate training load

• Reduce fatigue-related breakdown

• Improved running economy

• Injury prevention 
  

What areas matter the most and why

• Glute/Lateral hip strength 

• Biggest generator of power and force production 

• Assists with lateral hip control and load absorption with landing 

• Calf strength 

• One of the most heavily loaded muscle groups during running, especially with increases in pace 

• Core strength 

• Assists with ability to transfer load and force as well as maintain control under fatigue 

• Hamstring strength 

• Assists with propulsion and lower limb control during running 
  

Common Mistakes 

• Only stretching tight muscles 

• Tightness can reflect weakness, fatigue or an intolerance to load 

• Doing random instagram workouts that are not specific to the person or their running 

• Adding too much too soon - increased risk of developing overload injuries 
  

For most recreational runners, running 2 times a week is sufficient enough on top of running load. For those who are in a heavy training block e..g marathon training or ultra marathon training, strength training loads may be reduced in terms of timeframe or intensity and simply be a means for injury prevention or maintenance of strength. Consistency with strength training matters the most, sometimes it’s more so about the quality of the movement rather than the time spent in the gym.

References:

Balsalobre-Fernández C, Santos-Concejero J, Grivas GV. Effects of strength training on running economy in highly trained runners: A systematic review with meta-analysis of controlled trials. Journal of Strength and Conditioning Research. 2016;30(8):2361-2368.

Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine. 2014;48(11):871-877.

Bertelsen ML, Hulme A, Petersen J, et al. A framework for the etiology of running-related injuries. Scandinavian Journal of Medicine & Science in Sports. 2017;27(11):1170-1180.

Hypermobile Ehlers-Danlos Syndrome (hEDS): It’s more than just flexibility

Hypermobile Elhers-Danlos syndrome at its core is a connective tissue condition characterised by joint hypermobility, joint instability and chronic pain. This condition affects collagen and other components of the extracellular matrix proteins, which are essential for providing strength and flexibility to the skin, joints, and blood vessels.

But hEDS is far more complex than simply being overly flexible. It presents with a wide range of systemic symptoms that can significantly impact daily life and vary considerably between individuals. As such, a holistic, multidisciplinary approach to management is essential.

Core features:

·      Joint Hypermobility

·      Joint Instability

·      Chronic Pain

·      Mild Skin hyperextensibility

·      Abnormal scarring

Other associated symptoms:

·      Gastrointestinal issues

·      Headaches

·      Chronic Fatigue

·      Mast cell activation diseases

Causes:

There is no current research identifying a cause for hEDS, however it is evident that hEDS is hereditary with there being a 50% chance of passing the condition onto children.

Diagnosis:

If these symptoms sound very familiar it is worth a while following up with a Rheumatologist or GP to get diagnosed. There is no genetic marker for diagnosis however there is a 2017 clinical criteria that is often utilised. It may end up being a huge eye-opener allowing you to connect the dots between different health issues you may have been facing.

How physiotherapy can help?

·      Improving Joint stability

·      Targeted and tailored Exercise plans will assist in strengthening the appropriate muscles that will gradually increase joint stability.

·      Reduce Pain

·      Adjusting poor movement mechanics that may be linked to the pain.

·      Strengthening muscles so they can handle load without pain

·      Managing fatigue

·      Using pacing strategies and gentle, graded exercise to improve endurance without overloading the system.

Final thoughts:

A holistic approach is essential for the effective management of Hypermobile Ehlers-Danlos Syndrome (hEDS). Since symptoms can vary widely from person to person, it’s important to seek professional guidance and develop a personalised treatment plan tailored to your specific needs. With the right support, you can better manage your symptoms and work toward improving your overall quality of life.

The Ehlers-Danlos Society. (2025). Hypermobile Ehlers-Danlos Syndrome (hEDS). Retrieved from https://www.ehlers-danlos.com/heds/

Hypermobility Health. (2025). The EDS Iceberg: Understanding the Invisible Burden of Ehlers-Danlos Syndrome. Retrieved from https://hypermobilityhealth.com.au/wp-content/uploads/2025/01/EDS-iceberg-iStock-1401249912-1536x864.jpg

Physio Management of ITB Syndrome

What is ITB Syndrome?

Iliotibial Band (ITB) Syndrome is a condition that results in pain on the outer side of the knee, often experienced by athletes who engage in repetitive activities like running or cycling. The ITB is a thick band of connective tissue that runs along the outside of the thigh, from the hip to the shin, and plays a critical role in stabilizing the knee during movement. The ITB is an extension of the tensor fascia latae, gluteus medius, and gluteus maximus.

When the ITB becomes tight or irritated, it can lead to friction between the band and the lateral epicondyle of the femur. This friction can cause inflammation, resulting in lateral knee pain, particularly with activities that involve repetitive periods of knee flexion and extension, like running or cycling.

The ITB is in contact with the lateral epicondyle at about 30 degrees of knee flexion—which is around the angle your knee makes when your foot strikes the ground while running or cycling. This is known as the ‘impingement zone,’ and this is why activities that involve repetitive knee flexion can trigger ITB Syndrome.

Symptoms of ITB Syndrome: 

• Pain on the outside of the knee

• The pain gets worse with activity—the more you run or cycle

• Pain may radiate up or down the thigh and shin

• Clicking or popping sensation

How is ITB syndrome treated?

Fortunately, most cases do really well with conservative management, and patients will have a complete resolution of symptoms within 6-8 weeks. A combination of the following approaches is often recommended to manage and alleviate symptoms:

• Manual therapy to loosen the muscle attachments to the ITB (glutes, TFL)

• Strengthening of the hip abductors

• Gradual return to activity

Return to running:

• Gradual return to running on a flat surface

• Run at a relatively fast pace—don’t try to return to running at a slow pace

• Avoid downhill running

Running on a flat surface and at a fast pace has been shown to reduce time spent in the impingement zone- the time that the ITB is in contact with the lateral femoral epicondyle.

Examples of exercises to strengthen hip abductors: 

• Side-lying hip abduction holds

• Side-lying leg lifts

• Modified side plank + leg lifts 

• Banded crab walks

• Single-leg squats

• Banded glute bridges 

If this sounds like you, book in with a trusted physiotherapist at Lilydale or Healesville Physio & Sports Medicine for an individualised treatment plan. 

Example photos of exercises to strengthen hip abductors: 

Eg. Side-lying hip abduction holds

Eg. Side-lying leg lifts

Eg. Modified side plank + leg lifts 

Eg. Banded crab walks

Eg. Single-leg squats

Eg. Banded glute bridges 

References: 

Hadeed, A., & Tapscott, D. C. (2019). Iliotibial band friction syndrome. 

Balachandar, V., Hampton, M., Riaz, O., & Woods, S. (2019). Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment. Muscles, Ligaments & Tendons Journal (MLTJ), 9(2).