Prevalence of Lateral Epicondylitis and Associated Risk Factors Among Racket Sports Players in Lahore, Pakistan: A Cross-Sectional Study
Article Sidebar
Main Article Content
Abstract
Background: Lateral elbow pain related to repetitive wrist extensor loading is common in racket sports, but local evidence among Pakistani athletes remains limited. Racket sport players may be exposed to sport-specific mechanical demands, gripping loads, equipment-related factors, and inconsistent warm-up routines that contribute to symptom and functional burden. Objective: To estimate the frequency and severity of lateral elbow symptoms and PRTEE-measured functional impairment among active racket sport players in Lahore, Pakistan, and examine associations with demographic and sport-related factors. Methods: This cross-sectional observational study included 265 badminton, tennis, and squash players aged 18–35 years recruited from sports clubs, universities, and academies in Lahore. Data were collected using a structured questionnaire, the Patient-Rated Tennis Elbow Evaluation, and the Numeric Rating Scale. Descriptive statistics, Pearson correlation, and chi-square tests were used for analysis. Results: Participants had a mean age of 23.65 ± 5.38 years, and 161 (60.8%) were male. Badminton players constituted 236 (89.1%) of the sample. Only 11 participants (4.2%) had a PRTEE score of zero, while 254 (95.8%) reported some degree of PRTEE-measured pain or functional limitation. NRS pain was mild in 118 (44.5%), moderate in 50 (18.9%), and severe in 35 (13.2%) participants. Age was positively correlated with PRTEE total score (r = 0.31, p < 0.001). PRTEE severity categories were significantly associated with gender (χ² = 21.50, p < 0.001), racket grip size (χ² = 44.48, p < 0.001), sport type (χ² = 39.22, p < 0.001), and warm-up routine (χ² = 27.00, p < 0.001). Conclusion: Lateral elbow symptoms and PRTEE-measured pain and functional limitation were frequent among sampled racket sport players in Lahore. Age, gender, self-reported racket grip size, sport type, and warm-up behavior showed significant unadjusted associations with symptom severity. Findings support routine symptom screening, structured warm-up education, and ergonomic equipment guidance, while future studies should include clinical diagnostic confirmation and adjusted longitudinal analysis
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Ahmad M, Siddiqui MZ, Butt MH. Lateral epicondylitis: a review of pathology and management. J Pak Med Assoc. 2013;63(1):83-87.
2. Welsh RP. Degenerative tendinopathy of the lateral elbow: current concepts. Can J Surg. 2018;61(3):172-179.
3. Lambert C, Schwartz C, Otte A, Leemans A, Goyeneche G, Schwartz C. Acute-to-chronic workload ratio and upper limb overuse injuries in racket sports: a 2025 update. Sports Med Open. 2025;11(1):12.
4. Thomas J, et al. Equipment ergonomics and lateral elbow tendinopathy in racket sport athletes. Br J Sports Med. 2023;57(4):215-222.
5. Akbar H, Akhtar N, Naz A, Shahzad M, Maqbool S. Prevalence of lateral epicondylitis and its impact on upper extremity function in housewives. J Health Wellness Community Res. 2024;2(1):45-52.
6. Rehman SU, Ahmed I, Khan MA, Noor F, Shah MU. Prevalence of lateral epicondylitis and associated functional disability among residential painters in Peshawar. J Rehabil Sci Res. 2025;12(1):33-40.
7. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457.
8. MacDermid JC, Tottenham V. Responsiveness of the pain and disability subscales of the Patient-Rated Tennis Elbow Evaluation. J Hand Ther. 2004;17(3):313-318.
9. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798-804.
10. Rossi J, Grélot L, Blé MC, Champely S, Barla C, Berton E. Relationship between racket handle size and forearm muscle load in recreational tennis players. J Sports Sci. 2014;32(17):1649-1657.
11. Rodrigues JN, Bhatt A, Somanchi B, Moran M. Age-related risk factors for lateral epicondylitis in dominant versus non-dominant arm use. J Shoulder Elbow Surg. 2024;33(2):e44-e51.
12. Chen J, Wang Y, Zhang H, Liu L, Wang C. Meta-analysis of risk factors for lateral epicondylitis: implications for prevention. Clin Orthop Relat Res. 2024;482(3):520-531.
13. Fahlström M, Zeisig E. Lateral elbow pain in racket sports: clinical features, risk factors, and management. Scand J Med Sci Sports. 2022;32 Suppl 2:43-50.
14. Lapner P, Li A, Raveendran R, et al. Effectiveness of non-surgical interventions for lateral epicondylitis: systematic review and meta-analysis. JSES Int. 2022;6(4):627-636.
15. Karanasios S, Korakakis V, Whiteley R, Aptó A, Malliaropoulos N. Imaging findings in lateral elbow tendinopathy and diagnostic accuracy of clinical tests: a systematic review. Br J Sports Med. 2021;55(9):509-519.
16. Bretschneider SF, Stengel D, Ekkernkamp A. Occupational physical risk factors for lateral epicondylitis: a systematic review and meta-analysis. Am J Ind Med. 2022;65(3):196-208.
17. Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother. 2015;61(4):174-181.
18. Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med. 2015;49(8):555-557.
19. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461-469.