Treatment Options for Tennis Elbow
Tennis elbow, also known as lateral epicondylitis, is a common condition that causes pain and discomfort on the outer part of the elbow. It typically results from repetitive motion or overuse of the forearm muscles. This leads to irritation or inflammation of the tendons connecting the forearm muscles to the lateral epicondyle (the bony prominence on the outside of the elbow). While it is often associated with playing tennis, this condition can affect anyone who performs repetitive arm motions, such as painters, carpenters, or office workers.
If you are experiencing symptoms of tennis elbow, which may include pain, stiffness, or tenderness near the elbow, seek effective treatment to alleviate the discomfort and promote healing. Below are several evidence-based treatment options commonly used to manage tennis elbow.
- Rest and Activity Modification
The first step in managing tennis elbow is to reduce the strain on the affected arm. Resting the elbow and avoiding activities that aggravate the pain, such as heavy lifting or repetitive gripping motions, can help the body heal naturally. While complete rest isn't always necessary, minimizing aggravating activities and using supportive devices, like an elbow brace or elbow strap, can prevent further strain on the tendon.
Your physiotherapist can recommend a device like an elbow braces or elbow strap, if they expect these tools are right for you.
- Physiotherapy
Physiotherapy plays a crucial role in the rehabilitation of tennis elbow. A physiotherapist will guide you through exercises to strengthen the muscles around the elbow, improve flexibility, promote proper movement mechanics, and reduce discomfort. These exercises are designed to reduce stress on the affected tendon and gradually restore function.
Stretching and strengthening routines are always customized to you, based on the severity of your condition and your unique medical history. They may include:
- Flexibility exercises: Stretching the forearm muscles can help alleviate tension and reduce the strain on the elbow.
- Eccentric exercises: These exercises focus on lengthening the tendon while it is under tension, which has been shown to reduce pain and improve tendon health.
- Strengthening exercises: These exercises target the muscles of the forearm and elbow to improve endurance and prevent further injury.
Your physiotherapist has a wide range of other techniques that may help reduce your discomfort from tennis elbow, and make it easier to do your exercises and your day-to-day activities. This may include manual therapy (forearm massage, joint mobilization), acupuncture, dry needling, or electrotherapy (such as TENS).
- Over-The-Counter Medications
For individuals experiencing significant pain and inflammation, over-the-counter NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as Advil, may be reduce swelling and provide temporary pain relief. While NSAIDs can help manage symptoms, they should not be used as a long-term solution.
As physiotherapists, we can't prescribe medications. However, we can refer you to a pharmacist or medical doctor if we suspect medications could complement your physiotherapy treatment, or if we suspect medications are more appropriate than physiotherapy care.
It’s always best to consult with a pharmacist or medical doctor before taking any medication to ensure it's safe and appropriate for your condition.
- Corticosteroid Injections
For more severe cases of tennis elbow that do not respond to conservative treatment, your medical doctor may recommend corticosteroid injections. These injections help reduce inflammation and provide temporary pain relief. While corticosteroids can be effective in the short term, they should be used cautiously, as repeated use may weaken the tendon and increase the risk of further injury.
Our physiotherapists do not administer corticosteriod injections - we focus exclusively on drug-free approaches. However, we work as a team with your medical doctor and oversee your overall rehabilitation plan.
- Shockwave Therapy
Shockwave therapy is a non-invasive treatment that involves the application of high-energy sound waves to the affected area. This treatment has been shown to promote healing by stimulating blood flow to the tendon, breaking down scar tissue, and encouraging tissue regeneration.
Shockwave therapy isn't usually first-line treatment. Your physiotherapist may recommend it when other treatments, like your exercise program, activity modification, hands-on treatment have not provided sufficient relief.
- Surgery
In rare cases, when conservative treatments fail to provide relief and the pain is persistent for over a year, surgical intervention may be necessary. Surgery typically involves removing the damaged tissue and reattaching the healthy tendon to the bone. However, surgery is usually considered a last resort after other treatments have been exhausted.
Surgery is not provided at our clinic - our physiotherapists' role is to help you prevent surgery, or recover from surgery. Speak to your medical doctor if you suspect surgery is right for you.
Conclusion
While tennis elbow can be a frustrating and painful condition, it can be treated. A combination of rest, physical therapy, and conservative treatments can effectively alleviate pain and restore function. In more severe cases, interventions like corticosteroid injections, shockwave therapy, or surgery may be considered.
If you are experiencing symptoms of tennis elbow, it’s essential to consult a physiotherapist or a doctor to determine the most appropriate treatment plan for your specific condition. By addressing the issue early and using the correct treatment options, tennis elbow can be managed effectively, helping you get back to your daily routines and physical activities.
Written by Lauren Brigham, Master's of Physiotherapy Student, in collaboration with River East Physiotherapy
References:
Bonczar, M., et al. "Lateral Epicondylitis: The Condition and Current Management Strategies." Journal of Orthopaedic Surgery and Research, vol. 17, no. 1, 2022, pp. 1-12.