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Tennis elbow, also known as lateral epicondylitis, is a common condition caused by overuse of the muscles in the forearm. Physical therapy for tennis elbow can be extremely helpful for managing tennis elbow pain and restoring the normal function of the elbow and wrist.
Understanding Tennis Elbow
Tennis elbow is characterized by pain and tenderness on the lateral side of the humerus. It is commonly caused by repetitive gripping motions that strain the tendons attaching the muscles of the forearm to the bone. Racquet sports like tennis or badminton require these repetitive motions, as do other activities like golf, typing on keyboards, painting, and manual labor jobs. Over time, the repetitive stress leads to small tears and inflammation in the tendon attachments, especially in the extensor carpi radialis brevis muscle.
The pain and discomfort associated with tennis elbow typically start mild but can worsen over weeks and months if not properly treated. Common symptoms include:
- A gradual onset of burning or aching pain on the outside of the elbow. Patients often point with one finger to the sore spot.
- Tenderness or pain when pressure is applied to the lateral epicondyle, the bony part on the outside of the elbow joint.
- Weakened grip strength and difficulty lifting objects like a coffee cup or turning doorknobs.
- Stiffness, restricted range of motion, and pain when fully bending or straightening the elbow.
- Discomfort when gripping objects like a tennis racquet, golf club, or pen. The simple act of shaking hands can even be painful.
- In severe cases, the pain can radiate down the forearm towards the wrist.
While rest is important during symptom flare-ups, physical therapy can help manage tennis elbow pain and restore normal elbow and wrist function.
Physical Therapy Evaluation
During the initial evaluation, the physical therapist will have an in-depth conversation to learn about the patient’s symptoms, medical history, and daily activities. They will also perform a physical assessment of the elbow and arm to determine tennis elbow severity. Key aspects include:
- Discussing when symptoms began and what aggravates elbow pain. Was there a specific injury that started it or did the pain come on gradually?
- Asking the patient to point to the exact location of the pain. Palpating and applying pressure along the elbow joint and forearm muscles helps pinpoint tender areas.
- Testing range of motion by having the patient slowly and gently bend and straighten the elbow as far as tolerable. Measuring the degrees of motion.
- Checking grip strength with a dynamometer device that quantifies muscle force as the patient squeezes. Compared to the uninjured arm helps assess strength deficits.
- Observing how the patient performs tasks like lifting a box, twisting a doorknob, or mimicking a tennis swing. Any difficulty indicates functional limitations.
- PTs performs cozin’s and mill’s tests.
Understanding the injury extent allows customizing an optimized physical therapy program.
Physical Therapy for Tennis Elbow
The physical therapy goal is to reduce pain while also improving elbow and wrist flexibility, strength, and function so normal activities can be resumed. Specific techniques may include:
Targeted Stretching Exercises
Gentle stretching of forearm muscles and tendons improves flexibility, reduces stiffness, and relieves achiness by increasing blood flow. Helpful stretches include wrist flexor/extensor stretches, finger flexor stretches, and forearm pronation/supination stretches. The physical therapist demonstrates proper technique and prescribes a home routine.
Targeted exercises using resistance bands, light weights, or therapy putty help rebuild grip strength and stability around the elbow and wrist. Eccentric contractions are especially helpful – where the muscle lengthens while developing tension. Examples are slowly lowering a dumbbell while keeping the elbow straight and controlling wrist extension against a resistance band. Exercises are carefully progressed over time.
Manual Therapy Techniques
Hands-on modalities like massage, joint mobilization, and myofascial release applied by a physical therapist can relieve muscle tension, break up scar tissue, and improve elbow mobility. Other modalities like ultrasound, ice, heat, or electrical stimulation may also provide pain relief and promote healing.
Specialized tape around the elbow and forearm can offer subtle support and feedback to the muscles and joints. The tape may help mildly unload irritated tendons and enhance awareness of elbow position.
Guidance can be provided on modifying movements and activity duration to prevent elbow aggravation. Improving technique, using proper equipment, and building adequate rest is key.
Preventing Tennis Elbow Re-injury
To prevent tennis elbow pain recurrence, maintaining long-term flexibility and strength is essential. Continuing customized home exercise programs and practicing ideal activity techniques is advised:
- Warm up the arm before activities and cool down afterward.
- Using proper biomechanics and form for tennis strokes, golf swings, painting, typing, etc. Video analysis can help with technique.
- Taking regular short rest breaks when performing repetitive gripping tasks.
- Ensuring equipment like tennis racquets and keyboards are properly fitted.
- Gradually build up activity levels and avoid elbow overuse or overexertion.
- Applying ice after activity to control inflammation.
With diligent rehabilitation, preventive measures, and physical therapy guidance, tennis elbow can be overcome and normal work and recreational activities can be confidently resumed.
|Avoiding aggravating activities
|May prolong recovery if rest is excessive
|Requires commitment to the therapy program
|Applying ice packs to the elbow
|Over-the-counter pain relievers
|Temporary relief doesn’t treat underlying issue
|Special splints or straps
|Compression and support
|May restrict motion, not a lone solution
|Risk of side effects, don’t fix the cause
|Temporary effects, risks like infection
|Exercises, hands-on treatment
|Treats root cause
|Requires commitment to therapy program
|Tendon repair or release
|Last resort for severe cases
|Long recovery, not always successful
Eccentric exercise: A strengthening exercise where the muscle lengthens as it develops tension, such as slowly lowering a weight. Eccentric training helps rebuild strength and flexibility.
Electrical stimulation: Use of electric current to stimulate and contract muscles. Can be used in physical therapy to help reduce pain and swelling.
Extensor carpi radialis brevis: A forearm muscle often affected in tennis elbow due to repetitive wrist extension.
Flexion: Bending movement that decreases the angle of a joint. Elbow flexion involves bending the elbow to bring the forearm towards the upper arm.
Inflammation: The body’s response to injury or damage that includes pain, swelling, redness, and warmth around the affected area.
Lateral epicondyle: Bony part on the lateral side of the humerus that becomes tender and painful in tennis elbow.
Lateral epicondylitis: The medical term for tennis elbow, referring to inflammation of the tendons that attach to the lateral epicondyle.
Manual therapy: Use of hands-on techniques by a physical therapist, including massage, mobilization, and myofascial release.
Modalities: Therapeutic agents used in physical therapy like ice, heat, ultrasound, etc. They help relieve pain, improve blood flow, and support the healing process.
Range of motion: The extent to which a joint can be moved. Tennis elbow often leads to restricted elbow and wrist range of motion.
Repetitive strain injury: Injuries like tennis elbow caused by repeated small movements like gripping or twisting. The repetitive microtrauma leads to overuse inflammation.
Tendinitis: Inflammation of a tendon, such as in the wrist extensor tendons affected in tennis elbow.
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Minor tennis elbow may resolve in 2-3 weeks with rest and conservative treatment. More severe cases can last 6-12 months if not properly treated and re-injured. Recovery takes time as the tendon must rebuild collagen. Aggressive physical therapy can help shorten the duration.
Yes, it’s best to temporarily stop any exercises aggravating your tennis elbow like weightlifting, pull-ups, and backhand tennis strokes. Modifying grip, using lighter weights, and avoiding elbow extension can help ease back into lifting. Let pain be your guide.
Wearing a tennis elbow brace or strap just below the painful area can help by reducing strain on the tendon during activity. But braces should be used in combination with rest, ice, exercises, and massage for optimal recovery. Don’t over-rely on a brace.
Avoid lifting weights and other activities involving grasping, extending, and putting strain on your elbow. Instead do lower-body workouts, cardio, and light upper-body exercises that don’t worsen pain. Swimming and cycling are great low-impact options.
Ice therapy helps ease acute tennis elbow pain and inflammation. Heat may relieve residual stiffness and promote blood flow once acute inflammation subsides. Alternate heat and ice to address both pain and stiffness components. Avoid heat on acute inflammation.
Tennis elbow also known as lateral epicondylitis, causes pain focused on the outer elbow that radiates into the forearm and wrist. Those suffering from this condition often experience inflammation around the elbow joint along with pain when grasping objects or bending the arm. As the condition progresses, daily tasks like picking things up and shaking hands may intensify the pain.
|Tennis Elbow: Causes, Symptoms and Treatment
Muskan Thakur is a skilled physical therapist based in Los Angeles, USA. She completed her Bachelor of Physical Therapy (BPT) from Delhi University in 2010. Ms. Thakur furthered her studies by completing a clinical residency program focused on orthopedic physical therapy at Duke University in the United States in 2012. She then attained her Master’s in Public Health (MPH) from the Institute of Public Health in Delhi in 2015. With over 10 years of experience, Ms. Thakur employs a holistic approach combining manual therapy, therapeutic exercise, education, and lifestyle modifications to treat neurological, orthopedic, and musculoskeletal conditions.