Physical Therapy for Tennis Elbow

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 normal function of the elbow and wrist.

Understanding Tennis Elbow

Tennis elbow is characterized by pain and tenderness on the outside of the elbow. 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.

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.

Strengthening Exercises

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.

Kinesiology Taping

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.

Activity Modification

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.

Treatment	Description	Benefits	Considerations
Rest	Avoiding aggravating activities	Allows healing	May prolong recovery if rest is excessive
Ice	Requires commitment to the therapy program	Reduces pain/swelling	Applying ice packs to the elbow
Oral Medications	Over-the-counter pain relievers	Pain relief	Temporary relief doesn’t treat underlying issue
Bracing	Special splints or straps	Compression and support	May restrict motion, not a lone solution
Injections	Risk of side effects, don’t fix the cause	Powerful anti-inflammatory	Temporary effects, risks like infection
Physical Therapy	Exercises, hands-on treatment	Treats root cause	Requires commitment to therapy program
Surgery	Tendon repair or release	Last resort for severe cases	Long recovery, not always successful

Glossary

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 outer side of the elbow joint 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.

Source

National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
MedlinePlus

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