Physical Therapy for Tennis Elbow: 8 BEST Exercises

What is Tennis Elbow (Lateral Epicondylitis, Lateral Epicondylalgia)?

Medically, Tennis Elbow is referred to as, Lateral Epicondylitis or more accurately, Lateral Epicondylalgia. It is a type of overuse injury to the wrist extensor muscles and tendons that lie in the outer elbow/forearm area. These muscles have to work hard whenever we grip or manipulate objects.

Sometimes a sudden increase in repetitive gripping activities (such as playing a tennis match or gripping gardening tools) causes increased inflammation or irritation to the muscles involved.

I see this condition a lot in the spring as people tend to get outside and begin to perform a lot of outdoor sports or home and gardening activities after having spent a lot of time sedentary during the winter months. This sudden increase in work demand placed upon the wrist extensor muscles causes an overuse injury to them. In turn, pain and inflammation develop.

If the condition continues to worsen, the initial inflammatory response can die out leading to gradual tendon degeneration. (Remember that all muscles connect to bone via a tendon). If the condition progresses into this phase, it may last several months.

Symptoms of Tennis Elbow

The initial onset of pain will be located along the outside of the elbow where the wrist extensors are located. Pain will be felt with gripping activities. Typically, the harder that one has to grip causes a linear increase in elbow pain. The pain will often travel down the top side of the forearm along the wrist extensor muscles towards the wrist and hand.

Elbow pain will be characterized as a constant dull, ache with periods of sharp intense pain when actively performing gripping activities.

Weakness with painful activities is usually secondary to pain meaning that you won’t be able to lift or grip things with a lot of force simply because it hurts more when you do.

What if My Pain is Coming From the Inside of My Elbow Instead?

If you are feeling pain with gripping activities, but the pain is located on the inside of your elbow, then you are likely suffering from Golfer’s Elbow (Medial Epicondylitis) rather than Tennis Elbow.

Which Activities Aggravate Tennis Elbow?

Tennis Elbow is considered a “self-limiting” condition. This means that eventually, the elbow pain will be bad enough that you stop doing any kind of aggravating activities because it hurts to do so. Then, after a while of not doing those activities, the pain eventually subsides. However, this could take anywhere from 6-24 months to resolve itself!

If you understand the potentially aggravating activities, then you can stop or modify these activities earlier on in this condition, so you can prevent the condition from progressing further. Then, combining physical therapy exercises and stretches can help effectively reduce Tennis Elbow symptoms and prevent it from coming back in the future.

Aggravating activities for Tennis Elbow include:

• Gripping (smaller diameter objects worse than larger diameter)

• Twisting (screwdriver, opening a jar)

• Lifting/Pulling

• Pinching

• Typing/Mouse Work

• Writing

Tennis Elbow Treatment Options

#1. The first treatment for Tennis Elbow is to STOP performing repetitively gripping activities. This is not a “no pain, no gain” type condition. If you continue to perform painful, repetitive activities, it will continue to aggravate the muscles and tendons. Physical therapy for Tennis Elbow will focus on reducing the inflammation within the tissue, improving the flexibility of the forearm musculature, and then building strength to prevent future flare-ups.

#2. Wear a Tennis Elbow pressure strap with daily activities. I’ve had mixed results with these straps, but the concept behind these straps is to change the line of pull of the wrist extensor muscles thereby reducing the stress on the tendons as they insert into the bone. I usually recommend that my patients at least try wearing one of these as it certainly won’t hurt it and could potentially help relieve the elbow pain with daily activities.

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#3. Massage is a critical component of care for reducing tennis elbow pain. As mentioned before, Tennis Elbow is the result of inflammation and pain within the wrist extensor muscles of the top side of the forearm that travel to the outer elbow. These forearm muscles become extremely tight and tender when they are irritated. Performing daily massage twice per day along these muscles will help improve blood flow to reduce irritation and decrease the pain.

Use this: StickOn IASTM Stainless Steel Massage Tool

#4. Voltaren Gel (Diclofenac Sodium) is an over-the-counter nonsteroidal anti-inflammatory gel that can be rubbed over the skin several times per day. It soaks through the skin and has anti-inflammatory effects on the soft tissues just below skin level. It works quite well on superficial muscles such as those found in the elbow. Speak with your medical doctor or physical therapist to see if this would be safe for you to use.

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If you have elbow pain for several months or if it progressively worsens, then it’s time for you to see your medical doctor. He/She may recommend additional treatment options such as a corticosteroid injection or extracorporeal shockwave therapy.