Physio for tennis elbow: Causes, treatments, and exercises
If you have the symptoms of tennis elbow, it may feel painful at the moment, but with proper care and the help of a physio, you can find relief quickly. Treatment for tennis elbow doesn’t always mean surgery or similar invasive treatments.
Read on to discover the best tennis elbow treatments, or get in touch with a sports physiotherapist at Ultra Sports Clinic today.
What is tennis elbow?
Tennis elbow is clinically known as lateral epicondylitis. It's an injury caused by overuse of your muscles found in the forearm, attached to your elbow. Repetitive contractions or wrist movements (like ones required by manual tasks) can excessively strain the elbow's tendons. This injury is more commonly referred to as tennis elbow because it usually affects people who play tennis and either grip their racquets too tightly or play with poor technique. Despite its nickname, only about 5% of people affected by tennis elbow actually play tennis.
You can read more about other typical tennis injuries in our blog post here.
Overuse of these tendons may lead to a change in their structure, which can be painful. It can cause inflammation, tearing, degeneration, and eventually, a decrease in blood supply to the tendon.
What are the symptoms of tennis elbow?
Some common tennis elbow symptoms include:
Weak gripping strength
Burning pain felt in the outer part of your elbow
Elbow pain that is experienced at night
Difficulty moving your arm
A reddish or swollen elbow
These tennis elbow symptoms may worsen if you continue to use your forearms or wrists repeatedly. You should also keep in mind that tennis elbow commonly causes pain or discomfort while doing these activities:
When shaking hands
When gripping small objects, such as a cup of coffee, your phone, or a pen
When twisting your forearm to turn a door handle or open a jar
Sometimes, but not always, when lifting or bending your arm
The typical tennis elbow symptoms to look out for include pain or tenderness felt on the outside of your elbow. Particularly look out for pain around your elbow's bony bump. or the lateral epicondyle. Some will also experience discomfort in the forearms and back of the hand. If you feel pain inside your elbow, that may be a different injury known as a golfer's elbow.
What causes tennis elbow?
Tennis elbow is caused by repetitive and forceful motions that overuse the muscles that are attached to your elbow and used to straighten your wrist. Overuse puts a strain on these tendons and could create micro-tearing or develop inflammation on the outside of your elbow. This specific pain in the elbow is heavily tied to repetitive one-sided movements, and those working as electricians, carpenters, gardeners, or in desk-bound jobs can often suffer from this condition.
Some factors that can increase the chance of tennis elbow are:
Participating in sports that place a lot of force on the arms, such as racquet sports.
Occupations that require repetitive motions in the wrists and the arms
Your age - Tennis elbow is most commonly found in people aged 35 to 54.
How to check if you have tennis elbow
If you think you have tennis elbow but are unsure, try the following:
Coffee cup test - Try to pick up a cup of coffee or a glass of water with your injured arm and rate the level of pain you experience.
Palpating - Extend your forearm out onto a table and apply gentle pressure on the lateral epicondyle and the area above it to note any pain or swelling.
Chair pickup test - Stand in front of a light chair with a high back. Extend your injured arm straight ahead of you and bend your wrist so the fingers are faced downwards. Use your thumb, the first finger, and the middle finger to grab the back of the chair and lift it. Note any pain or tenderness.
If these tests point to tennis elbow, you may require further testing by a doctor. A medical professional may do a 'Mill's test', which examines your lateral epicondyle while fully flexing your wrist and rotating your forearm inward. They may also do a resistive tennis elbow test.
A doctor may also:
Use X-rays to rule out issues such as arthritis or broken bones
Conduct imaging tests like MRI, ultrasound
Conduct CT scans to look for damage in the tendons or muscles
Conduct an EMG check for compressed nerves.
How long does tennis elbow last?
Tennis elbow can resolve spontaneously after a year of complete rest. However, there is still an element of risk of developing the injury again if the root cause of the injury is not addressed. Physiotherapy treatment can help accelerate the healing process and prevent a recurrence of the injury with tools like manual therapy, taping, shockwave, and rehabilitation exercises.
How common is tennis elbow?
You don't have to play tennis or even be an athlete in order to get tennis elbow. Many other sports and activities can lead to this kind of pain. In fact, it’s very common to see this chronic condition in other sports such as squash, badminton, baseball, swimming and field throwing events.
Tennis elbow is the most common cause of persistent elbow pain.
It mainly affects men and women between the ages of 35 and 54.
Tennis elbow accounts for two-thirds of cases of elbow pain in the UK.
Tennis elbow affects up to 3% of the population every year. (This equates to four to seven cases every 1000 people)
Which sports can cause tennis elbow?
Tennis is the most common sport to causes tennis elbow, but it’s by no means the only one. There are many other sports that may cause this kind of pain in the elbow. Read on to find out why
Tennis - Your forearms clench and receive stress when hitting a backhand in tennis. Improper technique or gripping the racquet too tightly will add to that stress and could change the structure of your tendons. Most tennis elbow injuries in sports are brought about by poor technique.
Golfing - Playing golf too frequently can cause a lot of stress on the muscles found in your inner forearm. The resulting pain is similar to tennis elbow but is often referred to as golf elbow as it normally affects the inner elbow instead of the outer. This is more commonly referred to as ‘golfer’s elbow’, or medial epicondylitis.
Fencing - Repetitive arm motions, gripping your weapon too tightly, and poor technique can all cause tennis elbow in fencing (also referred to as fencing elbow).
Which professions can cause tennis elbow?
You don't have to be an athlete to experience tennis elbow. In fact, there are many professions that require repetitive arm and wrist motions that may leave you vulnerable to tennis elbow.
Some professions that may cause tennis elbow include:
Assembly line workers/mechanics
How is tennis elbow diagnosed?
There are a few ways to determine if you have tennis elbow. If you want to test for tennis elbow at home and before you go to a health professional, there are some tests you can carry out yourself. If you think you have tennis elbow but are unsure, a health professional will be able to carry out further tests before they diagnose you.
When to see a doctor
You should see a doctor for tennis elbow if the pain does not go away after a few days of rest. Treatment from a GP or physiotherapist will quicken the healing process.
Tennis elbow treatments
Tennis elbow is a "self-limiting" condition. This means that it will get better without treatment. That being said, treatment can help with pain, give temporary relief, or boost the healing process.
At home treatment
The most important thing you can do to start the healing process is to avoid the activities that put a strain on your arm, wrist, or elbow's tendons and muscles. This may mean that you alter the way you work out or you talk to your employer about changing the way you do your job in order to avoid strain.
Over-the-counter painkillers/ Non-steroidial inflammatory drugs
Over-the-counter painkillers such as paracetamol and ibuprofen can help relieve the pain from tennis elbow within the beginning phases of the injury. You can also find anti-inflammatory creams and gels to apply directly to the elbow or the area with pain.
Tennis elbow treatment from your GP
These can give short-term relief to tennis elbow pain if no other form of treatment is effective. You can have up to three injections in the same area with a three to six-month gap in between injections.
PRP injections for tennis elbow
Platelet-rich plasma is used to treat tennis elbow by speeding up the healing process and repairing damaged tissue. That being said, this only works in about 50% of the cases.
Surgery for tennis elbow
In some cases, surgery is recommended by a doctor to relieve pain by removing the damaged part of the tendon. This is usually only recommended if you are experiencing persistent and severe pain.
A GP may refer you to a physiotherapist. Our experienced sports physiotherapists use a variety of methods to restore movement and relieve you of tennis elbow pain. Find out more here.
Physio for tennis elbow
Physio treatments for tennis elbow will focus on managing pain while boosting flexibility and strength in your elbow, forearm, and wrist. If you need to get back to work in an occupation that requires repetitive movements, a physiotherapist may recommend an epicondylitis clasp to reduce elbow strain and keep you working.
You can read more about physiotherapy and how it differs from sports therapy in our guide, Physiotherapist vs Sports therapist: Which is right for you?
Physiotherapists encourage blood flow to your arm and relieve pain and stiffness with manual therapy techniques, such as massage and manipulation. They will give you exercises that can boost your affected arm's strength and mobility. They can also recommend the use of a brace, strapping, support bandage or splint (called an orthosis)
Physio for tennis elbow can also include shockwave therapy to stimulate, promote healing, and help relieve pain.
Preventative measures for tennis elbow
See that you learn and practice the proper technique for specific exercises, activities, or sports to avoid the repetitive motions that may lead to tennis elbow in the future. A physiotherapist can offer advice and provide options such as wearing braces or straps.
Suggested exercises for tennis elbow
Talk to your doctor or physiotherapist about which exercises are best for your rehabilitation or prevention goals. The following recommended exercises will work on stretching the muscles attached to the injured tendon to promote healing, muscle endurance, and improve resistance to repetitive stress.
Bend your elbow at a right angle and hold out your hand, palm up. Turn your wrist slowly so that your palm is now facing down. Hold for 5 seconds, and then slowly release. Do 3 sets of 10 repetitions.
Wrist turn with weight
Practice the above wrist turn exercise while holding a lightweight item, such as a tin of beans.
Keeping your arm straight in front with your palm facing down, gently bend your wrist down. Use the opposite hand to press the stretching hand back towards your body and hold for 15–30 seconds. Straighten your wrist. Gently bend the stretching hand backwards and use the opposite hand to pull the fingers back. Hold for 15–30 seconds. Do 3 sets with each wrist.
Wrist lift with palm down
Rest your bent elbow on a firm surface. Hold onto a lightweight (tin of beans). Slowly (4 seconds) lower the weight down so the wrist ends in a bent position. Repeat 12 repetitions and 3 sets.
Tennis elbow FAQs
Should I play through tennis elbow?
Depending on the phase of the injury, you can still participate in your sport. However, it is important to speak to your healthcare professional about modifying your training loads.
Are tennis elbow braces or straps effective?
Yes. Both braces and straps offer support during recovery.
Does tennis elbow affect one or both arms?
Usually, only one arm is affected.
Tennis elbow recovery time
Tennis elbow injuries will usually heal over time if rested for 12-18 months.
Are tennis elbow and tendonitis the same thing?
Is tennis elbow permanent?
No. Tennis elbow is not permanent. With the right treatment, exercises and rest, it can heal.
What does tennis elbow look like?
It could look exactly like a healthy shoulder externally. However, in certain circumstances, it may be swollen or slightly red.
Where to ice tennis elbow
Ice on the outside of your elbow. Do not ice your elbow for longer than 15 minutes, and only ice it once every 2 hours.
Who should I see for tennis elbow?
You can see a number of health professionals, including a physiotherapist, an osteopath and a chiropractor.
If you are experiencing pain in the elbow, and think it could be tennis elbow, don't hesitate to get in touch. Our sports injury specialists include physiotherapists and sports chiropractors. Our team will help you determine the best course of action.