• Michael Liougas

Physiotherapy for Tennis Elbow Pain

Tennis Elbow is a laymen’s term that has been coined or attributed to playing tennis. Most professional tennis players have suffered from some form of tennis elbow at one point or another during their career. It should be noted that tennis elbow can occur from everyday repetitive tasks, such as writing, knitting or gardening. Luckily for everyone, there’s physiotherapy for tennis elbow pain that can treat, eliminate and prevent the condition all together.


Image of the joint where tennis elbow occurs


The difference between tennis elbow and golfers elbow

Tennis elbow is medically termed Lateral Epicondylitis respectively. The main difference between Golfers’ Elbow and Tennis Elbow is the actual LOCATION of the pain on the elbow. Golfer's Elbow (Medial Epicondylitis) is located on the inside or medial part of the elbow, while Tennis Elbow (Lateral Epicondylitis) is located on the outside or lateral side of the elbow. The symptoms of either golfer's elbow or tennis elbow may occur suddenly or gradually over weeks to months. Golfer's Elbow is less common than Tennis Elbow.

Lateral Epicondylitis is caused by repetitive and overuse movements of the wrists and fingers. The tendons become damaged at the microscopic level causing increased inflammation with associated pain, thus is referred to as tendonitis of the elbow.


Tennis elbow vs golfers elbow

Common activities that cause Tennis Elbow

  1. Common Daily Activities such as writing and preparing foods may cause tendinitis of the elbow. Other examples include outdoor gardening tools such as hedge trimmers.

  2. Playing an Instrument: Many patients have complained of elbow pain with playing instruments, that require quick movements of fingers such as when playing the piano, brass instruments and drums.

  3. Sports Injuries: The repetitive and competitive nature to play at the optimal level, may cause players to place excessive strain on the tendons at the elbow, Poor swinging technique of either a racket or golf clubs are the most common sports-related elbow injuries. Swinging a racket or club to hit a ball at high velocity increases the eccentric contractile forces of the elbow muscles resulting in micro-tears and elbow pain. Oftentimes under developed weaker muscles lead to early pain onset, especially when starting to play new sports. Other sports-related elbow injuries arise from throwing a baseball or a football.

  4. Improper Exercising Technique such as weight training has also been a major contributor to elbow pain, a majority of exercises involve the use of one or both hands to hold the weight or bars. The constant pressure placed on the elbow muscles and lack of sufficient muscle recovery time is a major contributing factor to get tendonitis. Many novice athletes strive to get quicker results and overlook bio-mechanical deficiencies which may lead to early onset of tendinitis of the elbow. It is important to note that chronic tendonitis, is a form of repeated re-injury to the tendons, is medically referred to as Tendinosis. Tendinosis is often diagnosed with diagnostic ultrasound or an x-ray.

  5. Work-Related Injuries are extremely commonplace for elbow pain, specifically for trades professions such as electricians, plumbers, painters and carpenters, who use their hands to perform their jobs. In many instances, the jobs are time-sensitive and there is limited time to rest to allow for adequate healing and recovering of the overused tendons.

  6. Genetic Predisposition may also be a contributing factor that may predispose a person to be more susceptible to tendon injuries. A physiotherapist will perform a detailed assessment, including background familial related conditions to better understand the reason behind the elbow pain.


What is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow is inflammation of the tendon attaching to the outside or lateral side of the elbow. The proximal insertion site of the wrist and finger extensors attach to the lateral epicondyle of the elbow. The extensor tendons are used for extending the wrist and fingers


What are the symptoms of tennis elbow?

Tennis elbow symptoms may include pain while extending the wrist to lift an object or opening the fingers. Additional symptoms may include palpable tenderness along the outside of the elbow area, some tingling or numbness sensation on any or all fingers.

In many cases, the discomfort in the elbow is too painful to tolerate, which caused patients to tend to avoid using the hand, which leads to gradual weakness.

Another common symptom of tendon injury is stiffness, particularly first thing in the morning, but stiffness decreased with gradual movements throughout the day.


Risk factors for Tennis Elbow

Risk Factors that may contribute to increased risk for golfer's elbow or tennis elbow tendonitis may include age greater than 40 years old, overweight (Body Mass Index), smoking cigarettes that may reduce healing time and underlying health conditions such as diabetes.


Tennis Elbow physiotherapy assessment

Many patients can manage the mild symptoms of Tennis Elbow by simply avoiding the aggravating activity and allowing time to rest and heal. If the symptoms persist for greater than a week and there are no signs of improvement, it is important to seek medical advice. A short tennis elbow physiotherapy assessment is required before beginning treatment.

tennis physio

Best physiotherapy treatment for Tennis Elbow

Early physiotherapy treatment will yield optimal results much sooner, as well as reduce the risk for the development of scar tissue and calcium deposits. Avoidance of treatment may place your elbow at higher risk for tendon tears in the future.


A physiotherapist will use a conservative treatment protocol to reduce the inflammation and pain as an initial approach to the treatment of elbow pain. Once the pain is controlled, chronic tennis elbow physiotherapy treatment protocol focused on strengthening the damaged tendons. The recovery time is based on the extend of damage to the tendons.


The majority of patients do quite well with a conservative approach and are back to pre-injury levels in 8-10 weeks. The common principle used by physiotherapists to reduce inflammation and pain is the P.R.I.C.E theory.


P = PROTECT - the injured area with the use of a brace

R = REST - Allow resting time for the damaged soft tissue (Tendon) to heal

I = ICE - A cold compress may be used 2-3 times per day for 8-10 minutes. Always place a light towel between the skin and the cold compress to avoid freezer burn.

C = COMPRESS - A compression sling or brace (Elbow Brace) may be indicated for use to control the inflammation

E = ELEVATE – Keeping the elbow at or above heart level dramatically decreases inflammation (pain)


Additional Tennis Elbow physiotherapy management & treatment protocols


Gentle Stretches

Gentle stretches of the affected tendon are extremely important to perform 2-3 times per day. Each gentle stretch is generally held for 30 seconds and performed 3 consecutive times. A physiotherapist will demonstrate the stretching technique, and these particular stretches may be used as a form of warm-up before using the elbow.


OTC (Over the Counter) Pain Medications

If the cold compress does not provide sufficient pain relief, it is important to consult with your pharmacist for the ideal anti-inflammatory medication. These medications will allow the pain to subside enough, to allow the patient to cope with day-to-day activities, as well as be able to perform the mild strengthening exercises.


Modalities include Therapeutic Ultrasound & shockwave therapy

The physiotherapist will often use the ultrasound (Sound waves) in a pulsed mode to reduce inflammation and stimulate blood flow to promote healing.


Tennis Elbow manual therapy

A physiotherapist will often perform gentle effleurage massage techniques to remove inflammation and stimulate blood flow to promote healing. This is considered a part of the manual therapy process.


Strengthening Program

The Physiotherapist will create a customized strengthening program that will begin with isometric strengthening and quickly progress to the isotonic strengthening program. The progression and transition of the intensity of the strengthening exercises will be closely re-evaluated weekly by your physiotherapist.


physiotherapy for tennis elbow pain

During the isotonic strengthening, the physiotherapist will monitor the correct time to progress from concentric to eccentric strengthening. The final stage of physiotherapy will involve a plyometric program, which oftentimes is a simulation of the activity that initially caused the tendonitis of the elbow. An example, in the case of a tennis player, they would be swinging a weighted racket.


In rare instances, some patients will demonstrate little to no improvement with conservative treatment. It is highly recommended that additional resources be used such as speaking with your family care physician to explore the options of using additional diagnostic imaging such as an MRI (Magnetic Resonance Imaging).


The diagnostic images will demonstrate the severity of the damaged tendon and decipher whether the use of a cortisone injection will be an effective alternative to reduce the pain. Conversely, if the damage is beyond micro-tears (Tendonitis) and there is the presence of a partial or full-thickness tear, then surgical intervention may be required. In these circumstances, full healing may take up to 6 months.


Five tennis physio techniques to prevent tennis elbow injuries

The best way to avoid having any elbow pain at all is to approach the task at hand with caution and listen to your body for clues of discomfort. Every individual has a unique body make-up or structure and will respond differently when performing a similar task at hand.


Physiotherapists are a great resource, as bio-mechanical evaluations will shed light on how to modify or reduce the risk for elbow injuries. Education and understanding how the body works will be vital in the significant reduction of risk of future elbow injuries.


tennis elbow physiotherapy management


1. Allowing Sufficient Rest to Recover

Our bodies are a marvellous piece of biological engineering where initial signs of micro-trauma are detected and the inflammatory process quickly alerts us of a problem. Our bodies have the natural ability to heal for the most part, and it is always best to immediately reduce exposure to the aggravating activity or to simply stop the activity altogether.


2. Always Stretch Before An Activity

Performing gentle stretches is a great way to avoid placing sudden increased muscular-tendinous tension on the elbow. A slow and gradual warm-up will allow sufficient blood flow to adequately prepare the muscles to undergo expansion and contraction movements before performing day-to-day activities, playing a sport or work-related activity.


3. Modify Your Body Mechanics

Proper body mechanics is vital to prevent future injuries. A common task may be performed in numerous ways as all individuals have a unique body structure. Our bodies come in countless shapes and sizes, and oftentimes there is more than one way to complete a task at hand. In some instances, improper equipment may be the main contributing factor for elbow pain. For example, an electrician using a thicker handle screwdriver, instead of a thinner handle screwdriver may significantly reduce the risk of developing medial and lateral epicondylitis.


4. Strength is Important in Your Forearm

A Physiotherapist plays an important role in the prevention of elbow-related injuries. A detailed bio-mechanical orthopaedic assessment will provide the patient with advice on which muscles need to be strengthened. The forearm muscles will need to be strengthened gradually to deal with the high tensile forces exerted while playing sports.


5. Don't Over Do the Activity

It is important to allow the body to recover naturally after using the elbow, such as when playing tennis or painting a house. Performing a variety of different activities and movements will allow for the muscles to recover and a chance for other muscles to be utilized as well.


If You Have Golfer's Elbow or Tennis Elbow please call Global Health Physiotherapy Clinic at (416) 500-4200 to speak with our physiotherapist about how we can help!


Our dedicated physiotherapists are available 7 days a week to discuss conservative treatment options to promote optimal results and return to a pain-free lifestyle.


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