Tennis Elbow: Answers to Commonly Asked Questions

Tennis elbow, or **lateral epicondylitis**, is a common condition that causes pain and tenderness on the outer side of the elbow. While it’s often associated with racquet sports, anyone who performs repetitive motions involving gripping, lifting, or twisting can develop this condition. Physiotherapy plays a crucial role in the recovery process, helping reduce pain, restore function, and prevent further injury. If you're experiencing tennis elbow or want to learn more about how physiotherapy can help, read on for answers to some of the most common questions about this condition.

1. What Exactly Is Tennis Elbow?

Tennis elbow is an overuse injury involving inflammation of the tendons on the outer side of the elbow. It typically occurs when the tendons that connect the forearm muscles to the lateral epicondyle (the bony bump on the outside of the elbow) are overstrained due to repetitive movements. This results in pain and discomfort, which can limit your ability to perform daily activities, let alone engage in sports or physical work.

2. How Can Physiotherapy Help with Tennis Elbow?

Physiotherapy is a highly effective treatment for tennis elbow. The goal of physiotherapy is to reduce pain, improve flexibility, strengthen the muscles around the elbow, and restore proper movement mechanics. A physiotherapist can design a personalized rehabilitation program that includes:

- Pain management: Techniques like ice therapy, ultrasound therapy, shockwave therapy, acupuncture and manual therapy can help alleviate pain and inflammation.

- Stretching and strengthening exercises: Targeted exercises can improve flexibility and strengthen the muscles around the elbow, reducing strain on the injured tendons.

- Ergonomic education: A physiotherapist can provide guidance on posture, body mechanics, and how to adjust activities to reduce the risk of reinjury.

- Manual therapy: Techniques like joint mobilization or soft tissue massage can help improve mobility and promote healing.

With the right physiotherapy program, most people experience significant improvement within a few weeks.

3. What Causes Tennis Elbow?

While tennis elbow is often associated with tennis or other racquet sports, it can develop from any activity that requires repetitive use of the forearm muscles. Some common causes include:

- Racquet sports (e.g., tennis, squash, badminton) where repetitive gripping and swinging put stress on the elbow.

- Manual labor: Jobs that involve repetitive movements such as gripping tools, lifting, or twisting motions (e.g., construction workers, plumbers, or painters).

- Overuse in weightlifting: Poor form during lifting exercises can strain the elbow.

- Repetitive motions in daily activities: For example, prolonged use of a computer mouse, typing, or even repetitive gardening tasks.

Any activity that overworks the muscles and tendons of the forearm can potentially lead to tennis elbow.

4. What Are the Symptoms of Tennis Elbow?

The most common symptoms of tennis elbow include:

- Pain on the outside of the elbow: This pain may worsen when you grip, lift, or twist your arm.

- Tenderness: The area around the lateral epicondyle becomes sensitive to touch.

- Weak grip strength: Difficulty holding objects such as a tennis racket, a mug, or a door handle.

- Radiating pain: The pain may spread down the forearm and even into the wrist.

Pain typically increases with activities that stress the forearm muscles, such as shaking hands, turning a doorknob, or lifting objects.

5. How Can Physiotherapy Help in the Early Stages of Tennis Elbow?

In the early stages of tennis elbow, the primary goal of physiotherapy is to reduce inflammation and pain. Techniques used by a physiotherapist may include:

- Cold therapy: Applying ice to the elbow for 15–20 minutes helps reduce inflammation and numb the area.

- Ultrasound therapy: High-frequency sound waves are used to promote healing and reduce swelling in the tissues.

- Shockwave therapy

- Manual therapy: Soft tissue massage and joint mobilizations can help decrease pain and improve range of motion.

Physiotherapists will also work on teaching you activity modification to prevent further stress on the elbow while allowing healing to begin.

6. How Can Physiotherapy Help in the Later Stages of Tennis Elbow?

Once the acute pain starts to subside, physiotherapy focuses on restoring function, strength, and flexibility. This may involve:

- Stretching exercises: Gentle stretches to improve flexibility and prevent stiffness in the elbow and forearm.

- Strengthening exercises: Exercises like wrist curls, reverse curls, and eccentric strengthening can target the forearm muscles to help support the tendons and prevent further injury.

- Proprioception exercises: These help improve coordination and control of the muscles around the elbow joint, reducing the risk of reinjury.

- Taping or bracing: A physiotherapist may use kinesiology tape or an elbow brace to support the injured tendon and reduce strain during movement.

7. How Long Does It Take to Recover with Physiotherapy?

Recovery time varies depending on the severity of the injury and how well you follow your rehabilitation program. On average, it can take anywhere from 4 to 12 weeks for significant improvement. In the early stages, you might feel relief within a few weeks of following a physiotherapy plan. However, full recovery may take several months, especially if the condition is chronic or if it's been left untreated for a while.

Consistency with exercises and following the physiotherapist's guidance are crucial for a successful recovery. If you try to return to activities too soon, you risk re-aggravating the injury.

8. What Exercises Can I Do at Home for Tennis Elbow?

Once a physiotherapist has assessed your condition and provided specific guidance, there are a number of safe exercises you can do at home to aid recovery:

- Wrist flexor and extensor stretches: Gently stretch the muscles in your forearm to improve flexibility.

- Eccentric strengthening exercises: Using a light dumbbell, lower the weight slowly during wrist curls or reverse wrist curls to strengthen the forearm tendons.

- Isometric exercises: These involve contracting the muscles without moving the joint (e.g., pressing your hand against a wall or sturdy object) to build strength without straining the elbow.

Your physiotherapist will provide a tailored exercise plan based on your condition and recovery progress.

9. Can Physiotherapy Prevent Tennis Elbow in the Future?

Yes! Once you've recovered from tennis elbow, physiotherapy can help reduce the risk of future injuries. Key strategies include:

- Strengthening the forearm muscles: Stronger muscles help absorb stress and reduce strain on the elbow tendons.

- Improving biomechanics: A physiotherapist will assess your posture, body mechanics, and activity technique (whether you're lifting, playing sports, or typing) and offer suggestions for improvement.

- Ergonomic adjustments: If your work or hobbies involve repetitive motions, a physiotherapist can help you set up an ergonomic workstation or recommend modifications to your routine to minimize strain on the elbow.

10. When Should I See a Physiotherapist?

If you’ve been experiencing elbow pain that doesn't improve with rest, or if it’s affecting your daily activities, it's a good idea to consult a physiotherapist. Early intervention can help manage symptoms more effectively and speed up recovery.

You should see a physiotherapist if:

- The pain persists for more than a couple of weeks.

- The pain interferes with your daily tasks or work.

- You notice weakness in your grip strength.

- You want to ensure a proper recovery and prevent reinjury.

Final Thoughts

Tennis elbow can be a frustrating condition, but with proper physiotherapy treatment, most people can recover fully and return to their activities without pain. Physiotherapy plays a key role in managing symptoms, restoring function, and preventing future injuries. Whether you're in the early stages of tennis elbow or are recovering from a long-term issue, a tailored physiotherapy plan can help you heal and get back to doing what you love. If you think you may have tennis elbow, don’t wait—consult a physiotherapist today to get started on the path to recovery.

If you have any questions or concerns, please do not hesitate to contact me.

Roopdeep Kaur, PT, FRCms, MSc. PT, BPT

Orthopedic & Pelvic Health Physiotherapist