Rehabilitation of Tennis Elbow

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.

Aims of rehabilitation

• Reduce pain and inflammation.
• Identify possible causes of injury.
• Stretching and strengthening.
• Gradual return to activity.

A number of treatment methods are available in the rehabilitation of tennis elbow. In order to maximize the chance of a successful rehabilitation it is important to apply as many as you can.

It is important throughout the rehabilitation process to maintain fitness in ways that do not stress the elbow such as cycling or running so long as it is not painful.

Reducing pain and inflammation

• Rest from activity that causes pain. If you are a tennis player then stop playing. It is not just tennis that causes this injury or may aggravate it. Gripping anything tightly or for long periods may make it worse, even opening heavy doors.
• Wear a brace, support or heat retainer. This will give support and help prevent further injury. Increasing heat after the initial acute stage will stimulate blood flow and aid healing.
• Cold therapy should be applied in the early stages - first couple of days. This can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (later). Do not apply ice directly to the skin as this may cause ice burns - wrap in a wet tea towel.
• NSAID's (Non Steroidal Anti-inflammatory Drugs) such as Ibuprofen can help reduce pain and inflammation, especially in the early stages. It is thought they are less helpful later in the rehabilitation process. Always check with a Doctor before taking medication. You should not take Ibuprofen if you have asthma.
• This phase will usually take from 2 days to 2 weeks.

Identify possible causes

• Overuse is the main cause of tennis elbow. Doing too much, too soon without allowing your body to recover. Keep a training diary. This will allow you to look back and identify if you have been over training.
• The chance of suffering over use injuries is greatly increased if you have faulty technique. For example in tennis incorrect backhand technique, having the wrong grip size or badly strung rackets can all increase the chance of suffering tennis elbow.

Sports massage therapy

• Sports massage can play an important part in the rehabilitation process.
• Massage should be applied after the acute stage - lightly at first, below pain levels.
• Cross frictions at the site of injury can help stimulate healing and stripping techniques on the muscles will help relax tight and knotted muscles that may increase the strain at the elbow.
• Apply cold therapy after massage treatment.

Stretching

• Stretching should begin as soon as possible, gently at first and continue throughout the rehabilitation process and after.
• Hold stretches initially for 10 - 15 seconds - during the acute stage. Later stretches should be held for up to 40 seconds.
• Repeat stretches 5 times and aim to stretch at least three times a day.
• Click here for details of stretching exercises.

Strengthening

• Strengthening exercises should begin as soon as pain allows. This will depend on how bad the injury is.
• If it hurts during the exercise, after or makes it worse the next day then do not do strengthening exercises. Be patient.
• Start with static exercises. When these can be done comfortably move onto concentric and eccentric exercises.
• It is important that strengthening exercises are done before trying to return to activity.
• Apply cold therapy after strengthening exercises.
• Click here for more details on strengthening exercises.

Return to activity

• This should be done gradually and only when you can hit balls without pain.
• When you can comfortably manage the strengthening exercises then it may be possible to return to activity. If you are a tennis player ensure you have the correct technique. Wearing a brace can help take the strain off the elbow during the return to full fitness.
• Practice strokes without a ball to start with. Introduce a ball and gradually increase power in shots and number of practice shots played. For example session 1 - 20 strokes at 20% effort. Session 2 - 30 strokes at 40% effort and so on.
• This gradual increase should take place over a six week period. If you find you have pain during, after or the next day then take a step back.
• Throughout this phase it is essential that stretching and strengthening routines are maintained.