Outlined below is a simple treatment and rehabilitation program for tennis elbow. No single treatment is likely to be effective but a combination of methods can be successful.
Treatment for Tennis Elbow is based on reducing pain and inflammation then gradually increasing the load on the muscles and tendons to a point where the athlete can resume normal training and competition.
Self help treatment
Initial treatment is based around following acute first aid with the aim of minimising any bleeding / inflammation and swelling at the tendon attachment area. When this stage is complete, the next part of the recovery process is to restore the strength levels back into the wrist extensor muscles.
In the first 72 hours post injury, you should apply the principles of P.R.I.C.E. to the area. P.R.I.C.E stands for Protection, Rest, Ice, Compression and Elevation.
Protection of the inflamed tissue can be achieved by wearing an elasticated support and this will make the injured area feel more comfortable especially when the pain is sharp and intense.
The use of Tennis Elbow supports helps to protect the tendon attachment and provide additional support while it heals. The supports can also be used during the later stages of rehabilitation and when finally return to playing sport.
In the early stages we advise wearing a specialist tennis elbow brace around the forearm to support the healing tendon. It works by applying compression around the elbow and changing the direction of force that is transmitted through the tendon and hopefully reducing the strain on the painful area.
The second principle of acute injury management is to the rest from all sporting activities especially those that repeatedly use the wrist and arm muscles and also in the early stages of healing. In addition to resting from sport, some everyday activities (which place a large strain on the elbow) should be avoided such as gripping things or opening heavy doors and using tools such as a screw if possible.
Cold Therapy and Compression
Applying cold therapy is very important to reduce inflammation and swelling in the area and is best achieved by using a cold pack and compression bandage which combine to apply both cold and compression in one application (see below). If using a traditional ice pack do not apply directly to the skin (wrap in a damp towel) and do not leave it on the skin for more than 15 minutes otherwise it may cause an ice burn.
The final principle of PRICE is elevation but in Tennis Elbow injuries is the least important of the PRICE principles and is the most difficult to achieve effectively.
Read more on P.R.I.C.E and how to apply it.
No single treatment has been shown to be totally effective in treating Tennis Elbow although a combination of the treatments that are often performed by professional therapists (see below) are deemed to be the most effective.
A useful treatment for tennis elbow is friction massage of the tendon insertion. Once the initial inflammation has settled (after 5 day) place the 2nd finger of your opposite hand on the outside of the elbow and rub across the tendon (painful area) for 5 minutes. Do not press too hard but there may be some mild pain whilst having the area 'frictioned'. Repeat once a day. Do not carry on with this exercise if the pain worsens after the treatment.
Every Tennis Elbow injury will react differently to the different treatments available so using a number of them concurrently is often the most effective way of treating the condition. In addition to treating the current injury, it is also important to identify and correct any possible causes that may be either work related or sport related and your therapist will be able to advise how to achieve this.
In addition to home treatment, a full rehabilitation program should then be followed and this includes a number of stretching and strengthening exercises in order to restore normal function back into the arm.
What can a sports injury professional or doctor do?
Your therapist may choose to use different types of electrotherapy equipment to treat the symptoms. Some of the methods commonly used include the following:
- Ultrasound – this involves passing high frequency sound waves into the tissues. This vibrates the molecules and depending on if it is applied continuously or in pulses can generate heat.
- Laser – works by passing high intensity light into the tendon to reduce pain, inflammation and encourage cell reproduction. No heat is generated with laser treatment.
- Extracorporeal Shock Wave Therapy - works by passing shock waves (short but intense energy waves) which travel faster than the speed of sound, into the tissues.
A doctor may choose to prescribe anti-inflammatory medication such as ibuprofen to reduce pain and inflammation if it is present. This may be beneficial in the earlier stages but its effectiveness later in the rehabilitation process is controversial. You should not take Ibuprofen if you have asthma.
Manual therapy treatments such as massage therapy, myofacial release and transverse friction massage may be beneficial for Tennis Elbow, especially if the initial treatment of rest and cold therapy has not fully settled the problem. In particular, trigger points and localized knots within the extensor muscles of the forearm can be treated with a variety of massage techniques. Transverse friction massage is a popular and effective method and is used to treat both the attachment area itself and the adjoining tendon and the overall aim is to encourage effective healing and the formation of good quality scar tissue.
Dry needling or Acupuncture has been shown to be an effective treatment for tennis elbow (in some cases). It involves inserting needles of various lengths and diameters into specific points around the forearm and surrounding areas. The needle is usually inserted, rotated and then left in place for several minutes and the theory of how it works is to hopefully alter the way pain signals are transmitted via the nerve pathways.
Another treatment for Tennis elbow is injecting corticosteroid drugs into the area. Current evidence has shown them to be effective in the short term but the long term effects are debatable. In order to improve the chances of a good end result, the patient often requires a series of injections over a period of weeks or months as opposed to a one-off injection. The steroid should be injected around the area of the tendon attachment and not into the body of the tendon as there have been cases of tendon ruptures following steroid injections.
Other treatment that are sometimes used for tennis elbow include;
- Nitric oxide donor therapy patches - applied to the elbow may be beneficial over a period of months although approximately 5% of patients will have side effects including headaches and skin rashes.
- Botox injections - thought to improve short term pain relief although there is a very high likelihood that the forearm muscles will not function properly afterwards.
- Autologogous blood injection - involves centrifuging the patient’s own blood to separate the plasma from the red blood cells. The resulting plasma is rich in platelets that are effective for healing. This is then injected back in and around the site of injury. It is thought to re-initiate or enhance the inflammation repair response.
If all the conservative treatments mentioned above fail then surgery may be the only option, although it is likely to be a year before this is considered by a surgeon.