Tennis Elbow Overview
1. Understanding Tennis Elbow: What Is It?
Tennis elbow, or lateral epicondylitis, is not limited to players of the sport—it’s a tendinopathy caused by overuse or repetitive strain of the wrist and finger extensor muscles, which attach to the outside of the elbow. Pain, tenderness, and stiffness around the lateral epicondyle are common symptoms . Activities like gripping, twisting, or lifting can aggravate the condition .
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2. Diagnosis: Pinpointing the Problem
Clinical Assessment
Physiotherapists use specific tests to confirm the diagnosis:
• Cozen’s test: Pain elicited when resisting wrist extension.
• Maudsley’s test: Pain when extending the middle finger against resistance.
• Mills test: Pain when passively extending the elbow with forearm pronated and wrist flexed .
Imaging (When Needed)
• Diagnostic ultrasound is the gold standard for visualizing tendon degeneration or tear severity and guiding treatment planning .
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3. Physiotherapy Management: A Comprehensive Approach
Conservative First
Most cases resolve with rest, activity modification, and physiotherapy—invasive interventions are rarely needed .
Therapeutic Exercise
A structured and progressive exercise regimen should form the foundation of most management plans. Each program should be tailored to your specific needs and there isn’t a ‘one size fits all’ approach. Hence why a physio assessment is important initially to accurately diagnose and subsequently provide appropriate exercises. An example of some of the exercises are described below:
• Strengthening—wrist curls (flexion and extension), grip exercises, and eccentric loading. Programs typically span 6+ weeks to show significant improvement .
• Stretching—wrist extensor/flexor stretches promote flexibility. Hold 15–30 seconds, repeat daily .
Physiotherapy can be very useful for tennis elbow.
Manual Therapy & Modalities
• Techniques like joint mobilization, soft tissue massage, and myofascial release may help reduce pain and improve motion and can be used as an adjunct to your exercise program
• Adjuncts such as ultrasound therapy, electrical stimulation (TENS), dry needling, and shockwave therapy (ESWT) may be utilised also. .
Patient Education & Self‑Care
• Teach ergonomic adaptations and modifications in daily activities to offload the elbow .
• Bracing or taping can relieve tendon stress during functional tasks .
• Self‑care strategies include ice therapy (15–20 minutes, several times a day) and self‑massage, such as cross‑friction techniques .
Recovery Timeline
• Many individuals see improvement within 6-10 weeks of physiotherapy .
• However, full recovery—or continued improvement—may take several months of consistent effort and exercise adherence .
Advanced Interventions (if Necessary)
If non‑surgical approaches fail:
• Shockwave therapy, PRP, or ultrasound‑guided injections may be considered .
• Surgery is generally a last resort for persistent cases resistant to conservative management .
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4. Prevention: Ensuring Long‑Term Elbow Health
Preventive strategies include:
• Proper technique and ergonomic tools during sports or manual tasks .
• Regular strengthening and stretching to maintain tendon and muscle resilience .
• Adequate rest and recovery to avoid overloading the tendon. Avoiding sudden increases in loading volumes to reduce your risk of future relapse.