From the Guidelines
Lateral epicondylitis, commonly known as tennis elbow, should be treated with a combination of activity modification, rest, NSAIDs, ice, and physical therapy focusing on eccentric strengthening exercises, as this approach has been shown to be effective in reducing pain and promoting recovery 1.
Treatment Approach
The treatment of lateral epicondylitis typically involves a multi-faceted approach, including:
- Activity modification to avoid painful movements and rest from aggravating activities
- NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation
- Ice applied for 15-20 minutes several times daily, especially after activity
- A counterforce brace worn just below the elbow to reduce tendon strain
- Physical therapy focusing on eccentric strengthening exercises, including wrist extension exercises with light weights (1-3 pounds) for 3 sets of 15 repetitions daily
Key Recommendations
Some key recommendations for the treatment of lateral epicondylitis include:
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
- Cryotherapy to provide acute relief of tendinopathy pain 1
- Eccentric strengthening as an effective treatment of tendinopathy and may reverse degenerative changes 1
- NSAIDs for short-term pain relief, but with no effect on long-term outcomes 1
Long-Term Outcomes
Most cases of lateral epicondylitis resolve within 6-12 months with conservative treatment 1. If symptoms persist beyond 6-12 months, corticosteroid injections or other interventions may be considered 1. It is essential to note that locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes 1.
From the Research
Definition and Prevalence of Lateral Epicondylitis
- Lateral epicondylitis is a common problem among physically active individuals, affecting approximately 1 to 3 percent of the population 2.
- It is also known as tennis elbow, although this name is somewhat of a misnomer as the condition is often work-related and occurs in athletes and nonathletes alike 3.
Treatment Options for Lateral Epicondylitis
- Initially, lateral epicondylitis can be treated with rest, ice, tennis brace and/or injections 4.
- Physical therapy is initiated when the condition is chronic or not responding to initial treatment, with common rehabilitation modalities including ultrasound, phonophoresis, electrical stimulation, manipulation, soft tissue mobilisation, and stretching and strengthening exercise 4.
- Electrophysiotherapy and physical therapy have been shown to be effective in improving pain and function compared to placebo 2.
- Injections, such as corticosteroid injections, may provide short-term pain relief but have not been shown to provide long-term benefits 5.
- Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief 5.
- Surgery may be considered as a last resort for chronic or resistant cases 4, 6.
Efficacy of Treatment Options
- A systematic review and meta-analysis found that electrophysiotherapy and physical therapy were effective in improving pain and function, while injections did not improve any outcome measures 2.
- Another systematic review found that there was no conclusive evidence to support one preferred method of non-surgical treatment for lateral epicondylitis 5.
- A review of current concepts in the management of lateral epicondylitis highlighted the need for a standard protocol for treatment, given the numerous options available 6.