From the Guidelines
Tennis elbow management should prioritize relative rest, reduced activity, and eccentric strengthening exercises to promote healing and pain relief. The goal is to minimize further damage and alleviate symptoms, with a focus on improving quality of life and reducing morbidity. According to 1, relative rest and reduced activity are recommended to prevent further damage and promote healing and pain relief, although the duration of rest and avoidance of activity is not clearly defined.
Key management options for tennis elbow include:
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief
- Eccentric strengthening exercises, which have been shown to be an effective treatment for tendinopathy and may reverse degenerative changes 1
- Cryotherapy, such as repeated applications of melting ice water through a wet towel for 10-minute periods, to provide acute relief of tendinopathy pain 1
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, although they have no effect on long-term outcomes 1
- Topical NSAIDs, which may have fewer systemic side effects, although it is unclear whether they are better than other analgesics 1
It is essential to note that locally injected corticosteroids may provide acute-phase pain relief but do not alter long-term outcomes 1. Additionally, orthotics and braces may be used based on clinical experience and patient preference, but there are no conclusive recommendations for their use in elbow tendinopathy 1. Surgery is an effective option for carefully selected patients who have failed three to six months of conservative therapy 1.
From the Research
Management Options for Tennis Elbow
The management of tennis elbow involves a range of options, including:
- Conservative treatment programs, which have been shown to result in high success rates 2
- Nonsurgical treatment options, such as rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities 3
- Physiotherapy, which is the most commonly used primary intervention, but with a wide range of treatment options within this umbrella 4
- Surgery, which may be required as a last resort in patients with chronic symptoms 2, 3
Treatment Approaches
Treatment approaches for tennis elbow vary widely, with some common methods including:
- Education and exercise, although the type and dosing of exercise can vary greatly 4
- Passive modalities such as ice, taping, manual therapy, acupuncture, and electrotherapy, although the use of these modalities is not always supported by research evidence 4
- Corticosteroid injections, which are still commonly used despite a lack of supporting research evidence 4
Current Concepts and Research
Current research and concepts in the management of tennis elbow highlight the need for evidence-based guidance for physiotherapists treating patients with this condition 4
- The condition is estimated to affect 1-3% of the adult population each year, and is more common in the dominant arm 5
- Tennis elbow is generally regarded as an overuse injury involving repeated wrist extension against resistance, although it can occur as an acute injury (trauma to the lateral elbow) 5