From the Guidelines
The treatment for lateral epicondylitis (tennis elbow) should begin with conservative measures, including relative rest, ice application, and over-the-counter pain medications, as well as physical therapy focusing on eccentric strengthening exercises and stretching of the wrist extensor muscles, as recommended by the most recent and highest quality study 1. The goal of treatment is to reduce pain and inflammation, promote healing, and improve function.
- Relative rest is essential to prevent further damage and promote healing, as suggested by 1 and 1.
- Ice application for 15-20 minutes several times daily can help reduce pain and inflammation.
- Over-the-counter pain medications such as ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) can be used for pain and inflammation, although they may not alter long-term outcomes, as noted in 1.
- A counterforce brace worn just below the elbow can help reduce strain on the affected tendons.
- Physical therapy focusing on eccentric strengthening exercises and stretching of the wrist extensor muscles is highly effective, as recommended by 1, and should be performed 3 sets of 15 repetitions, twice daily for 6-12 weeks.
- For persistent cases, corticosteroid injections may provide short-term relief, though they aren't recommended for long-term management due to potential tendon weakening, as cautioned in 1.
- Newer treatments include platelet-rich plasma injections, which utilize the body's own healing factors. Most cases (80-95%) resolve with conservative treatment within 6-12 months, and surgery is rarely needed and reserved only for cases that don't respond to at least 6-12 months of conservative management, as indicated by 1. The condition results from repetitive microtrauma to the common extensor tendon at the lateral epicondyle, causing degeneration rather than inflammation, which explains why anti-inflammatory treatments alone often provide only partial relief. Key recommendations for practice include relative rest, reduced activity, cryotherapy, eccentric strengthening, and the use of NSAIDs for short-term pain relief, as outlined in 1.
From the Research
Treatment Options for Tennis Elbow
The treatment for lateral epicondylitis, also known as tennis elbow, can be divided into several categories, including:
- Conservative treatment: This approach includes relieving inflammation and pain with rest, ice, anti-inflammatory medications, and occasionally cortisone injections 2.
- Promoting the healing process: High-voltage galvanic stimulation can be used to promote the healing process 2.
- Exercises: Strengthening, endurance, and flexibility exercises for the arm and forearm can help in the treatment of tennis elbow 2, 3.
- Reducing overload forces: Using a counterforce brace and modifying the player's technique and equipment can help reduce the overload forces that caused the original injury 2.
Physiotherapy Techniques
Physiotherapy plays a crucial role in the treatment of tennis elbow, focusing on pain management, functional recovery, and recurrence prevention 3. Some physiotherapy techniques used in the treatment of tennis elbow include:
- Manual treatments: Joint mobilizations, soft tissue massage, and myofascial release can be used to treat pain and improve joint function 3.
- Exercise rehabilitation: Tailored exercises can be used to strengthen weak muscles and improve the biomechanics of the elbow joint 3.
- Modalities: Therapeutic agents such as ultrasound, laser therapy, and cryotherapy can be used in the treatment of tennis elbow 3.
- Complementary therapeutic agents: Taping and bracing can also be used as complementary therapeutic agents 3.
Treatment Effectiveness
An umbrella review of treatment options for tennis elbow found that injection therapies, such as autologous blood and platelet-rich plasma, are effective treatments, while acupuncture and shock wave therapy are not effective 4. The review also highlighted the value of physical therapy as a conservative treatment modality 4.
Clinical Review
A clinical review article on tennis elbow discussed the existing literature and current thinking on optimum treatment modalities, including the use of conservative treatment, physical therapy, and other modalities 5. The article also reviewed the literature available on Medline and discussed the condition with specialist colleagues in the field 5.