From the Guidelines
Tennis elbow can be effectively treated with a combination of rest, physical therapy, and medication, with the goal of reducing pain and inflammation, and promoting healing and recovery. The treatment approach should prioritize conservative measures, as most cases improve within 6-12 weeks with consistent treatment 1.
Initial Treatment
The initial treatment for tennis elbow should include:
- Reducing activities that aggravate the pain, particularly those involving wrist and arm movements
- Applying ice to the affected area for 15-20 minutes several times daily to reduce inflammation
- Using over-the-counter pain relievers like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) to manage pain and inflammation for 1-2 weeks 1
Physical Therapy
Physical therapy exercises focusing on stretching and strengthening the forearm muscles are crucial for recovery; these include:
- Wrist extensions
- Flexions
- Pronation/supination movements
- These exercises should be performed 2-3 times daily with 10-15 repetitions each 1
Support and Bracing
A counterforce brace worn just below the elbow can provide support during daily activities, although the evidence for its effectiveness is limited 1
Persistent Cases
For persistent cases, a healthcare provider might recommend:
- Corticosteroid injections
- Physical therapy modalities like ultrasound or electrical stimulation
- Surgery may be considered in carefully selected patients who have failed three to six months of conservative therapy 1
Addressing Underlying Mechanical Stress
Addressing the underlying mechanical stress is essential for both healing and preventing recurrence, as tennis elbow occurs when the tendons connecting forearm muscles to the elbow become inflamed from overuse or repetitive motions 1
From the Research
Treatment Options for Lateral Epicondylitis (Tennis Elbow)
The treatment for lateral epicondylitis, also known as tennis elbow, can be conservative or surgical. Conservative treatment is successful in up to 90% of cases 2. The following are some of the treatment options:
- Physiotherapy: focuses on pain management, functional recovery, and recurrence prevention 3
- Modalities: such as patient education, use of splints, anti-inflammatory medication, complementary medicine, and local injections 2
- Exercise rehabilitation: includes tailored workouts to strengthen weak muscles and improve elbow joint biomechanics, such as eccentric training and progressive resistance exercises 3
- Manual treatments: include joint mobilizations, soft tissue massage, and myofascial release to treat pain and improve joint function 3
- Bracing: can be effective in treating tennis elbow, and the extensor grip test has predictive value in assessing the effectiveness of bracing 4
- Corticosteroid injections: appear to be relatively safe and effective in the short term (2-6 weeks), but the existing evidence is not conclusive 5
Conservative Treatment
Conservative treatment is the initial approach for treating tennis elbow. It includes a combination of the above-mentioned treatment options. The goal of conservative treatment is to relieve pain, improve function, and prevent recurrence.
Surgical Treatment
Surgical treatment is considered only as a last resort, when conservative treatment has failed. Both open and arthroscopic methods are acceptable and have excellent results 2.
Assessment and Diagnosis
Accurate assessment and diagnosis of tennis elbow are crucial in determining the most effective treatment options. Physiotherapists play a vital role in correctly diagnosing the condition and distinguishing it from other musculoskeletal problems 3, 6.