Tennis Elbow Physical Therapy

You don’t play tennis—but your elbow hurts. How is that possible? Your Andre Agassi or Chris Evert days are behind you. That’s because approximately 40% of the general public will get lateral epicondylalgia (also known as tennis elbow) at some point. For some, tennis elbow happens when the muscles in your forearm are “overloaded” past what they are used to. For others, it just kind of happens. Tennis elbow was previously believed to be self-limiting—meaning that it would go away on its own after six months to a year. But now we know that for the majority, it’s not. We actually need to DO something to help it go away. What we should do is the tricky part.

Just like your mother always told you—patience is a virtue. It’s even more true in the case of tennis elbow. If we let it move to the “chronic” stage by using the “wait and see” approach (i.e. rest) it can linger much, much longer.

It’s Still Probably Not The Answer

If you’ve read any of my previous blogs, you know that I’m typically against early imaging for most musculoskeletal aches and pains. Tennis elbow is no exception. One study that used ultrasound found structural changes and tears in in the lateral elbow tissues of 50% of healthy, asymptomatic, age and gender matched individuals. This means that changes in the elbow tendons and tearing is normal and shouldn’t be a scary finding or result. While micro tearing is normal—pain is not. This is why we focus on changing your pain and function and not on what your MRI or ultrasound shows.


Conservative treatment (i.e. Physical Therapy) is recommended as the first line treatment for tendinopathy. Load management and exercise remain the cornerstone for managing tendinopathy. Eccentric (contracting the muscle while it’s lengthening), concentric (contracting while shortening), and isometric (fixed length contraction) all show positive benefits to treating tendons but none are reliably better than the others. This means that while exercise is usually the answer, the type needs to be individualized to the needs, goals, and response of the patients. Cookie cutter exercises aren’t enough.


What About Braces

Manual mobilization of the elbow, wrist, and thoracic spine shows some evidence for short term relief. Use of orthoses (e.g. splints) has conflicting evidence. One study showed some evidence for short term relief but there is no evidence that one type of orthoses is better than any other and adding them to exercise didn’t show any additional benefit. Because of this, it’s probably best to save your money. That brace does look pretty cool though…

Do Injections Help?

Corticosteroids shots have benefit in the short term but may have some long term negative effects on your tendon health. Cross-friction massage was in vogue for a time but, when studied, it appears to have no benefit to long term outcomes. Neither one of these treatments changes the structure or function of your tendons—which are what we really care about—so they should never take priority over exercise and load management.

Okay so exercise is great and it works but what exercises? How many reps? How much weight?

In the acute phase, we recommend avoiding any activities that cause a symptom flare-up or a pain >3/10. Isometric exercises typically have a pain relieving effect, so adding some of those can help in the short term. Improving forearm extensor strength and grip strength while working on shoulder and scapular strength is the main focus.

Here are some of our favorite exercises for tennis elbow:

If you have been dealing with tennis elbow—or any other tendon issue, you can contact us HERE!