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Exercise and physical therapy for tennis elbow

Treatment Overview

As part of a tennis elbow rehabilitation program, exercise and physical therapy may promote tendon healing, restore normal range of motion, and build muscle strength and endurance.

Your doctor or physical therapist can develop a home program that will help restore your elbow movement and prevent further injury. He or she will explain each exercise, including the correct technique and number of times you should repeat each movement.

Exercise

Exercises to build or maintain good fitness are important for your recovery. Walking, cycling, water aerobics, jogging, and other aerobic exercises can increase your heart and lung fitness and increase general strength and endurance, without making your injury worse. These activities also increase blood circulation; increased circulation supplies the injured tendon with more oxygen and may promote healing.¹

Appropriate exercises for stretching, strengthening, and increasing your endurance are vital to your recovery.² Your doctor or physical therapist can recommend the best stretching and strengthening exercises for your condition.

Physical therapy

There are several different types of physical therapy. Some examples include:

• Learning new techniques and using different equipment for activities to help prevent further injury
• Ultrasound applied over the tender area is commonly recommended, although there is little evidence to support its use. The theory is that this deep heat increases blood flow and tissue flexibility, and may decrease pain and muscle spasms. (Therapists don't often use ultrasound therapy on children.)
• Electrical stimulation, or transcutaneous electrical nerve stimulation (TENS), which involves a mild electrical current that travels through electrodes placed at nerve trigger points. The objective is to mask pain signals sent by the brain to the body. Its effectiveness has not been proven.
• Massage over an inflamed area, which may reduce the formation of scar tissue and help new blood vessels grow in the damaged tissue. Massage is done by making small, firm circles over the injured area. It should not be painful and may be helpful before and after exercises.
• Manual therapy (sometimes called body work) uses just the hands to cause relaxation, lessen pain, and increase flexibility. Besides massage, manual therapy includes manipulation to position joints and bones. Mobilization is another form of manual therapy. The therapist uses slow, careful movements to twist, pull, or push bones and joints into position.

What To Expect After Treatment

Tennis elbow recovery time varies with each person and may take several weeks to several months. Recovery may be faster and more successful when you follow a rehabilitation program that includes exercise and physical therapy.

Why It Is Done

Exercise and physical therapy are helpful for treating elbow pain and soreness.

Exercise and physical therapy after elbow surgery are an important part of your recovery and may promote healing and restore strength and flexibility.²

How Well It Works

Most people can improve their elbow flexibility and strength with exercise and physical therapy. Without a good rehabilitative exercise program, it is likely that tennis elbow injuries will not get better.²

Risks

If exercises or physical therapy are not done correctly, there is a chance of further injury to the elbow.

If your pain increases, stop the exercises or physical therapy and seek help and instruction from your physical therapist or other health professional.

What To Think About

Exercise and physical therapy can help to restore flexibility and strength in an injured elbow.

It's important to improve or change techniques and equipment that may have caused tennis elbow. You can consult:

• An occupational therapist, who can help you find new ways to do everyday things that cause pain or trouble.
• A sports trainer, who can help with sporting activities and equipment.
• An ergonomic specialist, who can design your equipment and train you in techniques that improve your workplace comfort and efficiency.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

Citations

1. O'Connor FG, et al., (1997). Managing overuse injuries: A systematic approach. The Physician and Sportmedicine, 25(5): 88–113. Also available online: http://www.physsportsmed.com/issues/1997/05may/oconnor.htm.

2. Kraushaar BS, Nirschl RP (1999). Tendinosis of the elbow (tennis elbow). Journal of Bone and Joint Surgery, 81-A(2): 259–278.

Other Works Consulted

• Boyer MI, Hastings H II (1999). Lateral tennis elbow: "Is there any science out there?" Journal of Shoulder and Elbow Surgery, 8(5): 481–491.

• Ciccotti MG (1999). Epicondylitis in the athlete. AAOS Instructional Course Lectures, 48: 375–381.

• Sevier TL, Wilson JK (1999). Treating lateral epicondylitis. Sports Medicine, 28(5): 375–380.

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