Tennis Elbow Physiotherapy

Get relief from tennis elbow with effective physiotherapy treatment specifically designed to target and alleviate pain caused by this common condition.


Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm. Despite its name, athletes aren’t the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers. The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow.

Pain can also spread into your forearm and wrist. It should be remembered that only 5% of people suffering from tennis elbow relate the injury to tennis! Contractile overloads that chronically stress the tendon near the attachment on the humerus are the primary cause of epicondylitis. It occurs often in repetitive upper extremity activities such as computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration. Despite the name you will also commonly see this chronic condition in other sports such as squash, badminton, baseball, swimming and field throwing events. People with repetitive one-sides movements in their jobs such as electricians, carpenters, gardeners also commonly present with this condition.


The majority of the patients complain of pain located just anterior to, or in, the bony surface of the upper half of the lateral epicondyle, usually radiating in line with the common extensor mass. The pain can vary from intermittent and low-grade pain to continuous and severe pain which may cause sleep disturbance. It is typically produced by wrist and finger extensor and supinator muscle contraction against resistance. The pain lessens slightly if the extensors are stressed with the elbow held in flexion.

On inspection, there is no remarkable alteration in the early stages. As the disease evolves, a bony prominence over the lateral epicondyle can be detected. Muscle and skin atrophy as well as detachment of common extensor origin can be seen as a result of corticosteroid injections or long-standing disease.

Range of motion is not usually affected. Motion may be painful in more advanced stages where it can be elicited in full elbow extension with the forearm pronated. If limited motion exists, other concomitant pathology needs to be excluded. There are many tests employed in LE physical examination. Maudley’s test, Thomson’s manoeuvre, diminished grip strength and the ‘chair’ test are some of the tests employed to reproduce the pain of tennis elbow.


Plain anteroposterior (AP) and lateral radiographs are useful for the assessment of bone diseases such as OCD, arthropathy and loose bodies.

Ultrasound is one of the most useful tools to diagnose or rule out LE. Structural changes affecting tendons (thickening, thinning, intra-substance degenerative areas and tendon tears for example), bone irregularities or calcific deposits can be detected.

Magnetic resonance imaging (MRI) is more reproducible, reduces inter-operator variability and gives more information about intra-articular pathology. Unfortunately, findings on MRI are not well correlated with the severity of clinical symptoms, and is an expensive modality to be used routinely for such a common condition.


Doctors sometimes recommend very different treatments for both tennis elbow and golfer’s elbow. According to the studies done so far, the following treatments can help:

Stretching and strengthening exercises: Special exercises that stretch and strengthen the muscles of the arm and wrist.

Manual therapy: This includes active and passive exercises, as well as massages.

Painkillers: especially non-steroidal anti-inflammatory drugs (NSAIDs).

Injections: Steroid injections.

Ultrasound therapy: The arm is exposed to high-frequency sound waves. This warms the tissue, which improves the circulation of blood.

The main treatment for symptom relief is usually a combination of stretching and strengthening exercises. NSAIDs are an option for short-term treatment. Steroid injections can also relieve the pain, but they may disrupt the healing process.

Most of the following treatment options for tennis elbow are also in market.

Braces / bandages: These are worn around the elbow or on the forearm to take strain off the muscles.

Injections: Injections into the elbow with various substances, such as Botox, hyaluronic acid or autologous blood (the body’s own blood).

Extracorporeal shockwave therapy (ESWT): A device generates shock or pressure waves that are transferred to the tissue through the skin. This is supposed to improve the circulation of blood in the tissue and speed up the healing process.

Laser therapy: The tissue is treated with concentrated beams of light. This is supposed to stimulate the circulation of blood and the body’s cell metabolism.

Transcutaneous electrical nerve stimulation (TENS): TENS devices transfer electrical impulses to the nervous system through the skin. These are supposed to keep the pain signals from reaching the brain.

Acupuncture: The acupuncture needles are inserted into certain points on the surface of the arm. Here, too, the aim is to minimize the perception of pain.
Cold: The elbow is regularly cooled with ice packs.

Massages: A massage technique called “transverse friction massage” is often used to treat tennis elbow and golfer’s elbow. It is applied to the tendons and the muscles, using the tips of one or two fingers.

Surgery: Different surgical approaches are used. Most of them involve detaching parts of the forearm muscles or separating and destroying the nerves that carry the pain signals.