Physical Therapy for Tennis Elbow
Tennis elbow is one of the most common elbow injuries that results from overuse of the muscles of your arm and forearm. It occurs in the tendons that attach your muscles to the rounded projection of bone on the outside of the elbow, causing radiating pain from the outside of the elbow to the forearm and wrist. Tennis elbow normally develops gradually over weeks and months due to repetitive use of the wrist, hand, arm, and elbow over time. Physical therapy is an effective treatment for tennis elbow, helping patients build muscle strength, regain function in the elbow and forearm, and manage pain.
Anatomy of the Elbow & Forearm
The elbow is a hinge joint that is made up of three bones: the humerus, the ulna, and the radius. The bones are connected through ligaments that provide the main source of stability in the elbow, while the biceps and triceps tendons attach the upper arm muscles to the elbow bones.
The muscles in your forearm cross the elbow and attach to the humerus at the outside bump (the lateral epicondyle). Most of the muscles and tendons that straighten the fingers and wrist come together and attach at the elbow, including the wrist extensor and wrist flexor muscles and tendons. All the nerves that travel down the arm pass across the elbow and are responsible for signaling your muscles to work and relay sensations of touch, pain, and temperature.
What is Tennis Elbow?
Tennis elbow is one of the most common elbow injuries that results from overuse of the muscles of your arm and forearm. It occurs in the tendons that attach your muscles to the rounded projection of bone on the outside of the elbow (the lateral epicondyle). In most cases, tennis elbow originates in the common extensor tendon where multiple muscles attach to the elbow. The affected fibers are most often the deep anterior fibers of the extensor carpi radialis brevis, which is responsible for extension and radial deviation of the wrist. The tendon undergoes degenerative changes due to being overworked and unable to handle the forces placed on the tendon daily.
Tennis elbow is more common among men than women and most often occurs between the ages of 30 to 50. While tennis elbow does affect tennis players, it also can affect manual workers, those operating machinery, or those working on a computer as these repetitive activities can irritate the wrist and forearm over time. This injury can develop among tennis players due to overtraining, a racquet that is too heavy, an improper grip or tennis technique, constant use of the backhand stroke, poor overall fitness, or a lack of sufficient strength in the core, trunk, and shoulder blade muscles.
Tennis elbow normally develops gradually over weeks and months due to repetitive use of the wrist, hand, arm, and elbow over time. Repeatedly contracting your forearm muscles causes stress on the tissues of the forearm and elbow, which can result in a series of tearings across the muscles and tendons of the forearm where they attach to the elbow, causing pain and loss of function.
Symptoms of tennis elbow can include:
Pain that radiates from the outside of the elbow into the forearm and wrist
Increased pain or difficulty when using the wrist and hand for everyday activities, particularly when gripping objects
Elbow stiffness
Weakness in the forearm wrist, or hand
Physical Therapy for Tennis Elbow
Physical therapy is an effective treatment for tennis elbow, helping patients build muscle strength, regain function in the elbow and forearm, and manage pain. Research has shown that exercise therapy is a more effective treatment for the majority of cases of tennis elbow than cortisone injections, medications, or surgery. In fact, there is strong evidence that suggests that cortisone shots provide short-term pain relief but lead to worse outcomes after 6 and 12 months compared to physical therapy management with substantial recurrence rates among those that received only cortisone shots for tennis elbow.
Early on in treatment for tennis elbow, when the pain is the most intense, the therapist helps manage pain using ice to minimize inflammation. The therapist also performs gentle passive exercises to move the wrist and elbow without straining the involved muscles and tendons. Manual therapy soft tissue and joint mobilizations are done to improve mobility and reduce tightness in the soft tissue and joint to help restore range of motion in the elbow and wrist.
The physical therapist also provides patient education, helping to retrain muscles to use them properly when engaging in repetitive activities and helping the patient modify these actions to minimize injury risk. As symptoms improve, the patient can move on to active exercises to gradually strengthen the wrist and forearm as well as the core and upper back muscles for a strong kinetic chain from the trunk and shoulder through the arm and wrist.
The dual rehab program involves:
An active aerobic warm-up to increase blood flow, soft tissue pliability, and body temperature to prepare the muscles and joints for movement.
Scapular muscle strengthening: Research has shown that shoulder girdle (scapular muscles) weakness is often present in tennis elbow patients. Targeted strengthening of the scapular muscles strengthens the kinetic chain and reduces stress on the elbow and forearm. The physical therapist guides the patient through a phased strengthening program of the scapular muscles: phase 1 involves isometric activations of the serratus anterior and trapezius muscles and scapular retraction training; phase 2 involves resisted strengthening of the scapular muscles and serratus anterior and trapezius; and phase 3 involves moderate to heavy loading and advanced resisted exercises of the scapular and back muscles.
Wrist & elbow muscle strengthening: Targeted strengthening of the wrist, elbow, and forearm muscles involves a progressive approach: Phase 1) neuromuscular re-education and isometric activation of the wrist extensors and radial deviators; Phase 2) progressive resisted strengthening of the elbow and wrist musculature; and Phase 3) moderate to heavy loading and advanced resisted exercises of the elbow and wrist musculature.
Manual therapy: soft tissue mobilizations to reduce pain and gently improve range of motion and function of the wrist, elbow, and forearm.
Wrist extensor stretching to increase muscle flexibility in the wrist and forearm.
In the video below, Mangiarelli Rehabilitation physical therapist Jen demonstrates three different treatment options to address tennis elbow:
