Introduction

Tennis elbow, also known as lateral epicondylitis,¹ happens most commonly in people who are between 35 to 54 years old and involves inflammation of the elbow, which can cause pain and other symptoms.² Tennis elbow is very common, affecting up to 3% of people in America every year.³ Even though it’s named after tennis, nine in ten people who have tennis elbow did not get it from playing sports.³

Most commonly, tennis elbow will get better by itself, but sometimes treatment like physiotherapy can help it to improve.²

This article will discuss tennis elbow and the physiotherapy exercises that can help.

What are the symptoms of tennis elbow?

People with tennis elbow experience pain around the outside of their elbow that reaches down towards their wrist.² This pain can range from mild irritation on moving to severe pain that stops you from sleeping.²

You may also find it difficult to stretch your arm out so that it is fully straight.² Tennis elbow can lead to the elbow joint being swollen and sore to the touch, and pain in the forearm.²

Tennis elbow can be more painful when:²

• Twisting your wrist
• Lifting things
• Holding something in a tight grip
• Bending your arm

What is tennis elbow?

The elbow joint is made of three bones (the radius and ulna, which are the two bones in the forearm, and the humerus, which is the bone in the upper arm).⁴ These three bones are held together by muscles (parts of your body which help you to move, breathe, and support your organs)⁵ and tendons (parts of your body which connect muscles to bones).6 There is a tendon in your elbow called the Extensor Muscle Tendon, and this is usually the part of the elbow which becomes inflamed in tennis elbow.³ 

The tendons that attach the muscles to the arm bones can get worn out and tired, or even get tiny microscopic tears in them.⁴ This normally happens when twisting and grabbing motions are done over and over again, making it a repetitive strain injury.³ If this happens, it can cause tennis elbow.⁴

People with tennis elbow often say that the pain is worse if they twist their arm, for example, when turning a doorknob.³ 

Who is at risk of tennis elbow?

Sports can be a cause of tennis elbow, though they are not the only thing that can cause it.¹

Things that increase the risk of someone developing tennis elbow are:^{1, 3} 

• Sports that are played with a racket
• Spending lots of time using a computer with a mouse
• Doing plumbing
• Cutting up food, especially meat
• Painting
• Using a screwdriver
• If you often lift more than 22 kg of weight
• If you are obese
• If you are over 40
• If you smoke
• If you play a musical instrument

Home treatments for tennis elbow

If you think that you have tennis elbow, it is recommended that you:² 

• Use an elbow, wrist, or forearm brace
• Rest the elbow as much as possible
• Use a cold or hot compress on the affected area
• Take paracetamol
• Rub anti-inflammatory gel on the area (remember that anti-inflammatory gels are flammable, and so you should avoid going near candles or other flames if you are using them)

If your tennis elbow does not improve on its own within two weeks, you should make an appointment with your doctor.

Physical therapy for tennis elbow

Physical therapy is a treatment designed to help people to improve their strength and flexibility after their body has been changed by something like illness, injury, or disability.² 

It can be used to help people whose brain or nervous system was damaged, whose lungs or breathing are affected, whose heart and circulation are not working as they should, or to help people whose bones and soft tissue have changed.² Tennis elbow falls under the last category.

Physical therapists are trained professionals who are experts in their job, and you should consult them before doing any physical therapy exercises.²

Some tennis elbow physical therapy exercises that your physical therapist might recommend will be discussed below.

Wrist extension stretch

For this exercise, stretch out one arm in front of you and hold your hand up with the palm facing outwards, as if you are warning someone to stop.⁷ 

On the other hand, gently press on the palm of your outstretched hand as if you are trying to push it back towards your body, but don’t let the elbow lock.⁷ You should feel a stretch in your forearm.⁷ Hold this for fifteen seconds.⁷ Repeat this four more times and then do the same for the other arm. ⁷ You should do this at least five days a week, but you can do this every day.⁷

Wrist flexion stretch

Hold your arm out straight in front of you and let your hand flop down so that your fingers are pointing to the floor and your palm is facing you.⁷ With your other hand, gently press on the back of your hand as if you’re pushing your hand towards you and you should feel a slight stretch.⁷ Do this for fifteen seconds five times, and then switch to the other arm. ⁷ You can do this five to seven days per week.⁷ 

Wrist extension

Stage 1

Bend your elbow at 90 degrees and place the inside of your forearm on a table so that it is supported, with the inside of your wrist at the edge of the surface and your hand hanging over the side.⁷

Begin with your palm down, and raise your hand as far as possible by bending your wrist backwards for one count. Slowly lower your hand over the count of three.⁷ Do this thirty times.⁷

Stage 2

Straighten your elbow a little, but keep your forearm resting on the table and wrist at the edge.⁷ Repeat the action of bending your wrist back to raise your hand as before.⁷

Stage 3

Fully straighten your arm and lift it from the table so that it’s no longer supported.⁷ Repeat the exercise thirty times as above.⁷ 

You can do this five to seven days per week.⁷

Wrist flexion

Stage 1

Bend your elbow to 90 degrees and place the back of your forearm on the table so that the back of your wrist is at the edge and your hand is hanging over the side with the palm facing upwards.⁷ Lift your hand by bending your wrist up and hold this for a count of one, then slowly lower it over a count of three.⁷ Repeat this thirty times.⁷

Stage 2

Straighten your arm a little, but keep letting the table support the back of your forearm.⁷ Repeat the motion of raising your hand for one, and lowering it over the count of three and repeat this thirty times.⁷

Stage 3

Straighten your elbow and take your arm off the table, and repeat the motion again another thirty times.⁷

This can be done between five and seven days per week.⁷

Forearm pronation and supination

Stage 1

Put the side of your forearm on a table so that the surface is supporting you and your wrist is at the edge of the table.⁷ Your palm should be facing the side.⁷

Slowly twist so that the palm is facing down, then slowly bring yourself back to the beginning position.⁷ Then slowly twist so that your palm is facing up towards the ceiling, and then slowly put it back to the starting point.⁷

Do this thirty times.⁷

Stage 2

Straighten your elbow slightly, but make sure the forearm is still supported on the table.⁷ Repeat the twisting exercises from stage 1 thirty times.⁷

Stage 3

Repeat the above thirty times again, but this time have your elbow straight and do not let the table support you.⁷ Do this for five to seven days per week.

For this exercise, and for the other ones that list stages, begin at stage one.⁷ Once you can do this for two days in a row without the pain increasing, you can progress to stage two and then to stage three.⁷ When you have reached stage three, begin at stage one again while holding a 1lb weight, and once you can do it for two days in a row with no increase in pain, gradually work your way up to 2lb and 3lb weights.⁷

Stress ball squeeze

You should do this after you’ve finished doing the above exercises for that day. For this exercise, you will need a rubber stress ball.7 If you are still using the table to support you in the earlier exercises, perform this exercise with support from a surface, too.⁷ 

Hold the stress ball in the palm of your hand and squeeze it in your fist.⁷ Repeat this ten times, then switch to the other hand. Do this once per day for between five and seven days per week.⁷

Finger stretch

This exercise should also be done after completing all the above ones, and if you’re still using a table to support yourself for the earlier ones, you should use a table to support you in this one, too.⁷

Put an elastic band around the fingers (but not the thumb) of one hand and then spread your fingers to stretch the band.⁷ Then let the fingers relax.⁷ Repeat this ten times, then switch to the other hand.⁷

Summary

Tennis elbow is common and can be very painful and upsetting. However, it can be treated and it normally will improve enough that it does not have a negative effect on the lives of the people who have had it at one time.