Many of our patients often ask us what the best Exercises for Tennis Elbow are and if it is curable. The short answer to this question is yes! However, before we start to talk about treatment and the exercises, let’s discuss what tennis elbow is in the first place.
1. WHAT IS TENNIS ELBOW?
“Tennis Elbow” is the commonly used name for a condition known as lateral epicondylitis. In other words, inflammation and irritation of the muscles and tendons at the outside portion (if standing with palms forward) of your elbow area. Basically, there are two main groups of muscles that run the length of your forearms. The ‘extensors’ are used when bending your wrist backwards and partially when bending your forearm towards your bicep. The ‘flexors’ are used when bending or curling your wrist forward and partially when extending your forearm away from your bicep.
When you overuse the muscles and tendons of the forearms, this can lead to repetitive stresses on the tissues, especially near where the tissues attach to the bones. These repeated movements can lead to micro-tears in the muscle or tendon fibres causing scar tissue build-up, inflammation and oftentimes pain.
When performing a backhand swing in tennis, force is transmitted to the muscle and tendon fibres at the outer portion of the elbow. Hence why lateral epicondylitis became commonly known as “tennis elbow”. Conversely, a golfer when performing the forward motion of their swing and striking the ground transmits force to the inner portion of the elbow area, and this can lead to a similar condition known as medial epicondylitis, or “golfers elbow.”
However, you don’t have to be a tennis player, golfer or playing any type of sport to develop this condition. Any work or activities which require repetitive overuse of certain movements or positions of the wrist, forearm or elbow may eventually lead to developing tennis elbow. Common examples of activities that may lead to a higher risk of developing tennis elbow can include:
- Painting
- Frequent playing of some musical instruments
- Plumbing
- Working on cars or mechanical equipment
- Frequent kitchen work, such as cutting with a knife
- Sports like badminton or table tennis
2. TENNIS ELBOW SYMPTOMS
Many people may be wondering “Is tennis elbow painful?” The answer is usually yes, especially in the new or acute stage after developing it. However, the frequency and intensity of the pain may fluctuate depending on your recent activities and other factors. If you’ve been having the pain for 6-8 weeks or longer, then it may have progressed to something called tendonosis. This often involves the deterioration of collagen in the tendons, which may become permanent if left untreated.
Most people will experience one or more of the following tennis elbow symptoms:
- Tenderness and/or swelling at the lateral (outside) portion of the elbow or upper forearm
- Soreness of the forearm muscles that bend the wrist backwards
- Stiffness of the forearm muscles or elbow joint after inactivity, such as waking up in the morning
- Worse pain when holding or squeezing an object, especially during the acute stage
- Chronic cases may notice one or more hard lumps or “knots” in the tissue surrounding the elbow or on the back of the forearm.
3. TENNIS ELBOW TREATMENT
Now that you understand a bit more about what tennis elbow is and where it comes from, let’s discuss useful forms of tennis elbow treatment. First, we must understand how long you have had the condition, and what are the likely aggravating factors which led to developing the problem. A proper history, physical examination and lifestyle advice to at least temporarily stop the activities which led to developing your tennis elbow is a good place to start.
Assuming you are in the acute stage of tennis elbow, you will likely have some degree of pain and inflammation in their muscle and tendon fibres. Initial treatments may be more passive in nature (being performed on you) and should be focused on helping you to relieve pain, and reduce swelling and inflammation as much as possible. Once pain and swelling have subsided to some degree, often active rehabilitation (exercises you perform) will be added to help you achieve long term recovery. We will discuss these in more detail in the next section.
Passive therapies which may help you achieve faster and more complete relief from tennis elbow may include the following:
- Cryotherapy (ice/cold pack application)
- Trigger point or myofascial therapy (performed by a trained doctor or practitioner)
- Low-level laser therapy (LLLT), also known as “cold laser therapy”
- Radial shockwave therapy (RSWT)
- Therapeutic ultrasound
Ask your doctor or therapist if any of these therapies may be beneficial for your tennis elbow treatment.
4. EXERCISES FOR TENNIS ELBOW
Once you are able to move the elbow and forearm with less discomfort, you are ready to start on rehabilitative exercises for tennis elbow. Or if you are having pain in other areas of your forearm or elbow, your doctor may prescribe additional elbow tendonitis exercises. Below we will describe some of the more useful home exercises for tennis elbow (aka lateral epicondylitis) in particular.
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- Wrist extensor stretch
– Hold your arm away from your body with the elbow straight and palm pointing downward
– Slowly bend your wrist downwards and use your other hand to pull the hand towards your body
– Hold this position for 30-45 seconds, making sure to breathe fully and slowly during the stretch
– For a stronger stretch, curl your fingers under (making a fist) while pulling the hand towards your body
– Repeat 2-3 times with at least 1-minute rest between sets
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- Wrist turn
– Stand or sit with your elbow bent at 90 degrees and your palm facing upwards
– Turn the palm slowly towards your body until you finish with the palm facing downwards
– Hold the position for 5-6 seconds, and perform 8-10 repetitions. Perform 2-3 sets with at least 1 minute rest between sets
– If you find this exercise too easy, you can perform it while holding a small dumbbell or weight in the hand
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- Fist Clench
– Sit with your arm extended over a table, palm facing upwards and just a slight bend in the elbow.
– Place either a rolled up towel, or a small ball in your hand
– Squeeze the towel or ball in your hand while gently curling the wrist upwards towards your body, but not lifting the forearm off of the table, holding for 6-8 seconds before relaxing
– Repeat 8-10 repetitions
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- Fingers extension with rubber band (*Note, only perform this once inflammation and pain has subsided at the problematic elbow, as this is to strengthen the extensor muscles and tendons)
– Stand or sit with your elbow bent to 90 degrees and point your fingers and thumb together
– Wrap a rubber band around the outside of your thumb and fingers about 1/3 of the way from the tips
– Extend your fingers and thumb stretching the hand open against the resistance of the rubber band and hold for 4-6 seconds.
– Repeat 8-10 repetitions. If the exercise becomes too easy, you can add another rubber band around the fingers to increase difficulty
There are a number of other things your doctor or therapist may recommend to go along with the above exercises or treatments. Depending on your specific condition, use of non-steroidal anti-inflammatory drugs and/or wrist supports may be advised along with the above therapies and exercises for your tennis elbow physiotherapy programme.
5. IS TENNIS ELBOW CURABLE
For most people their painful tennis elbow should be curable with the right combination of rest, treatment, exercise and supplements like turmeric or curcumin. However, the range of severity and duration of tennis elbow can vary quite a bit, so it is best to seek proper evaluation and advice if you think you have developed tennis elbow. If aggravating lifestyle habits are not addressed and the root causes of your pain identified, then this can become a long-term issue with degeneration of the tissues taking place.
Thankfully, at Elite Spine Centres our doctors of chiropractic are well-versed at taking care of patients with tennis elbow, golfer’s elbow, and other ailments of the forearm and elbow region. A proper analysis of your condition will be performed before any treatment is recommended. In addition to expert manual therapy, our patients have access to a wide range of advanced therapeutic technologies designed to speed up and improve the healing process. If you or someone you know is suffering from a painful tennis elbow, please don’t hesitate to get in touch and find out how we can help!
Author: Dr. Michael Bryant