Tennis Elbow: 6 Steps To Fast Track Your Healing
Tennis elbow is a common condition and, if left untreated can become annoying and persistent.
This quick guide will explain the cause of tennis elbow and walk you through a 6 step process to ensure your healing gets on the right track.
If you have any specific questions or want to get booked in right away for an assessment and treatment, please use our easy online booking system below:
What is tennis elbow?
Tennis elbow refers to pain coming from the tendons of the forearm that connect the muscle to the bone in the elbow (called the lateral epicondyle).
These tendons run from the fingers and wrist right up through the forearm and eventually insert into the elbow.
Tennis elbow can also be referred to as tendinitis and lateral epicondylagia but the current preferred name in the medical world is elbow tendinopathy.
Who does it affect?
It tends to affect people:
who use their arms a lot for work
most common between the ages of 35 and 50
people who have other conditions such as diabetes, high blood pressure, menopause
people who are very active, (especially with a big competition goal coming up) and tend to push themselves to get fitter
Interestingly, only about 5% of people suffering from tennis elbow actually play tennis!
Symptoms of tennis elbow
Pain and muscle tightness comes on gradually
Related to a recent increase in loading of the muscles in the arms
Often sore during warm up but then feels better during activity
Often feels worst 24-48 hours after activity
6 Steps To Fast Track Your Healing
Step 1. Get the right diagnosis
You will need to have a thorough examination by a physiotherapist to determine if you have have tennis elbow.
Sometimes elbow pain can be referred pain from your neck and shoulder.
Once we can clarify the diagnosis, we get figure out the best treatment plan for you.
Once you have been diagnosed with tennis elbow, it’s important to have realistic expectations of recovery.
Patience is definitely required as the healing process of tendons is longer than any other tissue in the body and take anywhere from 2 months to 2 years to full recover from tennis elbow.
You may need to continue with an exercise regime in the long term - even after you stop seeing your physiotherapist.
This will ensure that your pain stays away for good.
Learning to listen to your body and know how much your arms can handle is a very important skill to learn as you recover.
Step 2. Calm things down phase (4-6 weeks)
Firstly, stay calm and know that it will get better - your body is a powerful self healing machine.
But unfortunately recovery is very rarely linear, and more often ‘2 steps forward and 1 step back’ pattern. Or a bit all over the place (like in the picture below).
Recovery isn’t always linear !
To help calm things down, we need to identify all of the aggravating activities that are contributing to the tendons becoming overloaded.
This is probably the most important step in the calming phase and people who have persistent tendon pain often have not been able to identify and reduce the aggravating activities.
To be clear, our bodies our incredibly resilient and adaptable to many loads and stresses.
But when there is chronic overuse and loading without adequate recovery (sleep, nutrition and muscle care), then an overuse situation develops.
Relative rest is an important part of allowing the tendon to heal.
Common activities that increase the load on the elbow tendons are:
computer use - typing, using mouse e.t.c.
texting on your phone
gardening / weeding
Lifting heavy weights - bicep curls, overhead, swings, pullups
aggressive stretching of the tendons that can irritate them
lifting groceries all in one go
carrying a heavy bag around
knitting
lifting small / big children
racquet sports or rowing
driving lots in the car and gripping the wheel too firmly
Push-ups / yoga / body weight exercise on arms
Massaging / manual therapy
playing musical instruments
ironing
doing dishes
peeling vegetables
gripping a bicycle handle or car steering wheel
There are of course many more potentially aggravating activities, and you will need to really have a hard thing about your personal circumstances.
Next is to write out a list of all the activities that aggravate it.
And then prioritise the activities with the most important at the top.
Ideally try and cut out or delegate the bottom 80% of the activities that aren’t important for you to keep going with.
This might be enough to settle your symptoms and allow you to keep doing the important activities in your life.
Achieving the right loading dose is a real combination of art and science and quite frankly a bit of trial and error.
Learn to listen to your body during an activity and the 24 hours after when the tendon tendons tend to flare up and let you know if you’ve pushed too far.
As you progress through rehab, some level of pain will be normal and acceptable (see below).
Important to know: mini-flareups are completely normal during your recovery. In fact they are a sign you are on the right track as you are gradually building up your capacity.
So definitely don’t freak out when you get a flare-up!
Step 3. Ice/ Heat and TENS
Apply ice to the elbow regularly to reduce the pain and inflammation, particularly at the early onset of pain.
Some people find heat in the form of a wheat pack works better, as this can reduce the tension in the muscles and increase blood flow.
Another option is using a TENS machine that can stimulate blood flow to the muscles and tendons (this gives only short term relief and must be used in conjunction with other methods listed).
Step 4. Massage and dry needling
Techniques such as massage and dry needling can be used to release tension around the arms, shoulders and upper back.
Muscles that have been overused over a long period of time often form knots or trigger points that can be palpated easily.
When tight, they can become a source of referred pain, with each muscle having a different area of referral (see below).
Dry needling has the ability to get achieve a quicker and more effective deep release of the muscles. As tendons have quite poor blood supply, dry needling can also stimulate the deep blood flow and increase the healing process.
The effects of Dry Needling were studied in this new study that took 110 people with tennis elbow and evaluated two treatments.
One group received dry needling and other group received anti-inflammatory medication (Ibuprofen 100mg x 2 day) and a brace.
The patients were evaluated after three weeks and six months.
Results:
Although both treatment methods were effective at three weeks, dry needling was significantly more effective than the medication and brace group at six months.
Conclusion:
Because of the low complication rate, dry needling is a safe method, and it might be a more effective treatment option for tennis elbow.
At Kinfolk Physio & Wellness, in addition to specialising in dry needling, we also take a holistic view of your movement and set you up with a personliased home exercise program that maintains flexibility and builds strength and capacity, to give the best long term solution.
If you would like to get your elbow pain on the fast track to healing, please click below to book an Initial Assessment (or call us 1300 657 813).
Step 5. Graduated loading program (12 weeks - 2 years)
At the end of the day, we want to gradually build the capacity of your forearm muscles so they can withstand the demands from your daily life.
This involves a graduated, progressive program of specific strengthening under the supervision of a Physiotherapist.
We follow a 12 week program to rebuild strength in the muscles of the forearm, shoulder and even through the neck and core muscles.
You would be doing exercises 2-3 x per week for about 15 minutes.
Tendons require gradual load in order to heal properly, so it’s very important to continue to strengthen your muscles even if your pain has improved.
Our focus is on building your body's capacity so that you have a buffer or 'zone of relaxation' where you can handle with ease the stress and loads that are placed on your body in your life (see graph below).
The effort you put into building your foundation will result in:
- less pain and frequency of flare-ups that keep you out of action
- dramatically reduced need for pain medication
Building capacity is a bit like trying to scale a mountain.
You require a map telling you where you want to go (goal capacity) and where you currently are (current capacity).
Then you need a plan and to help you achieve your goals.
Mindset, sleep, nutrition and general fitness are all important ingredients as you gradually scale the mountain.
Get started on your journey…
To find out more about our loading program for tennis elbow and start your journey, please use our easy online booking system by clicking below.
Step 6. Create the optimal healing environment
With tendon problems, it’s really important to know that your body is always trying to heal itself.
So it’s important to try and create the optimal environment for that healing to take place.
This would include:
Get a good 7-8 hours of good quality sleep per night
Eat a high energy diet with sufficient protein and carbohydrates
Get enough rest during the week
Decrease stress in your life as much as possible
Ensuring your ergonomics at work are suitable
Do I need a cortisone injection?
If first-line treatments aren’t working a more invasive approach could be considered that includes a corticosteroid injection.
Corticosteroid injections, while giving effective short term relief, tend to wear off after 6-12 months, and the pain can return, (often worse than before).
The problem also with cortisone injections is they tend to weaken the tendons in the elbow, greatly increasing the risk of future overload.
Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association. Dan has a special interest in treating elbow pain. He has been working in private practice for 15 years. He is passionate about helping people to move better, feel better and get back to doing what they love.
