What is tennis elbow?
Tennis elbow is a condition which causes pain around the outside bony part of the elbow and down into the forearm.
It is also known as lateral epicondylitis or lateral epicondyle tendinopathy in medical terms.
It mainly affects people between the ages of 40 and 60. Men and women are equally affected with the most commonly affected arm is the dominant side.
Tennis elbow is often an overuse injury primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension.
Risk factors include:
- Smoking
- Obesity
- Repetitive movements which are carried out for more than 2 hours per day
- Vigorous activity (managing loads of over 20kg)
What are the symptoms of tennis elbow?
You may have some or all of these symptoms but the common symptoms of tennis elbow are:
- Pain on the outside of your elbow
- Pain from your elbow down into the forearm muscles
- Difficulty with gripping activities due to pain
- Difficulty with twisting movements such as opening jars
- Restriction in movement at the elbow
The pain can vary in intensity and can happen when doing certain activities only or can become more troublesome even at rest and may even disturb sleep at night time.
What causes tennis elbow?
Tennis elbow is caused by a variety of activities that involve repetitive use of the forearm muscles through repetitive extension movements of the wrist and hand. This includes gripping and twisting activities that are done in manual jobs or through prolonged use of a computer.
What can I do to help my tennis elbow?
The natural course of tennis elbow is favourable and in 80 to 90% of cases of tennis elbow people will have a spontaneous recovery. However, symptoms can take up to 12-18 months to resolve.
Changes in lifestyle and modifying the known causes, as previously explained, can reduce the symptoms getting worse. The one professional who can help you manage your symptoms is you!
Avoid aggravating movements
If your elbow pain is aggravated by certain movements try to avoid these aggravating movements. Often symptoms and flare ups of tennis elbow can be settled by modifying your activity. If certain movements or activities at your work seem to be the biggest issue in aggravating your symptoms you could speak to your occupational health department for an assessment and support.
Ice
Use a cold compress, such as a bag of ice, wrap this in a damp towel and place on the painful area. Leave for 15 minutes, checking the skin regularly. Repeat this 3-4 times per day particularly after activity. If you have any concerns about your circulation or ability to feel this area then please consult with your GP prior to applying ice to this area.
Painkillers
A range of different medications may be available to help reduce your pain to allow you to move more comfortably. Do not exceed the daily allowance of these medicines even if your pain is high and always consult a health professional prior to taking any new medication. If you are unsure of what medication you can take, speak with your local pharmacist, practice nurse or GP for guidance.
It is important that if you are prescribed medication that you take them regularly and at the recommended dose (see medication packet for details). All medicines can cause side-effects, particularly if they are not used as prescribed. Side-effects range from common to uncommon and vary from person to person. Information on possible side-effects are available on the leaflet inside the packaging of your medication. It is important to speak to your local pharmacist, practice nurse or GP who may be able to change the dose or the medication itself to something that is more suitable.
You should try and use the prescribed medication regularly at the recommend dose as prescribed. Some medicines can take a number of weeks to have significant effect, however this is dependent on the person. It is best to speak again with your GP or pharmacist about what other options are available if you don’t feel your medicines are helping.
Reduce or quit smoking
It is thought smoking could interfere with the circulation to tendons. This means the tendons are at increased risk of injury. If circulation is poor, tendons may take longer to heal or may not heal well. Previous smokers are also at increase risk of tennis elbow due to the previous exposure and effects of tobacco on the vascular system. You can find help to reduce or quit smoking.
Weight loss
Being overweight can increase the number inflammatory molecules in the body which can lead to local and systemic inflammation within the body and therefore poorer healing and resolution of pain.
You can calculate your body mass index (BMI) to find out if you are a healthy weight.
You can find help with weight loss here:
- East Ayrshire: Weigh To Go – East Ayrshire
- North Ayrshire: Weigh To Go – North Ayrshire
- South Ayrshire: Weigh To Go – South Ayrshire
Exercise
If you have a tennis elbow it is important to keep your arm moving. Rest can be helpful for a few days if you have had a flare up of pain but it is important to keep your elbow moving so it does not stiffen up and get weak. Exercises to maintain your elbow range of movement and strength are extremely important.
Local NHS Ayrshire & Arran physiotherapists have devised exercise clips to help with strengthening the correct muscles, which can be found further down this page.
Before undertaking the suggested exercises please review our disclaimer below.
What else can be done for tennis elbow?
- Epiclasp: some people find an epiclasp/ elbow orthosis is helpful in the treatment of tennis elbow. Research suggests they may be helpful in the short term but there is limited evidence to support their use and does not recommend any one in particular.
- Acupuncture: acupuncture may provide some short term relief in the treatment of tennis elbow. However, research remains unclear on long term benefits.
- Injection: current evidence has shown that a corticosteroid injection may provide some short term relief in the treatment of tennis elbow. However, the evidence shows long term (6months to 1 year) people who have had a corticosteroid injection the pain had returned or the pain was worse than people who had been treated with conservative measures only. This may be because people who have had a corticosteroid injection return to activity and aggravating movements sooner than if they had conservative treatments only; due to having less pain. However, this may cause more damage to the tendons rather than encouraging healing. For more information on corticosteroid injection please click HERE
- Surgery: surgery is only considered in extremely severe and persistent cases of tennis elbow and when conservative measures have not been effective in treating the condition. Research shows there is only a 60 to 70% chance of surgery helping to improve symptoms.
The research shows the best outcomes for treatment of tennis elbow are when multiple treatments are combined.
Tennis elbow exercises
The exercises in the videos below have been provided to help with your tennis elbow pain. If there is any doubt about your fitness to do these exercises then please discuss this with your GP.
You may find that these exercises may slightly increase your symptoms initially. However you should find that the exercises themselves will become easier to do and that you begin to move your knee more easily. It can take around 12 weeks for you to notice a great improvement.
If the exercises do cause some discomfort, then taking prescribed medication from your GP or pharmacist may help you to continue to exercise.
If these exercises cause a large increase in your pain, or after 12 weeks there are no noticeable changes in your day to day symptoms, please contact your GP or NHS Inform for more advice.
The guide below will help ensure you are working at the right level.
Pain during exercise
Within the scale, aim to stay in the green or amber boxes. If you are in the red area then you can modify the exercises by:
- reducing the amount of movement during an exercise
- reducing the number of repetitions
- reducing the weights
- reducing your speed
- increasing rest time between sets
Pain after exercise
Your pain or other symptoms should return to your pre-exercise baseline within 30 minutes of exercising. On the morning after your exercises, you should not feel an increase in pain or stiffness that lasts longer than 60 minutes.
Disclaimer
Please note: These exercises should not be used without prior consultation with a medical professional as the use of the wrong exercise may cause additional health related issues and discomfort. NHS Ayrshire & Arran and MSK NHS Ayrshire & Arran are not liable or responsible for any harm, losses or damages whatsoever resulting from the use or misuse of the information contained in or implied by the provided information in each video. These are provided for information only.
If you have any concerns about your ability to perform exercise then please discuss your concerns with your doctor or healthcare provider prior to participating in any advice that is on the MSK NHS Ayrshire & Arran website.
Please choose the most relevant exercise section for you.
Section 1: Isometric Strengthening Exercises
Isometric exercises are a type strength training that causes a gentle static contraction of the muscle.
This is usually the first phase of tendon rehabilitation where this type of exercise can help to reduce your pain if done correctly. These exercises need to be repeated several times a day and slowly increased to 40second holds to reduce pain, maintain some muscle capacity and tendon load.
In highly irritable tendons, shorter holding time may be indicated and can result in this phase taking longer to complete but should be steadily increased to 40 seconds over time.
This phase can take over 4 weeks to achieve before progressing to next section.
Exercise 1: Isometric Wrist Extension
To do this exercise position your painful arm resting on a table. Pull your hand back towards you so that your fingers are pointing to the roof. Bring your non-painful hand and gently place at the back of your hand pointing towards the roof. Gently push for 10 seconds. Repeat 5 times and repeat 4 times per day. If this exercise brings on pain then you are pushing too hard so slightly ease off your push.
Once you have reached 10 seconds contractions 5 times and you are able to do 4 times per day the slowly increase the time of your hold, so:
- Week 2 – increase to 20 seconds, 5 times, 4 times per day for a week
- Week 3 – increase to 30 seconds, 5 times, 4 times per day for a week
- Week 4 – increase to 40 seconds, 5 times, 4 times per day for a week
Section 2: Strengthening Exercises
Once pain has slightly settled you can progress to phase 2 and work on strength. Strength is the ability to produce force and in this context we are aiming to improve the muscle and tendon’s ability to produce force and manage load. Strength is an essential building block for muscle function, without adequate strength muscle will have poor power and endurance.
Exercise 1: Concentric Strengthening
To do this exercise, position your painful arm on a table with your palm facing downwards. Hold a small hand weight (or can or bottle of water) then slowly raise the weight towards the ceiling and then lower back to the starting position. Repeat 15 times as pain allows.
Once you become fitter and strong increase to 3 sets of 15 repetitions and try twice per day.
Exercise 2: Eccentric Strengthening
To do this exercise, rest your painful arm on a table with your wrist coming over the edge and palm facing downwards. Hold a small hand weight (or can or bottle of water). Slowly raise your painful wrist with your non-painful hand. Then slowly lower back to the starting position. Repeat 15 times.
Try to increase to 3 sets of 15 repetitions as your become fitter and stronger as your pain allows.
Exercise 3: Wrist Extension (with a broom handle)
This exercise can be done in either standing or sitting. Hold a broom handle or walking stick in both hands. Lift your arms to shoulder level. Keep both elbows straight with your palms facing down. Roll the broom handle backwards like your are trying to reel something in. Repeat 15 times twice per day.
Once you become fitter and stronger aim for 3 sets of 15 repetitions twice per day as pain allows.
Exercise 4: Towel Twist
To do this exercise, sit in a chair with your arms at shoulder level holding a rolled up towel in both hands. Keep elbows in straight position. Twist the towel – so you are turning the painful wrist towards the floor. Repeat 15 times. Then slowly increase to 3 sets of 15 repetitions as pain allows.
To progress this exercise then twist the towel in opposite directions like your are trying to wring water from the towel. Repeat 15 times and then slowly increase to 3 sets of 15 repetitions as pain allows.