Acute Management of Tennis Elbow & Golfer's Elbow

Updated April 2019

Tennis elbow refers to an injury causing pain and inflammation around the outside of the elbow. Despite its name, tennis elbow can occur in non-athletes as well. It is most often brought on by repetitive activities involving the wrist and hand (e.g. painting.) Inflammation occurs in tendons of the muscles which function to extend/bend back our wrist/hand, which insert back up to the outside of the elbow. This is why tennis elbow is sometimes called "lateral epicondylitis"

Similar to tennis elbow, golfer's elbow refers to the inflammation or irritation to a group of tendons that attach to the elbow. It also occurs most commonly following repetitive activities, not exclusive to golfing. However, unlike tennis elbow, the pain and inflammation occur on the opposite side of the elbow, where the wrist flexor tendons insert to the humerus. Golfer's elbow is sometimes called "medial epicondylitis."

Acute management of tennis elbow (and golfer's elbow) often includes the following:

1. Rest

• Rest, or activity modification is often essential to help decrease symptoms of both tennis elbow and golfer's elbow.

• This does not necessarily mean stopping an activity entirely.

• E.g. Perhaps an individual develops tennis elbow after starting a new job involving long days of repetitive desk work and typing.

• Sometimes a simple adjustment of the keyboard position relative to the wrist/hand can change the mechanics enough to take load off of these tendons and their insertion at the elbow.

• In other cases, it may mean decreasing frequency and intensity of training, or taking time off from a particular sport. Some may need to inquire about an option for modified duties at work to rest from repetitive wrist and hand activities.

• For tennis elbow, a brace may also be helpful in decreasing repetitive loading through a particular part of the tendons, allowing time for inflammation to settle.

2. Stretching

• If tolerated, stretching is a useful technique to help relief some of the pain involved with tennis elbow.

• Because the muscles on the top of the forearm give rise to the tendons which insert to the outside of the elbow (lateral epicondyle of the humerus), working to increase the length of some of these tight muscles can take tension off of the area of friction where the tendons meet the bone.

• The picture here shows a stretch to the extensor muscles of the forearm. In the case of golfer's elbow, the stretch will be in the opposite direction, to stretch the flexor muscles of the forearm.

3. Eccentric Muscle Strengthening

• As with most treatment protocols, strengthening is an important piece of the puzzle in treating tennis elbow and golfer's elbow .

• Eccentric strengthening refers to the work a muscle does while it is lengthening.

• E.g. When you do a bicep curl your muscle is shortening as you bend your elbow.

• As you lower the weight down and your elbow starts to straighten, your bicep is still working to control this movement, but it is lengthening as it does so - this is called an eccentric muscle contraction.

• This loading of the muscles and their tendons works to build up the tensile strength in regions that may have experienced micro trauma.

• This picture shows the positioning for golfer's elbow (left), and tennis elbow (right).

• Based on their assessment of you, your physiotherapist can determine when it is appropriate to

begin eccentric strengthening.

• Most of the exercises helpful in recovering from tennis elbow or golfer’s elbow are easily performed at home without a need for specialized equipment. For example, a soup can is about 1 lb and can be used instead of a 1lb dumbbell.

4. Ultrasound

• Another therapeutic intervention useful in treating tennis or golfer's elbow is ultrasound.

• This treatment technique requires training to administer, and can be found in many physiotherapy clinics.

• Ultrasound is applied to the tender area around the elbow, delivering sound waves to the tissue.

• This modality works to decrease pain and inflammation, and to speed up the healing process of the tendon.

This video outlines 3 exercises we may prescribe once the initial pain and potential inflammation stage has passed.

Riley Bay began her undergraduate studies in Victoria and graduated with a degree in psychology. She then completed her Masters of Physical Therapy at the University of British Columbia. Riley has gained further training in manual therapy techniques including Mulligan's Mobilization with Movement and The McKenzie Method. Through a combination of individualized therapeutic exercise, hands on manual therapy, and education, Riley is passionate about working together with her patients to help facilitate their return to the sports and activities that are important to them. Book with Riley today.