Condition guide
It is pain on the outside of the elbow that gets worse when you grip or raise your wrist. Despite the name, most patients do not play tennis: it is caused by overloading the shared tendon of the muscles that bend the wrist backwards. Gradual strengthening exercises are the foundation of treatment, and recovery takes patience.
The muscles that bend the wrist and fingers backwards attach by a shared tendon to the bony bump on the outside of the elbow (the lateral epicondyle). Loading this tendon more than it can handle, or in a way it is not used to, leads to pain. The problem is not so much inflammation as wear in the tendon and its failure to adapt to the load; that is why it is also called "tendinopathy".
In a study of 165 patients in Australia, a cortisone injection reduced pain in the first few weeks; however, after 1 year, 83% of the cortisone group had fully recovered or improved a lot, compared with 96% of the placebo injection group. The recurrence rate was 54% in the cortisone group and 12% in the placebo group.
In other words, the short-term relief from an injection may slow recovery in the long run and make it more likely that the pain comes back. If an injection is being considered, weigh up this risk together with your doctor.
The American Physical Therapy Association's 2022 guideline puts gradual strengthening exercises at the centre of treatment.
Exercises at home
You may feel some mild, bearable pain during exercise; if the pain is back to its starting level by the next day, carry on. Start with the isometric exercise and move on to the eccentric exercise as the pain eases.
Rest your forearm on a table with your palm facing down and your hand over the edge. Try to lift your wrist up while pressing down on the back of your hand with your other hand, so that your hand does not move. Press only as hard as you can without clearly increasing the pain. This is usually well tolerated even during the painful phase.
30–45 seconds, 5 reps, 1–2 times a dayRest your forearm on a table with your palm facing down. Hold a full water bottle or a light weight. Use your other hand to help lift your wrist up, then let go and slowly lower the weight over 3–4 seconds. Increase the weight as it gets easier.
15 reps, 3 sets, once a dayStretch your arm out in front of you with the elbow straight and palm facing down. With your other hand, hold the back of your hand and gently bend your wrist down and towards you; feel a stretch on the outside of your forearm.
20–30 seconds, 3 repsHold a soft ball or a rolled-up towel in your hand. Squeeze it only as hard as you can without increasing the pain, hold for a few seconds, then let go. This builds grip strength; if the pain increases, choose a softer object.
10 reps, 2–3 times a dayStand or sit up straight. Without lifting your shoulders towards your ears, draw your shoulder blades back and slightly down towards each other. Hold for 5 seconds, then relax.
10–15 reps, twice a dayTie a resistance band to a door handle or another sturdy anchor at chest height. Holding the ends of the band and keeping your elbows close to your body, pull back and squeeze your shoulder blades together. Slowly return to the start.
10–15 reps, 2–3 setsThe aim is not to stop using your arm, but to adjust the load on the tendon.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
A simple self-treatment technique to ease the pain.
A soft tissue technique for the forearm muscles.
Despite the name, most patients do not play tennis. The problem is overload of the shared tendon where the muscles that bend the wrist and fingers backwards attach to the outside of the elbow. In jobs that involve heavy use of the hand and wrist, it can affect up to 29% of people; it is most common in people aged 40–60.
A cortisone injection can reduce pain in the short term, but it may make the outcome worse in the long run. In a study of 165 patients, after 1 year, 83% of the cortisone group had fully recovered or improved a lot, compared with 96% of the placebo injection group; the recurrence rate was 54% in the cortisone group and 12% in the placebo group.
A strap worn on the forearm or a wrist brace can ease pain straight away when used during activity. However, the guideline is unable to make a recommendation about its long-term effect. A strap is not the whole treatment, but a tool that helps you manage the load.
It takes patience. More than half of the people who seek help in primary care may still have symptoms after 1 year, and recurrence rates of 20–38% within 6–12 months have been reported. Sticking with an exercise programme in which the load is increased gradually is the key to managing this process.
No. For a while, cut back on gripping and lifting tasks that clearly increase the pain, but do not put your arm in a sling. The tendon gets stronger by adapting to a load that is increased gradually, and the guideline also recommends building the load back up step by step.
The following may point to a problem other than tennis elbow. See a doctor without delay:
Sources
İhsan Eren