Tennis Elbow(Lateral Epicondylitis)

Comprehensive treatment guide for tennis elbow through evidence-based rehabilitation, progressive strengthening, and activity modification strategies.

1-3%

Population affected

35-50

Peak age range

90%

Conservative success

6-12

Weeks to heal

Understanding Tennis Elbow

What is Tennis Elbow?

Tennis elbow (lateral epicondylitis) is inflammation or microtears in the tendons that attach to the lateral epicondyle of the elbow, causing pain on the outside of the elbow.

Common Causes:

Repetitive gripping activities
Poor tennis technique
Occupational overuse
Age-related tendon degeneration

Common Symptoms

Pain on outside of elbow
Pain with gripping activities
Weakness in grip strength
Pain radiating to forearm
Stiffness in the morning
Difficulty lifting objects

Severity Classifications

Grade 1 (Mild)

Minimal pain with activity, no functional limitation

Symptoms:

Mild pain after activity
No pain at rest
Full grip strength
Normal daily activities

Treatment:

Activity modification, ice, anti-inflammatory medications

Recovery Time:

2-4 weeks

Grade 2 (Moderate)

Pain during and after activity with some functional limitation

Symptoms:

Pain during activity
Some pain at rest
Reduced grip strength
Difficulty with lifting

Treatment:

Physical therapy, bracing, activity modification

Recovery Time:

6-12 weeks

Grade 3 (Severe)

Constant pain significantly affecting daily activities

Symptoms:

Severe constant pain
Significant weakness
Unable to grip objects
Night pain

Treatment:

Comprehensive rehabilitation, possible injections or surgery

Recovery Time:

3-6 months

Treatment Phases

Phase 1: Acute Management (0-2 weeks)

Goals:

Control pain and inflammationProtect healing tissuesMaintain pain-free movement

Key Interventions:

Activity modification and rest from aggravating activities

Ice application 15-20 minutes, 3-4 times daily

Anti-inflammatory medications as prescribed

Gentle pain-free range of motion exercises

Counterforce bracing (tennis elbow strap)

Ergonomic assessment and workplace modifications

Phase 2: Progressive Loading (2-6 weeks)

Gradual introduction of strengthening and mobility

Goals:

Restore pain-free range of motionBegin strengtheningImprove tissue tolerance

Key Interventions:

Progressive eccentric strengthening exercises

Stretching program for forearm muscles

Manual therapy and soft tissue mobilization

Gradual return to functional activities

Heat therapy before exercises

Progressive loading with resistance bands

Phase 3: Functional Restoration (6-12 weeks)

Return to sport and work activities

Goals:

Full strength and enduranceReturn to activitiesPrevent recurrence

Key Interventions:

Advanced strengthening and conditioning

Sport-specific or work-specific training

Technique modification and education

Equipment assessment and modifications

Gradual return to full activities

Long-term maintenance program

Rehabilitation Exercise Program

Acute Phase Exercises (0-2 weeks)

Gentle Wrist Range of Motion

Pain-free wrist flexion and extension movements

Sets: 2-3 sets

Reps: 10-15 repetitions

Frequency: 3-4 times daily

Finger and Thumb Movements

Gentle finger flexion/extension to maintain mobility

Sets: 2 sets

Reps: 10-15 repetitions

Frequency: Hourly when awake

Shoulder Blade Squeezes

Maintain upper body posture and prevent stiffness

Sets: 2-3 sets

Reps: 10-15 repetitions

Frequency: 2-3 times daily

Progressive Loading (2-6 weeks)

Eccentric Wrist Extension

Controlled lowering of wrist with light weight

Sets: 3 sets

Reps: 10-15 repetitions

Frequency: Daily

Forearm Stretching

Gentle stretching of wrist extensors and flexors

Sets: 3 sets

Reps: 30-60 seconds hold

Frequency: 2-3 times daily

Grip Strengthening

Progressive grip exercises with therapy putty

Sets: 2-3 sets

Reps: 10-15 repetitions

Frequency: Daily

Resistance Band Exercises

Wrist extension and flexion with elastic resistance

Sets: 2-3 sets

Reps: 12-15 repetitions

Frequency: Daily

Functional Restoration (6-12 weeks)

Progressive Weight Training

Gradual increase in resistance for wrist and forearm

Sets: 3 sets

Reps: 8-12 repetitions

Frequency: 3-4 times per week

Sport-Specific Drills

Tennis or activity-specific movement patterns

Sets: 2-3 sets

Reps: 10-20 repetitions

Frequency: 3-4 times per week

Plyometric Exercises

Dynamic exercises for power and coordination

Sets: 2-3 sets

Reps: 8-12 repetitions

Frequency: 2-3 times per week

Endurance Training

Sustained grip and forearm endurance activities

Sets: 1-2 sets

Reps: 2-5 minutes

Frequency: 3-4 times per week

Prevention Strategies

Use proper technique in sports and activities

Strengthen forearm muscles regularly

Warm up properly before activities

Use appropriate equipment and grip size

Take regular breaks from repetitive activities

Maintain good overall fitness

Address muscle imbalances early

Modify activities if pain develops

When to Seek Medical Attention

Severe pain that doesn't improve with rest

Complete inability to grip or hold objects

Numbness or tingling in fingers

Signs of infection (fever, increased warmth)

Sudden onset of severe weakness

Pain that worsens despite treatment

Night pain that disrupts sleep

Loss of sensation in the hand

Elbow Braces

Tennis elbow straps

Ice Therapy

Pain relief solutions

Therapy Tools

Strengthening equipment

Back to Elbow Conditions Elbow Conditions Overview Next: Golfer's Elbow

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