Tennis Elbow: Symptoms, Causes, Exercises and Treatment

The main symptom is pain on the outside of the elbow, which can progress towards the wrist and hand.

The pain usually occurs in the following situations:

• bending or lifting the arm,
• when gripping small objects,
• during rotational movements (e.g. opening a jar),
• when the arm is fully extended. ^[1]

With the passage of time, tennis elbow pain worsens. If patients do not follow the regimen or it remains untreated, pain can plague them even when the arm is at rest. The pain is often compounded by difficulty with a weak grip. ^[2]

It brings pain and restriction of movement. Pain can be both burning and dull and is not limited to the elbow. The discomfort can spread throughout the forearm all the way to the wrist. ^[3]

What is tennis elbow

It is a commonly known term for lateral epicondylitis. This is a disease of the tendons and muscle tendons in the elbow area. Problems certainly do not arise only when playing tennis; people who overuse their forearm muscles at work or in their free time are much more likely to have tennis elbow.

The first step in diagnosing is a physical examination. During this examination, the doctor will assess the mobility, tenderness and possible swelling of the elbow. They will also check the movements of the wrist and fingers. The examination can be supplemented with other procedures. ^[6]

• Magnetic resonance imaging will show the degree of tendon damage.
• X-ray examination is used to view the condition of the bones and joints.
• Electromyography can reveal problems of neurological origin. ^[7]

• Tennis elbow affects 1% to 3% of the population.
• This is the most common cause of long-term elbow pain.
• Patients usually belong to the age group of 35-54 years.^[8]
• Only 10% of cases are related to playing tennis. ^[9]
• The disease is seven times more common than golf elbow.
• With golf elbow, patients have pain on the opposite (inner) side of the elbow. ^[10]

There are various options for how to treat tennis elbow. The most important thing is to follow the regimen – avoid activities and movements that provoke or aggravate pain. It is further recommended:

• Cool the elbow or forearm,
• perform stretching and strengthening exercises, if the condition of the elbow allows it,
• a tennis elbow brace is also used to a limited extent. ^[11]

Anti-inflammatory drugs can be used to relieve pain and inflammation. They are also available in the form of ointment or gel, which is applied directly to the affected area.

Treatment can include corticosteroids in injectable form. The medication is administered directly into the elbow area, but it only has a short-term effect. If the sprays help, they can be repeated up to three times at intervals of several months. ^[12]

Other therapy options include:

• The use of ultrasound to improve circulation and promote healing,
• Shockwave (physical therapy involving the transfer of mechanical energy to the tissue to relieve pain and increase blood circulation),
• Physiotherapy (various manual techniques and relaxation massages),
• Exercises to promote mobility and strengthen the forearm muscles. ^{[13] ,[14]}

Treatment usually takes six months to two years. Most patients (90%) make a full recovery within 12 months. ^[15]

Surgery is often the last option to address in patients with severe and prolonged pain. During the procedure, the damaged tendon is removed. ^[16]

Patients can perform various stretching exercises. The three basic exercises, the Liebscher-Bracht exercises, which take approximately seven minutes, can be performed anywhere without the need for special equipment .
The recommended frequency is twice a day (morning and evening), six days a week for three weeks. If the elbow pain persists, the exercises can be continued for longer.

Elbow stretching

• Stand against a wall and extend the affected arm in front of you so that the elbow is extended and the palm of the hand is touching the wall.
• Turn your palm to a position where your fingers are facing the ground.
• Press your hand forcefully against the wall.
• Feel your elbow stretch.
• Increase the force with which you perform the exercise and hold for 2.5 minutes.

Wrist stretching

• Stand against a wall and extend the affected arm in front of you so that the elbow is extended and the fist is touching the wall.
• Keeping your hand in a fist, bend your wrist and turn it so that the back of your hand is pressed against the wall.
• Increase the intensity of the exercise and hold for 2.5 minutes.

Stretching the shoulder

• Stand with your chest against the wall.
• Bend the affected arm so that the elbow points upwards and the palm of the hand touches the shoulder on the same side of the body.
• With the other hand, push the raised wrist towards the shoulder so that the upper arm is pressed against the wall.
• Feel the stretch in the shoulder area.
• Push with great force and hold for 2 minutes. ^[18]

It is advisable to practice the correct execution of the exercise with a physiotherapist.

Alternative treatments include:

• Herbal preparations with anti-inflammatory effects (such as arnica, turmeric and ginger) applied to painful areas. Herbal ointment  can relieve the symptoms of the disease.
• Essential oils (lavender, mint or eucalyptus) have an analgesic effect and relieve pain in some patients.
• Acupuncture promotes the healing process.
• Massages relax muscles, promote blood circulation and contribute to regeneration in musculoskeletal disorders. ^[19]

Prevention consists mainly in taking care of the muscles around the elbow. You should not overload them for a long time, and after the load it is recommended to relax and stretch the muscles.

• If certain movements and activities cause pain, keep them to a minimum.
• It is advisable to stretch the entire arm before sports or activities that put a strain on the elbow.
• Use appropriate equipment for racket sports.
• When performing manual tasks, ensure ergonomics and appropriate tools or equipment.^{[20] [21]}

There are a few myths that need to be debunked regarding tennis elbow.

All you need is an injection for tennis elbow. NO.  Anti-inflammatory spray with corticosteroids will only provide temporary relief, but will not solve the problem in the long term.

It’s better to leave the tennis elbow completely alone.
NO.  Too much passivity and prolonged immobilization of the elbow can lead to further problems with limitation of movement. The affected elbow needs adequate and appropriate activity within a sparing regime. For example, relaxation and stretching exercises are suitable. ^[22]