The BEST Tennis Elbow Treatment (science-based)

If you have a tennis elbow also known as lateral epicondylitis, then you probably have 3 main questions: What caused it? How long will I have to deal with? What can I do to get rid of it?

You’ve come to the right place. Because in this article, I will be presenting the current scientific evidence to you. This way, you will quickly find out which treatment options really work, and which ones are a complete waste of time and money. And of course I will also show you recommended exercises, so that you can start your rehab right now.

What Causes Tennis Elbow?

It is assumed that tennis elbow is caused by overuse of the muscles that extend the wrist. To be precise, the extensor carpi radialis brevis (ECRB) is the most commonly affected in over 95% involvement according to Keijsers et al. (2019).

How Long Will You Have to Deal With It?

Let’s start with some great news first: Tennis Elbow is a so-called “self-limiting condition”. This means that it usually gets better without you having to do anything about it.

To be exact: 80% of people are pain-free after 6 months and 90% of after 1 year.

Before you stop reading this article now and just do nothing, you can actually speed up this process with therapy. Papers like the one done by Keijsers et al. (2019) show this.

What Are the Best Treatment Options and Exercises?

We’re now going to talk about all the 10 major treatment options out there and discuss, whether they are useful or not.

Injections

Of course, there are different types of injections (corticosteroids, platelet-rich plasma, autologous blood therapy, Botox, etc.), each with different mechanisms of action.

Let’s start with corticosteroid injections, since these are the most commonly performed.

Although corticosteroid injections provide short-term relief, scientific literature now advises against them.

On one hand, they lead to a higher recurrence of pain (Bisset et al. 2011).

On the other hand, they also slow down the healing process because collagen and proteins are broken down (Barnett et al. 2019).

In larger studies, such as the one by Coombes et al. (2010) it was even found that people receiving corticosteroid injections had worse long-term outcomes than those receiving a placebo treatment!

For other types of injections, the research is so contradictory that they cannot be recommended.

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Training

You might be wondering: Since the medical term for tennis elbow is lateral epicondylitis, we’re talking about an inflammation. And it seems like a bad idea to put stress on inflamed tissue, right? That’s a good point!

However, thanks to research articles like the one by De Smedt et al. (2007), we now know that, similar to other tendon issues, inflammation is not the primary concern here.

Studies actually show that it is more effective to perform exercises to reduce pain and improve arm function than other measures like ultrasound or manual therapy.

Generally, strength training is recommended for such tendon pains because it yields very good results, is inexpensive, and makes patients less dependent on therapists (Ortega-Castillo et al. 2016).

You might have heard that isometric exercises (which means static exercises) or eccentric exercises (where the negative phase of movement is emphasized) should be done.

However, this isn’t 100 % correct in all cases. There’s a study by Peterson et al. (2014), which saw short-term benefits from eccentric training but found no differences in the long run.

Ultimately, it’s about load management. If you do too much too soon, it doesn’t matter whether you did it through isometric or eccentric exercises.

For tendon issues, one can follow the 24-hour.

Pain during and 24 hours after training should ideally be below 3/10. A score of 5/10 would still be acceptable, but anything higher isn’t.

And which exercises should you do exactly?

Various studies indicate that we should train the elbow in all its ranges of motion (pronation, supination, radial deviation, ulnar deviation, flexion, extension).

If you want to integrate these exercises a little more you can do something like a Zottman Curl.

Try to perform these exercises 2-3x per week for 3 sets of 10-15 repetitions.

According to studies like the one by Vicenzino (2003) it is also recommended to train the upper body in general instead of just focusing on the elbow. We’re talking:

In the beginning, you just have to be careful, that you don’t overdo it with the general upper body exercises. If, for example, you wanted to do weighted pull-ups, this puts a lot of stress on the elbow, which could be too much depending on your phase of rehab.

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Manual Therapy

Manual therapy for the elbow, wrist, and cervical-thoracic spine can reduce pain and increase the strength of the pain-free grip immediately after treatment. The emphasis is on immediately after treatment – not long term.

Studies published specifically in journals focused on manual therapy indicate that manual therapy should only be an adjunct treatment for tennis elbow and not the main component of care (Vicenzino 2003).

Orthoses

Current research does not provide a recommendation for orthoses. Therefore, I would focus more on other methods.

Ice Treatment

Currently, ice treatment cannot be recommended since it appears to have no additional benefit (Manias and Stasinopoulos 2006).

Acupuncture

Acupuncture seems to reduce pain in the short term, as indicated by the study by Trinh et al. (2004).

Laser Therapy

Bjordal et al. (2008) demonstrated in their study that laser therapy (at a specific wavelength) can lead to short-term pain relief. Other studies show that laser therapy is no better than placebo treatment, so I believe it’s not worth spending money on.

Ultrasound & Iontophoresis

A study done by Bisset et al. (2011) shows that we don’t know whether these methods have any benefits beyond the placebo effect. They would certainly not be the treatment methods I would rely on. They could only be considered as adjunctive measures – just as manual therapy.

Shockwave Therapy

According to Dingemanse et al. (2014) the evidence is still unclear regarding shockwave therapy’s effectiveness compared to placebo treatments or other interventions.

Surgery

A recent review by Bateman et al. (2019) found that surgeries do not yield better results than non-operative measures or even placebo treatments.

To be fair, the research here is still quite limited, and there are certainly individuals for whom surgery would be appropriate. This should be clarified personally if all conservative methods have failed.

By the way – if you’re sitting right now, while you’re reading this article. Check your posture for me. You probably find yourself in a hunched position. Is that a bad thing? Check out this article to find out.

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