Tennis Elbow

Part II

What can you do to help?

The most important thing to do is first, learn why and how the elbow is being reinjured.

You must completely stop activities that cause the pain, such as heavy lifting with the palm facing down, firm gripping, or repetitive or resistive wrist extension. No other treatment will be helpful if you the area is continually reinjured and stop the vicious circle of tearing and healing and tearing again before the healing scar can mature and accept that load, nothing else (pills, splints, exercises) will work!

Ice for five to fifteen minutes at a time on the area which is most swollen and tender. After the acute stage has resolved, healing (scar formation) has had a chance to take place, and the scar has matured to the point that it can take some pulling by the muscles; you can start to slowly and gently resume activities.

It is very important that you not overuse your arm while the healing is taking place. If it still hurts, even a little, you are overdoing it! The only way to break the cycle is to rest your arm until the vicious circle is broken.

Sometimes a band wrapped around the forearm near the elbow (tennis elbow strap) can be used to protect the injured muscles as they are healing. Anti-inflammatory medication can be taken by mouth. In severe or long-lasting episodes, an injection of steroids into the area may relieve the discomfort. There is some controversy about cortison for tennis elbow. We should discuss this in the office, though I do find an injection can help many people.The therapist will teach exercises that stretch and strengthen the muscles to help prevent the condition from returning. Some patients respond to additional treatment through therapy. As the condition improves, there is usually a slow return to normal activities. Recurrence of this condition is common.

Exercises should not be performed until the area is no longer swollen and tender. If, during the course of strengthening the muscles, you experience tenderness and/or pain, STOP! You are starting the vicious circle all over again. Rest until you can do the exercises without pain. Lateral epicondylitis is often a nagging or chronic condition sometimes requiring many months for healing to occur.

If nonsurgical forms of treatment do not eliminate the pain of this condition, surgery may be recommended. I need to discuss with you the surgical treatments for lateral epicondylitis and the possible outcomes.

Injection of blood

The problem in tennis elbow is a lack of adequate healing. An injection of your own blood can help.

What can a therapist do to help?

The most important thing a therapist can do is to help to teach you about the anatomy of the area and the mechanism of injury. They can help identify aggravating activities and suggest to you alternative postures. They can provide a forearm strap or wrist brace to help protect the irritated area. They can instruct you in a home program of massage, heat, ice and other treatments aimed at making the area more comfortable. Once you have let the scar tissue mature, they can supervise a set of progressive exercises designed to gradually strengthen and recondition the irritated muscles. Remember, however, even if the therapist has given you exercises to do, STOP if you experience the pain returning.

Revised 10/7/09 wh