Tennis Elbow Physiotherapy Treatment - Ultimate Guide

Tennis Elbow Physiotherapy Treatment - Ultimate Guide

PHYSIOTHERAPY Body parts: Elbow,

Lateral epicondylitis or tennis elbow is a common overuse injury that affects the elbow joint and surrounding muscles, causing lateral elbow pain. It is considered a general health issue in Singapore with a treatment market size forecast of nearly $11 billion by 2030.

While the name commonly suggests a relation with tennis players, anyone who performs repetitive motions putting stress on the arm, wrist, and fine motor skills can be susceptible to this condition. Manual labor like painting, plumbing, and carpentry provides a high risk of developing a tennis elbow.


On the bright side, you can treat a tennis elbow without invasive or surgical methods. Physiotherapy is usually the "first-line" and best treatment doctors recommend to help patients with LE feel better.

In this article, we'll dive into the tennis elbow physical therapy treatment options, diagnosis, causes, and symptoms involved, as well as appropriate exercises and preventive measures.

What Is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow is an inflammation of the tendons that connect the forearm muscles to the bony prominence on the outside of the elbow called lateral epicondyle. Repetitive movements that put stress on the elbow joint, such as gripping, lifting, and twisting can cause micro-tears in these elbow tendons, leading to severe pain.

There are also degenerative factors that contribute to its development. However, several studies also found improper two-handed backhand executions from racquet sports, elbow instability, and bodily mechanisms or dysfunctions as the main culprits.

Diagnosing Tennis Elbow

The diagnosis of tennis elbow is typically made through a physical examination. Your physiotherapist will assess your elbow joint, range of motion, and strength. They may also ask you about your symptoms and medical history. In some cases, imaging tests such as X-rays or MRI scans may be ordered to rule out other conditions.

You can book an appointment with experienced and trusted physio and hand therapy specialists in Singapore such as Phoenix Rehab for a detailed and exact diagnosis of what's causing the pain and discomfort. Prepare to undergo treatment programs that are created specifically to meet your needs.

Causes of Tennis Elbow Pain

We've discussed how elbow pain, particularly in the case of tennis elbow, can be caused by a variety of factors. Understanding the underlying causes is crucial for developing an effective treatment plan.

Let's take a closer look at the main causes of elbow pain below.

Overuse Injuries

One of the primary causes of tennis elbow is overuse. A repetitive movement that stresses the elbow joint and surrounding tendons can lead to micro-tears and inflammation. Activities that commonly contribute to overuse injuries include:

  • Racquet sports like tennis, squash, and badminton
  • Repetitive gripping and lifting tasks, such as those in construction, painting, or carpentry work
  • Typing or using a computer mouse for extended periods

Over time, these repetitive movements can irritate and inflame the tendons, leading to the characteristic pain and discomfort of the tennis elbow.

Repetitive Motions

Closely related to overuse injuries, repetitive motions are a major contributing factor to elbow pain. Movements that involve repeatedly bending, extending, or rotating the elbow and wrist can gradually wear down the tendons and muscles, making them more susceptible to injury.

Poor Biomechanics

The way an individual moves and uses their body can also play a role in the development of elbow pain. Poor posture, improper technique, or muscle imbalances can all contribute to excessive stress being placed on the elbow joint. For example, a tennis player with a faulty swing or grip may be more prone to developing a tennis elbow.

Trauma or Injury

Acute injuries, such as a fall or direct blow to the elbow, can also lead to elbow pain. These types of traumatic events can cause damage to the tendons, ligaments, or bones in the elbow, leading to inflammation and discomfort.


As we get older, the tendons and muscles around the elbow joint can become less flexible and more prone to injury. This is particularly true for those who have been engaging in repetitive activities or sports for many years. The natural aging process can make the elbow more susceptible to overuse injuries and chronic tendinitis.

Signs and Symptoms of Tennis Elbow Pain

The main symptoms of tennis elbow can be hard to brush off. If you are experiencing the following instances, pay attention to the signs for early intervention and ensure it does not happen to your other arm.

Localized Pain or Discomfort

You may notice that the outer side of your elbow becomes a painful area, with a persistent ache or sharp pain. This discomfort often worsens with certain movements, such as bending the arm or lifting objects.

Muscular Fatigue

Weakness can manifest in your forearm muscles, making simple tasks like holding a cup or typing on a keyboard feel more challenging. This weakness may develop gradually over time.

Functional Impairment

Activities requiring pain-free grip strength or lifting may become troublesome due to the pain and weakness. It becomes impossible to lift objects without them feeling heavier, and you may struggle with tasks that were once effortless.

Wrist Discomfort

Alongside elbow pain, you might experience discomfort when rotating your wrist, such as turning a doorknob or using a screwdriver. This additional discomfort can further hinder everyday activities.

Handshake Tenderness

Shaking hands or squeezing objects can elicit sharp pain or a dull ache in your elbow. This tenderness may make social interactions or simple gestures uncomfortable.

Limited Mobility

Stiffness in the elbow joint may develop, making it difficult to fully extend or flex your arm. This stiffness can contribute to overall discomfort and restrict your range of motion, impacting various aspects of your daily life.

Treat Tennis Elbow with Physiotherapy Techniques

Physiotherapy is a highly effective treatment for tennis elbow pain. It can also help improve mobility and encourage healing. You will need a physiotherapy technique that works, which is why it's important to choose experienced specialists.

Below are the most common physiotherapy treatment programs and methods that can help in treating tennis elbow pain.

Manual therapy

This involves the use of hands-on techniques to improve joint function and accelerate tissue repairs, such as joint mobilizations, soft tissue massage, and myofascial release.

Therapeutic Modalities

Physiotherapy treatments often incorporate therapeutic modalities to aid in pain management and tissue healing. This includes ultrasound, laser therapy, cryotherapy, and electrical stimulation, commonly used to increase blood flow to the affected area.

Complementary Therapies

In addition to traditional physiotherapy techniques, complementary therapies like taping and bracing may be utilized to provide additional support and stability to the elbow joint. These adjunctive treatments can help control pain, reduce strain on the tendons, and enhance the effectiveness of the overall rehabilitation program.

Self Pain Management

This involves the use of techniques such as heat therapy, cold therapy, rest, and nonsurgical ways you can do it at home.

Post-Treatment Patient Education

Your physiotherapist will educate you on proper movement techniques and posture to reduce further strain on the elbow joint.

Physiotherapists ensure a continuous healing process by educating patients post-treatment. This includes proper movement techniques, posture, and self-management strategies to prevent further strain on the elbow joint. Patient education is essential in empowering individuals to take an active role in their recovery and maintain long-term elbow health.

Tennis Elbow Preventive Measures

Preventing tennis elbow involves taking proactive steps for significant reduction of stress on the elbow joint and painful area. This involves ensuring you take adequate rest and interspersing activities that engage the elbow with breaks to prevent overuse and subsequent strain.

You should also use correct movement techniques during activities involving the elbow, as improper form can exacerbate stress on the joint and lead to injury. Additionally, integrating regular strengthening exercises into your routine can enhance the resilience and endurance of the forearm muscles, making them better equipped to withstand repetitive motions without succumbing to strain.

Stretching exercises before and after activities involving the elbow joint are also helpful. These stretches help alleviate muscle tightness and enhance overall joint mobility, promoting healthier movement patterns and mitigating strain.

Furthermore, make sure to utilize appropriate equipment tailored to your needs, such as selecting a tennis racket with the correct grip size, and distributing force more evenly across the joint.

Exercises for Tennis Elbow Pain

Speaking of exercises, let's explore deeper on how it helps fix tennis elbow. Here are some exercises you can try and observe if it fits your needs.

Wrist Extension

Strengthening the wrist extensors and muscles involved in tennis elbow is paramount for effective rehabilitation.

An effective exercise for this purpose involves holding a light weight with your palm facing down. Slowly lift the weight by extending your wrist, ensuring a controlled movement throughout. Lower the weight gradually to engage these muscles fully with each repetition.

Towel Twists

Enhance pain-free grip strength and manage tennis elbow pain with this exercise. Towel twists provide an excellent method to achieve this. Simply hold a towel with both hands and twist it in opposite directions. This exercise activates the muscles responsible for maintaining a strong grip and can significantly contribute to your recovery.

Eccentric Training

Eccentric exercises make a significant difference in tennis elbow rehabilitation. This type of exercise focuses on controlled lengthening of muscles while under tension. Studies show that eccentric exercises demonstrate greater effectiveness in treating lateral epicondylitis compared to bracing, ultrasound, and combinations of various interventions.

To perform eccentric exercises for tennis elbow, hold a weight in your hand with your palm facing down. Slowly lower the weight by bending your wrist, ensuring a controlled and gradual descent. This movement not only strengthens the wrist extensors but also helps improve their resilience against repetitive strain.

Maintain Proper Form

Throughout these exercises, remember to keep your shoulders relaxed and your upper arm stable. This allows the focus to remain on the targeted muscles and ensures optimal engagement.

Gradual Progression

Gradually advance your exercises to enhance your tendon's ability to tolerate increased loads. Here are various methods to progress your exercises:

  • Adjust elbow and forearm position: Start with a flexed elbow and forearm in supination, then gradually increase the elbow extension angle as you progress.
  • Fingers Flexion vs. Extension: Begin with your fingers in flexion, then advance to extension to effectively load the long extensor muscles.
  • Incorporate resistance: Introduce resistance by using exercise bands or dumbbells to provide additional challenge and stimulate muscle growth.
  • Engage in bilateral movements: Since many individuals experience symptoms on both sides, bilateral movements can be beneficial. This supports evidence suggesting a link between central sensitization and tennis elbow.
  • Implement functional training: Integrate functional exercises that target the entire upper limb, promoting overall strength and coordination.
  • Emphasize weight bearing: Include weight-bearing exercises to further strengthen the muscles and improve stability in the affected area.

With the right physiotherapy treatment, prevention strategies, exercises, and management, it's possible to recover and restore function after having lateral epicondylitis.

Don't struggle with elbow pain and seek medical attention from a qualified healthcare professional. They can help to diagnose the cause of your pain and develop a treatment plan that's tailored to your specific needs. With a prompt response to this condition, you can get back to your normal activities and enjoy a pain-free life.

Phoenix Rehab: Where you regain the life you love

Singapore's most experienced and trustworthy physio and hand therapy specialists who are dedicated experts in diagnosing and treating pain and injuries in bones, muscles, ligaments, tendons and joints.

65 8800 1830 |
10 Sinaran Drive, Novena Medical Centre #10-09, Singapore 307506
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