How is tennis elbow treated?

Applying heat and ice in combination works extremely well, as ice controls swelling and heat heals and promotes blood flow and also relieves the tightness and pain.

Although not founded in clinical research, the tennis player's treatment of choice is frequent icing and compression (Cold compression therapy) for inflammation, and taking anti-inflammatory pain-killers, such as ibuprofen.

In general the evidence base for intervention measures is poor. A brace might also be recommended by a doctor to reduce the range of movement in the elbow and thus reduce the use and pain. Also, ergonomic considerations are important to help with the successful relief of lateral elbow pain.

Initial measures

Rest, ice and compression are the treatments of choice. There are many excellent cold compression therapy products available. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain, and inflammation.

Exercises and stretches

Stretches and progressive strengthening exercises are essential to prevent re-irritation of the tendon. Progressive strengthening for this condition involves using weights or elastic theraband to increase pain free grip strength and forearm strength.

Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff, scapulothoracic and abdominal muscles by Physiotherapists to help reduce any overcompensation in the wrist extensors during gross shoulder and arm movements.

Physiotherapy

With physiotherapy, ultrasound can be used to reduce the inflammation and promote collagen production although the current evidence for its efficacy is inconclusive. Manual therapy (a form of physiotherapy) is an important part of the treatment; and can take the form of elbow joint mobilisations/manipulations and/or extensor muscle tissue mobilisations.

Nerve mobilisation can also be helpful if the Physiotherapist finds a positive nerve tension test in their assessment. The most common upper limb nerve found to be sensitive is the radial nerve for this condition. Elbow clasps are also found to give temporary relief of symptoms.

Local steroid injections

Intra-articular glucocorticoid steroid injections can resolve episodes for several months, but there is a risk of later recurrence. Following an injection, the patient normally experiences increased pain over the subsequent day before the steroid starts to settle the condition over the next few days.

As with any steroid injection, there is a small risk of local infection and tendon rupture. Most doctors will restrict giving further courses after two injections, as there is less likelihood of effectiveness but increased risk of side-effects.

As opposed to short-term effects, the longterm benefits of local steroid injection are less clearly established.

Surgical intervention

If conservative measures fail, release of the common extensor origin may be helpful.

Alternative treatments

Laser Therapy
The Use of Laser Therapy (Low Power or Low Intensity Laser Therapy) is a currently used treatment.

The approach was spun off of research on how light affects cells. The findings, that light stimulates and accelerates normal healing, sparked the creation of several devices. The dosage often determines the extent of the success with this treatment, so it is generally recommended that experienced clinicians apply the therapy with a device that can be 'customized.'

Professional athletes have used the therapy, and it has gained attention in the media lately, on shows like the Canadian health program "Balance" on CTV.However studies evaluating the efficacy of laser therapy for tennis elbow are currently contradictory.

Acupuncture has also been proven to be beneficial but evaluation studies are also inconclusive.