Massage therapy · Kitchener–WaterlooTennis Elbow

Tennis elbow involves the tendons and the muscles in the forearm. These forearm muscles work to extend (straighten) the fingers and the wrist. The forearm tendons attach the muscles to the bone, at the lateral epicondyle. The tendon that is most often involved with this condition is the extensor carpi radialis brevis (American Academy of Orthopaedic Surgeons, n.d.).

1. Stop Aggravating Your Arm Pain

This might sound obvious, but identify the movement that is causing the pain. It is usually a repetitive movement such as mouse clicking, carrying shopping, gripping an object or playing a certain sport. When you identify the cause, reduce or stop the movement (NHS, 2024).

2. Rest

The first step in the recovery process is to allow your arm the time it needs to rest. Stop or cut down on sports, heavy work activities and other activities that cause pain for several weeks (American Academy of Orthopaedic Surgeons, n.d.).

3. Ice or Heat

Try a hot or cold pack (or a bag of frozen peas) on the outside of your elbow for up to 20 minutes every 2 to 3 hours (NHS, 2024). You can use whichever feels better. Always wrap the ice or heat pack in a towel to protect your skin from burns.

4. Check Your Equipment

If you play any racquet sports, you might need to have your equipment checked to make sure it fits properly. Stiffer racquets and looser-strung racquets can reduce the stress placed on the forearm, which means the forearm muscles won't have to work as hard. If you are using an oversized racquet, changing to a smaller head may help (American Academy of Orthopaedic Surgeons, n.d.).

5. Use a Coach

Seek advice from a coach on correct technique for your sport, as poor technique can put your arm and elbow in a mechanically poor position. Improper stroke technique is a risk factor for tennis elbow (American Academy of Orthopaedic Surgeons, n.d.).

6. Tennis Elbow Support

A tennis elbow support (forearm strap or brace) is worn just below the elbow, over the back of the forearm. It may help to relieve symptoms by resting the muscles and tendons (American Academy of Orthopaedic Surgeons, n.d.). You can buy these from pharmacies (NHS, 2024). I can also supply a basic forearm strap and show you where to wear it.

7. Check Your Computer Posture

Ask a colleague to take a photo of your side profile at work and bring it to your appointment, and I'll guide you on a good computer set-up.

Options outside my scope

• Anti-inflammatory tablets: a family doctor or nurse practitioner may prescribe these (NHS, 2024).
• Steroid injection: an injection of a steroid medicine around the painful area. Steroid injections should be used very sparingly for tennis elbow, as too many can weaken the bone where the tendon attaches (American Academy of Orthopaedic Surgeons, n.d.).
• Platelet-rich plasma (PRP) injection: a small sample of your own blood is spun to collect the platelets, which are then injected into the affected area (American Academy of Orthopaedic Surgeons, n.d.).
• Shockwave therapy: sound waves are sent into the elbow to encourage healing; many doctors consider it experimental (American Academy of Orthopaedic Surgeons, n.d.).
• Acupuncture: fine needles are inserted into the skin; it appears to give short-term pain relief only (Cutts et al., 2020).
• Ultrasound therapy: a physiotherapist may sometimes use ultrasound therapy (NHS, 2024).
• Surgery: an operation to remove the damaged tendon, usually only considered when other treatments have not helped over many months (NHS, 2024; American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

• A graded stretching and strengthening programme for the forearm and wrist
• Hands-on work for the forearm, elbow, neck and shoulder
• A forearm strap, taping, and activity and desk set-up advice

Day to day, we'll look at spreading out heavy gripping and at your desk set-up. Keep your home programme going for a couple of months after you're back to full activity.