What to Expect from Physical Therapy for Tennis Elbow

Tennis elbow—also known as lateral epicondylitis—is a painful condition that causes symptoms in the outer portion of the elbow and occasionally into the forearm or wrist. Once thought to be an inflammatory issue in your tendon, this diagnosis is now understood to be more degenerative in nature. It is caused by the overuse of the wrist and finger extensor muscles that attach to the outer area of the elbow.

While up to 3% of the population experiences this condition at some point, most cases are mild and self-resolve. In some instances, however, physical therapy (PT) may be needed to prevent your tennis elbow from worsening.

If left untreated, lateral epicondylitis pain can become more intense and can significantly hinder your ability to perform daily tasks like using a computer, getting dressed, or lifting and carrying objects.

For more information about physical therapy for tennis elbow, take a look at the sections below.

When You Need Physical Therapy

Tennis elbow is frequently a self-limiting condition and many minor cases resolve on their own with treatment like:

• Resting the arm
• Over-the-counter pain medication
• Activity modification

That said, some instances are more significant and should be seen by a physical therapist. Several symptoms can be indicative of a case that may benefit from formal therapy treatment.

Lateral epicondylitis typically begins with tenderness over a boney area (called the lateral epicondyle) on the outside of the elbow. Early on, this pain is typically only present when the muscles that attach to this area are turned on. The most irritating activities include:

• Lifting
• Typing
• Extending the wrist or fingers in an upward direction

In addition, tasks that involve turning the forearm so that your palm is facing upward can also be provocative.

As the condition progresses, the pain can get more intense and can spread into the muscles of the forearm and wrist.

Your symptoms can also become more frequent and may even start to be present at rest. If this occurs, or if activity modification does not significantly improve your symptoms after a few weeks, it is important to speak to a physical therapist.

Treating lateral epicondylitis with physical therapy was found to be more effective in reducing pain than self-management of the condition after six weeks of care.

What Physical Therapy Entails

There are several different things that a physical therapist does to help reduce the symptoms associated with tennis elbow. This includes:

• Education: Your PT will likely spend time discussing the movements and activities that can aggravate your condition and provide you with less irritating modifications for your daily tasks (ergonomic and lifestyle modification education). They can also help you select a wrist or elbow brace that can reduce the stresses placed on the degenerated tendon (bracing education).
• Stretching: The goal of therapy is to stretch out the affected area and to build strength in the affected muscles.
• Strengthening: Your therapist will help select appropriate exercises that accomplish these goals and will progress them as they become easier.
• Manual therapy: Manual therapy techniques, such as massage or light mobilizations to the elbow, may also be performed to help reduce pain and improve your arm function.

While modalities like ultrasound or electrical stimulation may also be used for pain relief, their benefits are still in question, and they should not take priority over stretching and strengthening.

Tennis Elbow Exercises

Your physical therapist may suggest a wide array of exercises to help you stretch and strengthen the affected area of the elbow. Some of the most common techniques are detailed below.

Wrist Stretch

1. Extend your arm in front of your body with your elbow straight and your palm down.
2. Lightly push your hand downwards with your unaffected hand until a stretch is felt in the wrist or forearm area.
3. Hold this position for 30 seconds before releasing it and complete two to three repetitions. Do this at least five times each day. 

Wrist Isometrics

1. Sit upright with your arm resting on a table and your palm hanging off the edge.
2. With your palm facing downwards, extend it fully towards the arm.
3. Use your other hand to apply pressure on the back of the palm without allowing the wrist to move. Apply enough pressure to feel a strong muscle contraction, but not so much that you experience pain.
4. Hold this for 45 to 60 seconds before relaxing and completing two to three reps. This can be done one to two times per day.

Extension Eccentrics

1. Begin with your arm comfortably resting on a table and your downward-facing palm hanging off the edge.
2. Move your wrist upwards towards you.
3. Use a light weight (1 lb. can of soup or beans) in the hand with palm facing down, extend the wrist, then focus on slowly lowering the wrist with the weight in it.
4. Perform three sets of 10 repetitions of the eccentrics each day.

Supination Eccentrics

1. Start with your arm and palm resting comfortably on a table.
2. Rotate your forearm so that your palm is facing upward and make a fist with your hand.
3. Using your unaffected hand, apply force to the affected fist as you attempt to turn the palm downward.
4. Over a duration of about three seconds, slowly let the unaffected side to “win” as the forearm rotates inwards.
5. Try three sets of 10 repetitions of the supination eccentrics daily.

Palm Slides

1. Sit with your arm resting on a table and your palm facing downward.
2. Keeping the pads of your fingers and your palm in contact with the surface, slide your fingertips backward as your knuckles rise in the air. Do not allow your fingers to bend as you do this.
3. Complete the exercise 10 times and try three sets each day.

Outlook

As mentioned previously, tennis elbow is typically a self-limiting condition with mild cases usually resolving on their own. Individuals with a more flared-up elbow that is not responding to activity modification alone may need to participate in therapy and perform the suggested exercises for several months before symptoms resolve. That said, PT has been found to improve your pain and function in as little as six weeks.

In rare cases, physical therapy does not provide relief from lateral epicondylitis and surgery may be necessary. This is relatively uncommon and it is estimated that 80% to 95% of people respond to nonsurgical treatments. In these less frequently seen situations, up to four to six months of PT may be necessary after an operation to help you restore function in your arm and return to more physical tasks.

Frequently Asked Questions

What kind of physical therapy can you do for tennis elbow?

Physical therapy focusing on improving flexibility and building strength in the shoulder blades, shoulder, forearm, wrist, and finger muscles can help combat the symptoms of tennis elbow.. Supplemental manual techniques focusing on massaging and mobilizing the affected area can also be performed.

How often should you do physical therapy exercises for tennis elbow?

Stretching exercises should be completed frequently (five times per day or more) each day. Strengthening exercises can be done in two different sessions in the same day. It's best to check with your physical therapist to confirm cadence.

How long is physical therapy for tennis elbow?

While significant improvements in pain have been shown after six weeks of physical therapy, you may need to continue for two to three months depending on the severity of your condition. After being discharged from PT, it is important to continue with the prescribed exercises until the condition completely resolves.

A Word From Verywell

Tennis elbow can be a pesky and frustrating condition that can significantly limit your daily tasks. While it is OK to try to self-manage the condition at first, it is best to speak to a physical therapist about your issue if symptoms start to get more frequent or intense. Oftentimes, a few simple exercises and some education on the condition are all you need to rid yourself of your lateral epicondylitis pain.