As a physical medicine and rehabilitation specialist, tennis elbow—also known as lateral epicondylitis—is one of the most common musculoskeletal conditions I encounter in clinical practice. Although it may appear to be a simple overuse injury, it often requires a comprehensive evaluation and a personalized treatment plan due to its variable symptoms and healing response.
What Is Tennis Elbow?
Tennis elbow occurs when the extensor muscles in the forearm are overused, leading to micro-tears and degeneration in the tendons attached to the outer part of the elbow.
Common Causes Include:
- Repetitive use of the wrist and elbow (e.g., carpentry, cleaning, frequent keyboard/mouse use)
- Repeated gripping or twisting motions
- Improper sports techniques, especially in racket sports
- Poor posture and inadequate ergonomic setups
- Age-related loss of tendon elasticity
Symptoms of Tennis Elbow
Patient-reported symptoms are critical in diagnosing tennis elbow. The most frequent complaints I encounter include:
- Pain and tenderness on the outer part of the elbow
- A feeling of weakness when gripping objects
- Difficulty with daily tasks such as opening jars or shaking hands
- Pain that may radiate down to the fingers
- In some cases, numbness or tingling in the hands and fingers, especially if nerve involvement is suspected
If neurological symptoms are present, further evaluation is essential to rule out radial or median nerve involvement, often through electromyography (EMG).
Effective Treatment Approaches for Tennis Elbow
Treatment should be tailored to the individual's symptom severity, activity level, and physical condition. Here are the most effective methods I use in clinical practice:
- ESWT (Extracorporeal Shock Wave Therapy): High-frequency sound waves stimulate cellular repair in the affected tendon, reduce pain, and relieve inflammation—especially beneficial for chronic pain.
- PRP (Platelet-Rich Plasma): Concentrated platelets derived from the patient’s own blood are injected into the damaged area to promote tissue regeneration. Particularly effective in long-standing cases.
- Manual and Osteopathic Therapy: This holistic approach addresses not just the elbow, but also the neck, shoulder, and nerve pathways by releasing soft tissue restrictions and improving circulation.
- Counterforce Bracing: Special elbow braces help reduce strain on the affected tendon, allowing for pain relief during daily activities.
- Splinting: In acute pain phases or during sleep, wrist and elbow splints can immobilize and rest the area, preventing further microtrauma.
- Exercise and Rehabilitation: Stretching and strengthening exercises help restore muscle balance and reduce tendon overload. A customized physiotherapy program enhances functional recovery.
- Ergonomic Adjustments: Workspaces and daily habits should be evaluated to identify and correct risky behaviors. Adjusting keyboard/mouse positions and incorporating rest breaks can make a big difference.
Post-Treatment Considerations
Although most patients report significant pain relief and functional improvement after treatment, the post-treatment phase is crucial in preventing recurrence and maintaining gains.
Key Strategies for Long-Term Success:
- Gradual Return to Activity: Avoid overloading the elbow; increase activity levels progressively.
- Exercise Adherence: Continue the stretching and strengthening routine taught by your physiotherapist.
- Reinforcing Ergonomic Habits: Make posture and workspace improvements a permanent part of daily life.
- Mental and Emotional Support: Patients with chronic pain histories benefit greatly from encouragement and psychological support.
- Follow-up Appointments: Regular check-ins with your specialist help monitor progress and adjust treatment if necessary.
In some cases, mild pain may return, but this can usually be managed with short-term physiotherapy and lifestyle adjustments.
Conclusion: Every Tennis Elbow Case Is Unique
With early diagnosis, the right treatment plan, and patient cooperation, tennis elbow is highly manageable. However, recovery requires consistency, patience, and a personalized approach. Our goal is not only to relieve pain but also to restore function and improve overall quality of life.
Every patient is unique, and so should be the rehabilitation plan. In managing musculoskeletal conditions, science and empathy go hand in hand.
Dr. Elif Berber
Physical Medicine and Rehabilitation Specialist
