Physical therapy
There are several recommendations regarding prevention, treatment, and avoidance of recurrence that are largely speculative including stretches and progressive strengthening exercises to prevent re-irritation of the tendon and other exercise measures.One way to help treat minor cases of tennis elbow is simply to relax the affected arm. The rest lets stress and tightness within the forearm slowly relax and eventually have the arm in working condition—in a day or two, depending on the case.Other approaches that are not experimentally tested include eccentric exercise using a rubber bar. The exercise involves grasping a rubber bar, twisting it, then slowly untwisting it. Although it can be considered an evidence-based practice, long-term results have not yet been determined.There are differences in opinions on whether it is okay if pain occurs during these exercises. Some suggest pain of less than 5/10 is okay.Moderate evidence exists demonstrating that joint manipulation directed at the elbow and wrist and spinal manipulation directed at the cervical and thoracic spinal regions results in clinical changes to pain and function. There is also moderate evidence for short-term and mid-term effectiveness of cervical and thoracic spine manipulation as an add-on therapy to concentric and eccentric stretching plus mobilisation of wrist and forearm.
Tennis elbow, also known as lateral epicondylitis or enthesopathy of the extensor carpi radialis origin, is a condition in which the outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm. Onset of symptoms is generally gradual although they can seem sudden and be misinterpreted as an injury. Golfers elbow is a similar condition that affects the inside of the elbow.Enthesopathies are idiopathic, meaning science has not yet determined the cause. Enthesopathies are most common in middle age (ages 35 to 60).It is often stated that the condition is caused by excessive use of the muscles of the back of the forearm, but this is not supported by experimental evidence and is a common misinterpretation or unhelpful thought about symptoms. It may be associated with work or sports, classically racquet sports, but most people with the condition are not exposed to these activities. The diagnosis is based on the symptoms and examination. Medical imaging is not particularly useful. Signs consistent with the diagnosis include pain when a subject tries to bend back the wrist when the wrist is against resistance.Treatment involves decreasing activities that bring on the symptoms together with physical therapy or other treatment gradually increasing loads. Pain medications such as NSAIDS or acetaminophen (paracetamol) may be used. A brace over the upper forearm may also be helpful. The role of corticosteroid injections is debated.