What is the best way to treat tennis elbow?

Physical therapist here with a good track record of guiding people through tennis elbow rehabilitation.

Tennis elbow is a form of tendinopathy. There is a plethora of “therapies” that can sometimes provide temporary relief, but there is no quick fix.

Tennis elbow is most often self-limiting. This means that it’s a condition that resolves itself over time, 12 months or so in this case. Most treatments studied in the literature perform equally well for this reason – they simply do not modify the condition at all. This also causes people who have dealt with tennis elbow to advocate some therapies they found helpful when in reality they happened to use that therapy at a time when the condition resolved on its own.

There is one known effective treatment for tendinopathies which involves gradually loading the tendon over 6–18 weeks while using strategic rests. My personal favorite involves training every other day, with usual sports training first (which may mildly aggravate symptoms) and tennis-elbow-focused exercises last (involving heavy slow resistance training for the wrist extension and sometimes grip – these will be more painful) with the other days being “no pain” days with pain-free exercise allowed but no aggravating activities. There are other ways to successfully load the tendon, and probably best to figure out what works for you with a physical therapist.

Tendons are heavily reliant on loading to regulate their rebuilding process, and for this reason complete rest is usually equivalent to pressing the pause button on a dvd. The tennis elbow neither progresses nor regresses, but the pain goes away because nothing is aggravating it. However, soon after resuming the activities, the symptoms return.

Since loading therapy is intensive and requires a large time investment, there is often little need to consider it since tennis elbow is usually not serious and resolved over time. In many cases, simply ignoring it is best – that means usual training as tolerated, no rest but no ramping up either. If symptoms still persists after 12 months, then the loading therapy is definitely indicated.

Avoid anti inflammatories (both steroidal and non-steroidal) as they will inhibit the tendon healing. For older people (that is, older than say 35), a high fruit intake (5–10 pieces per day, type is irrelevant) has a theoretical basis based on lifestyle risk factors that have little relevance for young athletes but much relevance for middle aged desk workers. However, there are currently no clinical trials to support fruit as part of a rehabilitation plan. It’s a healthy addition though, so no harm even if the evidential support is weak.

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