Friday 26th November, 2021

How to treat tennis elbow at home

Tennis elbow
In this article we show you how to effectively treat tennis elbow at home

Tennis elbow is where abnormal tension in your forearm muscles cause stress where they attach at your elbow causing it to become inflamed. It is actually a quite easy problem to treat at home.

In this article we will show you how to tell if you have tennis elbow, then the step by step management that takes into account both the inflamed attachment and the cause.

CONTENTS

What is tennis elbow
What doctors too often miss that stops it getting better
How to tell if you have tennis elbow
Basic home treatment and management of tennis elbow
Appendix: self massage and trigger point therapy for your forearm muscles
Professionals
References

Tennis elbow with cause

What is tennis elbow

As this diagram shows abnormal tension on the muscles in your forearm (blue arrow) causes stress where they attach at the outside of your elbow. Over time this can cause the attachment to become inflamed. There are two causes of this abnormal tension.

Intermittent tension

Every medical text book will tell you that tennis elbow is caused by repeated use. This is why it is called an overuse injury.

Constant tension

Constant tension is caused by the muscles being abnormally tight (1-3). The most common reason is that they contain (myofascial) trigger points which are parts of the muscle that have spasmed causing a lump. We will discuss these later.

What doctors too often miss

Medical journals tend to just mention the intermittent tension and ignore the constant tension (4,5). Because of this doctors prescribe rest, thinking they are removing the stress allowing the elbow to heal. With the constant tension remaining it does not.

When the elbow fails to heal therapies such as drugs, needles, laser, and massage are directed at the sore elbow, while all along the abnormal tension is preventing it from healing (6-11).
Further, as discussed in our article Tennis elbow , you may end up being given:

  • exercises which just further stress the attachment, or
  • stretches, which will stress the attachment, while only temporarily relieving tension in the muscles containing trigger points.

How this home treatment will be different

Simply speaking, the home treatment we will share will remove both the intermittent and constant tension, allowing your elbow to heal. If done early the elbow will easily heal itself. If the condition is worse we will advise some simple things to help settle it down.

How to tell if you have tennis elbow

Lets look at how tennis elbow is diagnosed. The tests are something simple you can do yourself, but please discuss them with a professional.

Symptoms of tennis elbow

The symptoms of tennis elbow are pain at the outside of your elbow, aggravated by activities such as bending back your wrist or fingers, or by gripping.

Simple tests for tennis elbow

There are two basic ways a doctor will test for tennis elbow:

  1. examining your elbow for tenderness
  2. provocation tests that stress the attachment to see if they cause pain
Tennis elbow examination
Examine for tender bony bump at outside of elbow
Examining for tenderness

Examine the outside of your elbow. It will be very tender at the bony bump (lateral epicondyle) and for 1-2 cm towards your wrist (the tendon).

Provocation tests

There are a couple of tests with the impressive sounding names Mills and Cozens tests, but these are basically I) bending your wrist forward to tighten the muscles at the back of your forearm that attach to the lateral epicondyle, and ii) bending the wrist back the other way against resistance. These pull on the area injured in tennis elbow, so if they cause pain it is considered positive.

Tension test for tennis elbow
Stretching forearm muscles causes elbow pain
Tennis elbow test: stressing forearm muscles
Stressing forearm muscles will cause elbow pain

Are trigger points and muscle tightness placing tension on your elbow

The next step is to see if you have trigger points in your forearm muscles creating tension and preventing your tennis elbow from healing. The simple steps are:

  1. examine your muscles for trigger points
  2. see if treating the trigger points relieves the elbow

Examine your muscles for trigger points

This can be done using the technique demonstrated in our video on forearm muscles. If you find trigger points they will certainly be causing the muscles to be tight, so they will be involved. If pressing on them causes your elbow pain it also shows that they are indirectly causing pain as well.

Examining for trigger points
Examining forearm muscles for trigger points

See if treating the trigger points relieves the elbow

What you do here is simply:

  • do the tennis elbow tests,
  • treat the trigger points, then
  • repeat the tests.

A noticable inprovement means that the trigger points are involved.

Step one:

Try gripping something or bending your wrist back to reproduce the pain, then examine the outside of your elbow for tenderness.

Step two:

Temporarily relieve the tension in your forearm muscles by treating the trigger points using either of the two methods shown below.

Step three:

Re-test your elbow by doing the activity that previously caused pain and by examining the side of your elbow. If the activity is less painful or the tenderness at the side of your elbow is reduced it is a sign that tension due to trigger points is contributing to you tennis elbow.

Basic home treatment and management of tennis elbow

In this section I’ll go over a basic step by step conservative plan that should fix most tennis elbow problems.

  • Step one: settling the tennis elbow down
  • Step two: the healing stage
  • step three: rehabilitation
  • issues that may stop your elbow healing
  • prevention

Step one: settling the tennis elbow down

Tennis elbows are often continually sore, with sharp pain upon movements. If this is so the first step is to settle it down so it stops hurting so much and can start to heal.

Modifying activities

While your tennis elbow is settling down you will need to reduce or modify all activities that aggravate the injury. These activities will be very obvious. They will be the ones that hurt.

Reducing the tension in the forearm muscles

At this stage you can start reducing the tension on the injury by treating the tightness and trigger points in the muscles of your forearm. We show you techniques you can use in the appendix. It is most important that you only treat the muscles, not the injury. All massage techniques should stop at least 2cm from the painful bump at the side of your elbow.

Braces

If you can avoid using one that’s great, but sometimes braces can be used to reduce the tension of the muscles on the injury.

Stop hurting the injury

A lot of common tennis elbow treatments actually aggravate the injury. These include massage to the elbow, needles, stretches and exercises. Stop these and let the injury settle.

Assist settling the injury

Sometimes anti-inflammatory drugs are used to help reduce pain and swelling. However, these can have dire side effects (12-16). They also artificially block the pain making you think the injury is better than it is, causing you to overdo it and cause more damage. The safest way to help reduce pain and swelling is by applying an ice pack 5 minutes per hour for 48 hours.

Step two: the healing stage

After settling down your elbow may still be a bit sore, but should be relatively pain free except where movements stress the injury. During this phase you continue to minimise stress on the injury while allowing it to heal.

Treatment of forearm muscles

Continue to apply therapy to your forearm muscles. As discusses in our article Why do trigger points keep coming back , problems such as trigger points in your forearm muscles will take a large number of applications of therapy to completely remedy.

Gradually re-introduce activities

It is important to re-introduce activities to get your muscles and joints working normally again. Allow your body to tell you what you can and cannot do. If an activity causes pain the part that it stressed will not have healed yet.

Step three: he rehabilitation phase

If you have had your problem for some time tissues may have shortened and you may have lost strength in some muscles. If this is so, as healing is completed and activities become pain free it is time to start introducing stretching and strengthening exercises.

Special note on stretches and exercises.

We often see stretches and exercises recommended to relieve tennis elbow. These may give short term relief, but stress the injury to it’s long term detriment. Leave the stretches and exercise to the rehabilitation phase when the injury has healed. You will be much safer and better off.

Issues stopping your elbow from healing

When tennis elbow don’t heal issues like scar tissue and adhesions are blamed, but in the overwhelming number of case the tightened forearm muscles are the problem. However, sometimes issues like scar tissue and adhesions are actually a problem. In this case the conservative care I have recommended will take stress of the injury and help a lot, but you may need some professional help to deal with this remaining issue as well.

Plumber working with pliers
If you use your forearms a lot for sport or work regular self massage or trigger point therapy will help prevent tennis elbow

Prevention

Of course the easiest way to treat tennis elbow is to avoid it in the first place. Over time repetitive use of your forearm muscles will cause them to tighten and develop trigger points, causing abnormal tension on the attachment point to the outside of your elbow. If your sport or occupation involves repeated use of your forearms we recommend that you use the techniques described in the appendix to take care of your forearm muscles and avoid problems altogether.

Appendix: self massage and trigger point therapy for your forearm muscles

Basic principles

For this you need to forget any advice you’ve seen about massaging the sore elbow to stimulate blood flow and break up scar tissue. That is little use and more often than not stirs up the problem. Instead you will be focusing on:

  • relieving abnormal tension, and
  • treating trigger points that refer pain which mimics and adds to tennis elbow pain

The muscles

Forearm muscles
Important muscles at the back of your forearm shown attached to the outside of your elbow

The main muscles

There are many muscles at the back of your forearm from your elbow to your wrist. These are very important because:

  • most attach to the lateral epicondyle so if they are tight they will stress the injury, and
  • most have trigger points that refer pain to your elbow

Other muscles

There are several other muscles that are important. Some (eg. triceps) can have trigger points that can refer pain to your elbow. Others often work together with your forearm muscle to perform tasks. If there are issues with some muscles others are forced to compensate. For simplicity consider all the muscles of your arm.

The techniques

In this guide I’ll show you two self massage and trigger point therapies you can easily do at home:

  1. a simple manual massage technique that needs no special equipment, and
  2. vibration massage

Basic manual massage

Forget the special patterns, rubbing across fibres and the other secret sauce recipes you see advised for massaging tennis elbow. There’s no real need for a lot of it, some is actually harmful, and the basic technique I’ll show you works just fine. You can use this technique on any muscles you can comfortably access yourself.

Basic self massage
Basic self massage: like squeezing an old sponge

What I’ll get you to do is imagine your forearm muscles are like old sponges filled with gunk. Lubricate your forearm, then using light to moderate pressure with your thumb move slowly from your wrist to your elbow like you are squeezing out the gunk.

  • Massage like this must be done towards your heart because your lymphatic (drainage) vessels and veins have one way valves. Massaging the other way would be trying to force fluids the wrong way through these one way valves.
  • Stop two cm before the painful bony bump at your elbow, otherwise you risk further damaging the healing injury.
  • Work systematically to cover all the muscles
  • Repeat the process using gradually more pressure to penetrate deeper.
Basic trigger point therapy
Basic trigger point therapy: hold the pressure for 5-10 seconds

Trigger point therapy

This basic massage technique can be easily modified to become a highly effective trigger point therapy. As you move along the muscle you may find part that is particularly tight, and some may contain a tender lump that possibly refers pain. These are possible trigger points. When you get to these tight spots or lumps stop and maintain pressure for 5-10 seconds before moving on.

Vibration massage (Our recommendation)

Vibration massage is widely used by professionals to provide massage and to treat trigger points. It is done by simply placing the vibration massager over the trigger point allowing the vibrations to penetrate and have their effect. Because it does not require penetrating pressure it is relatively safe, and because no special skills are required it is far easier to self apply.

The scientifically proven effects of vibration massage

Why vibration massage works

As shown in this diagram vibration penetrates your muscles and helps reduce spasm, muscle tightness, restricted blood flow, and any build up of toxic wastes. For more information please see our guide The scientifically proven effects of vibration massage- with clinical applications.

Using a vibration massager
Using a vibration massager

How to use vibration massage

Using vibration massage is extra-ordinarily easy. I ask that before using this therapy you check our  Vibration massage usage guide but basically all you need to do is place the vibration massager on the muscle over muscle to be massaged or the trigger point and let the vibrations penetrate for 30-60 seconds. This can easily be repeated every day. Please note that you need a proper effective vibration massager. As discussed in our article Should I get a massage gun or a vibration massager most of the common massage guns and percussion massagers will be ineffective. 

There are two basic patterns you can use to massage using a vibration massager. As for the manual massage don't apply directly to the painful elbow.

Systematic approach

Use a systematic pattern massaging one part at a time so you cover the whole muscle.

Specific approah

Examining the muscle and working on any problems found.

The DrGraeme Ultimate Quad Head Massager
The DrGraeme Ultimate Quad Head Massager

How to choose a vibration massager

For how to choose an quality massager that will do a great job and that you will be extremely happy with please see our article How to choose a massager, or you can go straight and check out our economical, easy to use professional standard machines The General Purpose Massager or our Ultimate Quad Head Massager.

Professionals

DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.

References

. Fernández-Carnero J, Fernández-De-Las-Peñas C, De La Llave-Rincón AI, Ge HY, Arendt-Nielsen L, Johnson GW, et al. Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia. Clin J Pain . 2007;23(4):353–60.
2. Aggarwal A, Daniel J, Palekar TJ. Prevalence of Myofascial Trigger Points in Brachioradialis, Biceps Brachii, Triceps Brachii, Supinator and Extensor Carpi Radialis Brevis in Lateral Epicondylitis. Indian J Physiother Occup Ther - An Int J. 2020;(1):14–8.
3. Fernández-Carnero J, Fernández-De-Las-Peñas C, De La Llave-Rincón AI, Ge HY, Arendt-Nielsen L. Bilateral myofascial trigger points in the forearm muscles in patients with chronic unilateral lateral epicondylalgia: A blinded, controlled study. Clin J Pain. 2008;
4. Smidt N, Windt DAWM Van Der, Assendelft WJJ, Devillé WLJM, Bos IBCK. Corticosteroid injections , physiotherapy , or a wait-and-see policy for lateral epicondylitis : a randomised controlled trial. Lancet. 2002;359:657–62.
5. Johnson GW, Cadwallader K, Scheffel SB, Epperly TEDD. Treatment of Lateral Epicondylitis. Am Fam Physician. 2007;(76):843–50.
6. kotteeswaran k. EFFECT OF MYOFASCIAL TRIGGER POINT RELEASE THERAPY AND ACTIVE STRETCHING ON PAIN AMONG LATERAL EPICONDYLITIS PARTICIPANTS. Int J Res Anal Rev. 2019;6(2):184–8.
7. Lin MT, Chou LW, Chen HS, Kao MJ. Percutaneous soft tissue release for treating chronic recurrent myofascial pain associated with lateral epicondylitis: 6 case studies. Evidence-based Complement Altern Med. 2012;2012.
8. Trivedi P, Sathiyavani D, Nambi G, Khuman R, Shah K, Bhatt P. Comparison of active release technique and myofascial release technique on pain, grip strength & functional performance in patients with chronic lateral epicondylitis. Int J Physiother Res. 2014;2(3):488–94.
9. Khuman R. Myofascial release technique in chronic lateral epicondylitis: a randomised controlled study. Int J Heal Sci Res. 2013;3(7):45–52.
10. Ajimsha M. Effectiveness of myofasial release for lateral epicondylitis in computer professionals. Arch Phys Med Rehabil. 2012;93(4):604–9.
11. Trudel D. Rehabilitation for patients with lateral epicondylitis : a systematic review. J hand Ther. 2019;17(2):1–3.
12. Fine M. Quantifying the impact of NSAID-associated adverse events. Am J Manag Care. 2013;19(14 SUPPL.):267–72.
13. Blower AL, Brooks A, Fenn GC, Hill A, Pearce MY, Morant S, et al. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmacol Ther. 1997;11(2):283–91.
14. Cryer B. NSAID-associated deaths: The rise and fall of NSAID-associated GI mortality. Am J Gastroenterol. 2005;100(8):1694–5.
15. Sostres C, Gargallo CJ, Arroyo MT, Lanas A. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2010;24(2):121–32.
16. Patrignani P et. al. Managing the adverse effects of nonsteroidal anti-infalmmatory drugs. Expert Rev Clin Pharmacol. 2011;4(5):605–21.

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Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more