Tennis elbow is the common name for an overuse syndrome causing pain at the outer side of the elbow. As a fellow sufferer of tennis elbow I know how unpleasant and annoying it is, but as a result I also know how to cure tennis elbow fast and prevent its recurrence.
Despite its name, tennis elbow is actually more common in non-tennis players and, although it affects the elbow, is triggered by repetitive or excessive extension of the wrist joint below, which puts tension on the extensor muscle tendons where they insert into the humerus bone.
What is tennis elbow?
Tennis elbow is known medically as lateral epicondylitis. This describes an inflammation (the –itis ending) of a bony protuberance (the lateral epicondyle) on the outer side of the lower humerus where ligaments from the forearm muscles attach to move the elbow joint.
When looked at under a microscope, however, there are few signs of inflammation. Instead, the affected tendon (usually the extensor carpi radialis brevis tendon, but sometimes the extensor digitorum or extensor carpi ulnaris) shows degenerative breakdown changes within its blood vessels and collagen fibres.
This degenerative process, which occurs one to two centimetres before the tendon inserts into the bone, is more correctly called a tendinosis or tendinopathy rather than a tendonitis.
A similar condition affect the tendons that insert on the medial epicondyle on the inside of the elbow is commonly called golfer’s elbow.
The gnawing, persistent pain and tenderness of tennis elbow is thought to result from the poor blood supply and typically comes on 24 to 72 hours after repeated wrist extension activity.
Anything that promotes the growth of new blood vessels into the area will speed tendon healing.
Tennis elbow symptoms
Tennis elbow is common, with between one and three people out of every hundred developing symptoms every year.
It affects men and women equally, and is more common over the age of 40 – possibly because of the age-related degenerative changes that tend to occur in tendons. Some studies suggest that smokers are more susceptible.
Typical symptoms of tennis elbow include:
- localised tenderness on the outer, bony part of the elbow
- stiffness or aching of the elbow – especially in the morning
- worsening pain when grasping an object.
Pain when picking up and holding a cup is a good indicator that you have tennis elbow, and is known as the ‘coffee-cup sign’.
What causes tennis elbow?
Tennis elbow is related to repeated, excessive extension of the wrist – a movement that is involved in gripping any wielded item too tightly, including a tennis racquet, paintbrush, hammer or screwdriver.
In my case, tennis elbow resulted from carrying heavy shopping bags up a hill three times a week. Unfortunately, it affected both my elbows at the same time so I needed to find approaches that cure tennis elbow fast. I learned my lesson, and now also use shopping bags with shoulder straps rather than carrying them in my hands.
How to cure tennis elbow
You may have heard the depressing news that tennis elbow symptoms usually take up to one year to subside. This negative outlook is based on studies of one year’s watchful waiting – ie doing nothing except taking painkillers. This is, in fact, the standard approach as, after one year, watchful waiting achieves better results than corticosteroid injections and better results than physiotherapy. As a result, injections are no longer in fashion and people with tennis elbow are left to struggle on with painkillers alone.
I resolved my bilateral tennis elbow within three months using the following self-help treatments:
- topical painkillers such as diclofenac gel
- a neoprene elbow brace for warmth and support
- a tennis elbow pressure pad
- magnetic therapy to stimulate healing
- ultrasound to stimulate healing
- exercises to build grip strength
- supplements to stimulate tendon repair.
NB Always tell your doctor if you develop pain that limits your activities, persists despite treatment, or if you noticed weakness or numbness in the hand.
Initial treatment involves resting the are as much as possible and applying an ice pack or heat pack – which ever you find most effective – to limit pain and tenderness. If there is any associated swelling, then an ice pack usually works best.
Topical Pain relief for tennis elbow
Wherever possible, topical pain relieving creams and gels are used rather that oral pain killers. This is particularly true of non-steroidal anti-inflammatory drugs (NSAIDs) as oral NSAIDs can cause gastrointestinal side effects and, with long-term use, increase the risks of heart, liver and kidney problems.
A gold-standard Cochrane review found that topical NSAIDs were significantly more effective than placebo for treating tennis elbow, with the level of benefit gained rated as 7 on a scale of 0 to 10. Diclofenac gel is available from pharmacies as Voltarol Pain-eze.
I’ve also used Polar Frost freezing gel and MSM cream and found them just as effective.
Tennis elbow braces
A tennis elbow counterforce brace stabilises and rests the elbow joint and reduces tension forces on the affected tendons to promote healing and reduce pain. A brace that overs the elbow joint also provides warmth, opening up blood flow and delivery of oxygen, and improving the flushing away of cell wastes. This stimulates healing and reduce pain associated with poor blood supply.
Braces with a raised pressure pad are designed to press against the extensor tendons, easing pain and reducing overstretching. The tendon pad is positioned over the tenderest spot, which is usually 1cm to 2cm below the tip of the elbow on the outside of the arm for treating tennis elbow. For golfer’s elbow it is position on the inside of the arm.
A study involving 50 people with tennis elbow compared two different types of treatment brace. Half used an elbow bandage, while half used a wrist resting splint which held the wrist so it was bent slightly backwards. In those using the elbow brace, pain during rest and movement was significantly decreased at 2 weeks with significant improvements continuing at 6 weeks. Although it was not superior to the wrist splint, it was the more popular option as it could be hidden under clothing and was more practical and cosmetically acceptable.
Narrower, tennis elbow bands are suitable for milder cases, and to help prevent recurrences.
Magnetic therapy for tennis elbow
I am a great fan of magnetic therapy, which is gaining ground in the medical treatment of wounds and fractures. Applying pulsed electromagnetic fields has proven successful in reducing inflammation, swelling, pain, and speeding recovery after orthopaedic surgery and I’ve found magnet therapy very helpful in treating my tennis elbows.
Magnetic therapy increases blood flow through tiny capillaries to provide damaged cells with more oxygen, nutrients and healing factors to reduce stiffness, soreness and hasten recovery. Magnetic fields also penetrate up to 2cm into the body to reduce the activation of pain receptors in the skin and underlying tissues.
Magnetic therapy also reduces inflammation so that repair, healing and recovery can occur more effectively.
I used Homedics IHeal device, which generates a pulsed electro-magnetic field. Simply attach with its strap, switch on and leave it to work for up to 10 hours at a time. It is clinically proven to reduce pain, inflammation and to speed recovery by 30 per cent. Suitable for soft tissue injuries including tendonitis, carpal tunnel syndrome, repetitive strain injury, tennis and golfer’s elbow, sports’ tendon injuries and arthritic inflammation.
I also wore a magnetic bracelet (and still do).
Build grip strength to cure tennis elbow
Flexible rubber exercise bars increase grip strength, reduce pain and promote healing of tennis elbow. Using a technique known as the Tyler twist, these exercises can strengthen wrist extensor muscles and tendons. They have been shown to reduce tennis elbow pain by 81% compared with 22% improvement in those receiving standard treatment, and significantly improved wrist grip strength compared with no significant improvement in those using standard treatment.
Source: Tyler et al. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J Shoulder Elbow Surg. 2010 Sep;19(6):917-22.
Basically, you hold the flexible bar vertically in front of you with your injured had on the bottom end, and extend your wrist. Then hold the upper end of the bar with your other hand, so the palm is facing away from you. Twist the top of the bar while stabilising the bottom of the bar with your lower hand. Then straighten your elbows and turn the rubber bar horizontally so your wrist on the injured side is extended and your other wrist flexed. Slowly release the bar with the wrist on your injured side. It’s easier to do than it sounds!
Acupressure for tennis elbow
Results from six studies show that acupuncture is effective for short-term pain relief in tennis elbow. Hand-held electric acupressure devices that stimulate acupressure points in a similar way to needles are available for home use and preferred by many people.
Ultrasound therapy for tennis elbow
Ultrasound is widely used by physiotherapists to boost blood and lymphatic circulation, stimulate protein synthesis, regenerate damaged tissues and promote healing of sports injuries. Self-administered ultrasound therapy is now available for home use and is highly effective for improving tendinopathy such as tennis elbow.
In people with tennis elbow, sustained ultrasonic therapy produced significant improvements in grip strength and pain within the first two weeks of a six-week study.
A 12 week study involving 49 people found that ultrasound plus exercise was more effective for reducing pain, and improving pain-free grip strength than injections with local anaesthetic and corticosteroid drugs.
Intensive red light therapy is also effective for warming parts of the body, boosting circulation, alleviating pain and stimulating healing.
Supplements for tennis elbow
I used Healthspan glucosamine and chondroitin plus krill oil to treat my tendinitis (and still take them). If my tennis elbow ever recurs, I would now also add LQ Liquid Joint Care supplements which were highly effective in treating my recent anterior cruciate knee ligament injury. These supply glucosamine, chondroitin, collagen, ginger and vitamin C to promote healing of joint tissues, including tendons.
Glucosamine, chondroitin and collagen provide building-blocks for repairing tendons and joints as well as providing an anti-inflammatory pain-killing actions.
Krill oil provides omega-3 fatty acids and powerful antioxidant pigments that have a marked anti-inflammatory pain-killing action. CLick here to read more about the benefits of krill oil.
Anti-inflammatory herbs such as bromelain, turmeric or ginger extracts are also effective.
Massage for tennis elbow
Finally, massaging trigger points that cause pain is incredibly helpful, and can reduce tennis elbow discomfort. It is especially effect as you can accurately pinpoint the tender spot. The easiest way is to use spiky massage balls.
If you are flexible you can even use your own knee and body weight to improve blood flow to the elbow and reduce pain, as shown in the video clip below.
Applying infrared light also has a therapeutic, warming effect to reduce pain and stimulate healing.
I’ve covered a lot of approaches here, and you may find that you only need one or two especially if your symptoms are mild.
For maximum results, however – especially when both arms are affected – you may need to use them all. The combination of ice packs, topical pain relief gels, elbow pressure bands, magnetic and ultrasound therapy, plus glucosamine, chondroitin and krill oil, really worked for me.
What approaches worked best for you?