The ideal treatment of tennis elbow involves a combination of lifestyle changes and light therapies to aid the healing of the affected muscles and tendons. Allowing the muscles to rest is essential and the vast majority of patients improve the condition without the need for surgical treatments.
Initially, the most important steps to managing the symptoms of Tennis Elbow are simple lifestyle changes that promote the natural healing of the muscles and tendons in the area.
Where possible, the muscles in the forearm should be allowed to rest completely by ceasing the activities that were likely to cause the condition. In some cases this is not possible, however, due to causative activities that are work-related, which may require some modifications to help reduce the pressure on the area.
For example, an elbow brace may be beneficial to support the area and reduce the tension on the tendons. Similarly, changing the technique or equipment used can also help to improve the condition, such as the racquet used in tennis.
Most patients find that the associated pain is the most troublesome symptoms and often seek relief for this. Non-steroidal anti-inflammatory medications such as aspirin or ibuprofen are most commonly recommended, due to their double action as an analgesic and anti-inflammatory.
For more severe cases, cortisone steroid injections may provide stronger anti-inflammatory action and help to reduce the swelling and pain in the area. This should not, however, be considered as a long-term approach and a maximum of three injections should be administered over time.
Physical therapy involves certain exercises to help in the strengthening of the muscles and subsequent improvement of the condition. It is suggested that patients be referred to a physiotherapist for individualized recommendations to help them improve the condition.
The exercises usually promote healthy movements and stretching of the muscles in the initial stages, then progressing to exercises that are intended to strengthen the muscles. There are several different types of exercises that may benefit.
In addition to these exercises, physical therapy may include other approaches such as ultrasound, heat or ice treatments. These mediums can be applied to the area to reduce the pain and promote healing.
Treatment with extracorporeal shockwave therapy is a relatively new development that uses shock waves directed towards the elbow and affected tissues. These waves lead to “microtrauma”, which promote natural healing in the body.
This is relatively successful, helping to improve symptoms for approximately 60% of patients. For this reason, it is a second-line option that should be considered after pharmacological and physical therapies, but before surgical treatments, which carry a higher degree of risk.
The vast majority of patients with Tennis Elbow do not require surgery but it can be an effective solution for those individuals that are not successful with other treatments.
The surgery involves the removal of the diseased tissue, which is then replaced with new and healthy tissue. There are two techniques currently used in practice, both of which are performed as day surgery in outpatients:
- Open surgery: performed via a large incision into the elbow
- Arthroscopy: performed with the use of several instruments inserted into several small incisions
Rehabilitation therapy is usually required in the weeks and months following surgery. Initially, the new muscles should be stretched softly to improve the moment in the area. Strengthening exercises can be introduced approximately 8 weeks following surgery and individuals may return to full athletic activities within 4-6 months.
Additionally, some treatments are being investigated for use in the future to help people with Tennis Elbow. For example, administration of platelet-rich plasma (PRP) may help to speed the natural healing process. The current research supporting this treatment is promising, although further research is necessary before it becomes a reality in practice.