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Tennis elbow | What’s the best treatment?

Tennis elbow, or lateral epicondylitis as it’s also known, is characterised by pain on the outer part of the elbow. It often results from repetitive arm movements. Whilst rest and anti-inflammatory medications can provide some short term relief, for many it’s not enough to provide full, long term results. Here at The Physios, we recommend following the steps below for a smooth and complete recovery. See our previous blog for more information on what tennis elbow is and what causes it.


Step 1- Load Management

If you don’t get this bit right, nothing will help. If you take anything from this blog, make it this!

As discussed in our previous blog, tennis elbow is typically the result of a sudden, or prolonged overload of the muscles that attach to the outside of the elbow. Simply put, the tendon that anchors these muscles to the outside of the elbow isn’t sufficiently strong enough to withstand the amount of activity that you’re asking it to carry out. In order to for the tendon to repair, it’s imperative that the cycle of overload is broken. You must therefore eliminate or at least cut back on as many of the aggravating activities as possible.


Step 2- Shockwave Therapy

Shockwave therapy (SWT), also known as extracorporeal shockwave therapy, has emerged as a game changer in the treatment of tennis elbow. SWT owes its heritage to lithotripsy which has been around since the 1970s. It utilises focused shockwaves to break apart gall and kidney stones so they can be passed. A number of years later, a bit of lateral thinking and a strong evidence base now presents SWT as a ‘gold standard’ treatment for chronic tendon related conditions.

tennis elbow

As previously discussed, tendons go into a state of disrepair and degeneration, which results in scar tissue formation. SWT aims to agitate or ‘shock’ the injury back to its acute phase of healing using acoustic energy. Think of it as pressing the reset button. Not only does SWT ‘reset’ the stalled healing process and expedite a return to activity, there is often also a noticeable reduction in pain.


Step 3- Strengthen

A progressive strengthening programme is essential for a full, long term recovery. Strengthening exercises improve the tendon structure at a cellular level. In turn, this increases the load-bearing capacity of the forearm extensor tendons. When executed well, this crucial piece of the jigsaw should enable a gradual return to all normal activities, whatever the goal may be.


Injections for tennis elbow

Injection therapy can be considered if symptoms fail to respond to the above steps. In relation to tennis elbow, there are two options:

Steroid injections

Corticosteroid injections can offer significant short-term pain relief and improved function. However, while effective for immediate symptom management, the long-term benefits remain controversial. You can read more detail about the pros and cons of steroid injections here.

Platelet Rich Plasma (PRP)

PRP is a form of regenerative medicine. It involves injecting the affected tendon with platelets harvested from a patient’s own blood sample. This gives a ‘biological boost’ to the natural healing process. Because of this, it bypasses the potential risks associated with corticosteroids. A detailed overview of PRP can be found here.


Which option is best for you?

The option that is best for you will depend on several factors such as: how long you have had symptoms for, how severe the pain is and what activities you need to be able to do on a daily basis.

Our experienced physiotherapists can assess your condition and recommend a treatment plan tailored to your needs. Whichever route you take, unfortunately there’s no quick fix. That said, with several treatment options available, outcomes in the long term are generally favourable.


If you would like to book an appointment with one of our clinicians click here. Alternatively give our friendly reception team a call on 0114 267 8181.