Tennis & golfer’s elbow: adherence to rehabilitation program is key


“Elbow tendinopathy,” commonly called tennis or golfer’s elbow, is an overuse injury. Playing tennis or golf can cause this, but so can other things. It’s the most common condition affecting the elbow.

Recovery can take three to four months, although pain can go away in 6-12 weeks. Left untreated, patients can end up with chronic pain. Treatment focuses on resting and protecting the injured tendon so it can heal, swelling go down and muscle strength improve. Patience and careful adherence to a rehabilitation program is key to improvement.

Tennis elbow versus golfer’s elbow

Patients sometimes confuse tennis elbow and its cousin golfer’s elbow with carpal tunnel syndrome because elbow pain can extend into the forearm. Tendons are tough bands of tissue, which connect muscles to bones. They help your muscles move your bones.

  • Tennis elbow is an injury to the outer elbow tendon.
  • Golfer’s elbow is an injury to the inner elbow tendon.

Tennis players with tennis elbow

Beginning tennis players are candidates when they frequently contract their wrists on strokes, don’t follow through sufficiently and lead with their elbows.

Over half of the force for a tennis serve should come from the hips and pelvis. Not from the wrist.

Many tennis pros recommend staying away from a lightweight racquet with a heavy head and a grip that’s too small. Lower string tension transmits less force to your elbow. For more information, visit

Elbow tendinopathy symptoms

If you’re right handed, you’ll be more likely to get tennis or golfer’s elbow in your right elbow. Left-handed people usually experience pain in the left elbow. Symptoms include:

  • Elbow pain that gets worse
  • Pain from the outside of your elbow to the forearm and back of the hand when grasping or twisting
  • Pain when shaking hands or turning a doorknob
  • Hard to hold a coffee cup

Risk factors

  • Performing repetitive movements for two or more hours daily
  • Improper weight lifting techniques when routinely lifting 44 pounds or more
  • Poor tennis and golf techniques and inappropriate equipment


A medical professional can diagnose your problem after performing a physical exam and listening to your signs, symptoms and description of pain. There’s often pain:

  • When the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow
  • Also, near the elbow when the wrist is extended against resistance or bent backwards, like revving a motorcycle engine


The goal of treatment is to relieve pain and swelling, then increase muscle strength.

Pain relief

In the beginning, Aceaminophen (Tylenol and other brands) in limited amounts may offer pain relief. Usually, two 375 mg tablets every four to six hours as needed. But don’t take more than 4000 mg of Acetaminophen a day.

Talk with your doctor before taking any if you have liver disease or drink alcohol regularly.

Another choice in the beginning is nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil and other brands) or naproxen (Aleve and other brands) used sparingly. Patients can take 400-800 mg of ibuprofen every six to eight hours, but no more than 3200 mg per day. If naproxen is preferred, 440 mg every 12 hours.


For up to three days after an injury, ice your elbow for 20 minutes every two hours to help reduce swelling. Keep your elbow above your heart level when possible to limit swelling.

Arm brace

A tennis elbow brace or strap can apply pressure to your forearm muscles, reducing pressure on the elbow’s injured tendon.

  • Most drug stores sell arm braces with ice packs for $10-20.
  • When you put the arm brace on, make sure the cushion rests on your forearm muscles, three to four inches from the tip of your elbow bone.
  • The brace may help you for six weeks after your injury.
  • But only wear the brace while you’re working or playing sports. You need to be trying to regain range of motion at other times without the brace by bending and stretching your elbow in a pain-free range of motion. If it hurts, stop.


Using a deep heat setting from ultrasonography, high frequency sound waves vibrate tissues deep inside the injured area, creating heat.

  • This lets healthy tissue grow, thanks to more blood getting to your soft tissue damaged area.
  • Other benefits? You’ll have less pain and inflammation; fewer muscle spasms, faster healing and more range of motion.

Sound-Assisted Soft Tissue Mobilization

This can break up adhesions in the muscles and reduce chronic inflammation. Chiropractic adjustments to the elbow and wrist can also help in the healing process.


A stretching program helps relieve muscle spasms and lengthen shortened muscle-tendon units.

  • Perform stretching exercises following activity when muscles are warm.
  • Before activity, a gradual warm-up involving the major muscles is more helpful. Hold stretches for 20-30 seconds. Longer holds provide no additional benefit.
  • Stretch three to five days each week. Flexibility gains from one stretching session last 90 minutes.

Gains from regular stretching sessions last for weeks.

Flexibility Exercises

These can improve your arm’s strength and ability to move.

Tennis elbow: While standing or sitting upright, hold your injured arm straight out in front of you and lower your hand. Your fingers will be pointing toward the floor. Then use your healthy arm’s hand to hold your injured arm’s hand. Press your thumb on the injured palm and use your fingers to try to bend the wrist further. Hold for 30 seconds; repeat three times. Do this stretch several times every day.

Golfer’s elbow: Stand an arm’s length away from a wall with your injured arm closest to the wall. Place your palm on the wall with fingers pointing down. Apply gentle pressure to the hand. Hold for 30 seconds, repeating three times. Perform this exercise several times daily.

Strengthening Exercises

After your flexibility has improved and you have little or no pain, your medical professional will give you strengthening exercises.

Symptoms often get worse in the beginning as weight placed on the tendons increase. But your doctor can make sure that weight is heavy enough to promote healing, yet not so heavy that it might make your injury worse, impair function, cause excessive pain and/or discourage you.


  • Stretch your forearm muscles at your wrist before and after use.
  • Strengthen forearm muscles.
  • Tennis and golf players can take lessons to improve technique and get advice in choosing equipment.
  • Lift weight with a rigid stable wrist to reduce the force your elbow feels.
  • Apply ice to the outside and inside of your elbow for seven minutes after heavy use.

Robert W. Ferguson, D.C., F.I.A.M.A., state-licensed chiropractor and acupuncturist, sees patients at 2250 W. 86th Street, Ste. 100, on the north side of Indianapolis by Le Peep restaurant. Just look for the orange sign.

Chiropractic Rehabilitation & Acupuncture now accepts Healthy Indiana Plan for chiropractic services, and most insurance for chiropractic therapy and acupuncture.

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