The key to tennis elbow (lateral epicondylitis) treatment is through tendon stimulation. Common treatments for tennis elbow are physiotherapy and cortisone injections, but it has long been misunderstood as to which treatment is best. Researchers have finally put treatment options for tennis elbow to test in order to uncover which one is the best to offer relief.
In many cases, tennis elbow will improve on its own without treatment, but patients may experience symptoms for years to follow. Lead researcher Morten Olaussen said, “Tennis elbow can be very distressing. Patients have to suffer persistent and often severe pain. They have reduced function in the elbow, and many have to go on sick leave.”
The researchers completed an in-depth literature review to determine the effectiveness of treatments for tennis elbow. They suggest that cortisone injections should be used with caution, as many patients experience relapse, and the long-term effects are widely unknown.
The researchers reviewed the effects of no treatment for tennis elbow, physiotherapy treatment alone, and physiotherapy combined with cortisone injections. The research took the form of a randomized, placebo-controlled study where patients were divided into three groups and were monitored for one year.
The researchers found that two-thirds of patients recovered without any treatment. For the remaining one-third who still experienced symptoms after a year, further treatment was required and physiotherapy alone was no more effective than no treatment at all.
Olaussen added, “It came as a surprise that physiotherapy, especially eccentric exercise, did not help. This type of exercise has otherwise proved to be effective for chronic symptoms. Perhaps the acute condition that we have studied is an infection that later develops into a chronic condition, with changes in the tissue and tendon? Or possibly the combination of the different types of physiotherapy that we used was detrimental.”
Physiotherapy combined with cortisone injections led to short-term results, and after one year’s time all three groups experienced the same improvements.
“The main conclusion was that two-thirds of patients with acute tennis elbow recover after one year without any special treatment.” Olaussen concluded. “In our study, physiotherapy had little effect. If you need a quick recovery, cortisone injections together with physiotherapy may be appropriate. Many people will then experience a quick recovery, but symptoms will temporarily worsen after a while. This means that we cannot recommend this treatment to everyone, even though it has no long-term detrimental effect.”
Treating Epicondylitis, Saline Injections as Effective as Platelet-Rich Plasma Injections
Another study compared treating tennis elbow with either saline injections of platelet-rich plasma (PRP) injections and found that saline injections were equally as effective. Lead researcher Patrick Le Goux explained, “While PRP injections were shown to have no inherent benefit in the treatment of epicondylitis, what is exciting is that pain scores in both treatment groups decreased significantly over the course of the trial. The healing process is stimulated by the echo-guided injection of a substance and/or by the own effect of the needle (needling); the injections stimulate the process of tendon repair through an irritation effect, a technique known as prolotherapy.”
The researchers administered injections every four weeks of either PRP injections or saline, and were evaluated every one, three, six, and 12 months. The study consisted of 50 patients with confirmed tennis elbow, but only 44 participants completed the study.
After six months, no statistical differences were found in either group. At six months, 34 percent of all patients were asymptomatic, and at 12 months, 66 percent of patients were asymptomatic. At 12 months, only 23.8 percent of patients still experienced symptoms.
How Long Does Tennis Elbow Recovery Take?
Tennis elbow takes time to recover. It is not a quick or easy recovery and it takes a dedicated effort to keep joints strong and healthy. Resting the elbow and being mindful of any pain is the key to recovery. Doctors suggest stopping any daily activities or exercise if it causes pain.
Tendons and ligaments take longer to heal than muscles because of their structure. They do not receive as much oxygen as other tissues, therefore taking longer to heal. With proper treatment and detailed exercises done in a specific order, you should notice an improvement in approximately 1 – 3 weeks depending on level of activity. Most people can expect the injury to be completely healed in 6-8 weeks.
Tennis Elbow Lifestyle and Home Remedies
Different studies reveal that you don’t necessarily need injections when it comes to treating tennis elbow, and that home treatment options may very well be an effective mode of treatment. Here are some tips to help treat and improve tennis elbow:
- Rest your hand, fingers, and forearms, and stop activities that may aggravate these tendons.
- Apply ice and hot packs to the area – alternating between cold and hot may offer relief and reduce swelling.
- Wear a counterforce brace when partaking in activities that involve the hand, forearm, and fingers.
- Try elevating the elbow when in pain.
- Use over-the-counter pain medications.
- Do simple exercises and warm-ups to prevent the tendons from becoming stiff.
- Massage in avocado oil or calendula oil, which can improve inflammation.
- Combine fenugreek and milk to make a paste and apply it to the painful area like an ointment – consuming fenugreek can also give
- you the benefit of its anti-inflammatory properties.
- Consume garlic to reduce inflammation in the body.
- Complete stretches and strengthening exercises gradually when the pain goes away.
These home remedy tips can help you improve your tennis elbow and speed up recovery.
Exercises for Tennis Elbow
To perform a wrist turn, bend the elbow at a right angle. With palm facing up, twist the wrist around gradually until the palm is facing down. Hold the position for 5 seconds, repeating nine more times. This exercise should be repeated for a total of 3 repetitions.
Wrist turns with weight
This exercise is the same as the wrist turn previously mentioned, but in this version, a weight is added. A light weight should be used such as a small dumbbell or a tin of food.
Wrist lift, palm up
Start with palm up and grip a light weight. Bend the elbow at a right angle and extend the hand outwards. Bend the wrist up towards the body and hold the position for 5 seconds. Release slowly. Repeat for a total of 3 sets of 10.
Sit with forearms resting on a table. With palms facing up, hold a ball or small towel and squeeze. Hold for 10 seconds. Repeat 20 times.
Stand straight with arms at sides. Slowly bend arm upwards until the hand touches the shoulder. Hold the position for 15 to 30 seconds. Repeat for a total of 10 times.
Supination with a dumbbell
Sit in a chair with elbow resting on the knee. Hold a dumbbell vertically allowing the weight to help rotate vertically, arm outward turning the palm up. Rotate the hand back the other direction so the palm is facing down. Repeat this 10 times.
Sit in a chair holding a towel in bot hands. Rotate wrists in opposite directions as if wringing out water. Repeat 10 times in each direction.
With slow gentle movements everyday, tennis elbow can start to heal. If you feel any pain or discomfort with any of the exercises stop them immediately.