Contact details

Musculoskeletal physiotherapy
Haringey patient enquiries 020 8442 6272
Islington patient enquiries 020 3316 8840

Please see our website for more leaflets at
www.whittington.nhs.uk/mskphysiotherapy












Whittington Health
Magdala Avenue
London
N19 5NF

Phone: 020 7272 3070

Date published: 29/10/2012
Review date: 29/10/2014
Ref: Phys/TGE/1
Whittington Health
Please recycle







Tennis elbow or golfer elbow
(Epicondylalgia)













A patients guide
















. caring for you
Page 1


This leaflet will give you information on tennis elbow and golfers
elbow also called lateral or medial Epicondylalgia.


Tennis elbow and golfers elbow
Tennis elbow and golfers elbow are considered to be overload
injuries caused by repetitive stress at the muscle tendon junction of
the extensor (tennis elbow) or flexor (golfers elbow) muscles of the
forearm and their origin point at the bone of the elbow




Signs and symptoms
There will be increased pain over the inner and/or outer aspect of
elbow (epicondyle) radiating into the forearm that can get worse with
wrist flexion or extension movements and/or gripping or grasping.
The onset of pain is usually gradual and aggravated by using the
affected muscle group.

Page6



Notes:



































Page 5


Stretching exercises




Keeping the elbow straight, grasp your hand and slowly bend wrist
down (tennis elbow) or up (golfer elbow) until a stretch is felt.
Hold 30 seconds and then relax. Repeat five times. Do three
sessions per day.


It is not unusual for it to be a bit sore when you restart a new
activity for the first time, so get back to your usual activities
gently.

It usually takes six -12 weeks to get back to sport but can take
up to one year for full recovery.


Physiotherapy can be very helpful in helping you maximise your
recovery, reduce your risk of re-injury and should be the first point of
call before any other more invasive forms of treatments. If you
experience significant pain during or after performing the exercises,
stop and discuss it with your doctor or physiotherapist.

Page 2


Treatment
The main priority is to reduce the pain, avoid the aggravating factors and
strengthen the corresponding muscle group. To do this, follow this simple
advice:

Rest will help protect the area while the tissues are healing.
Avoid excessive activity (i.e. lifting/gripping) of the affected
extremity in the first few days then return to gentle and pain free
movements.

Ice will reduce potential swelling and bleeding and ease pain.
Wrap an ice pack or something from the freezer (i.e. bag of peas)
in a damp towel and apply to area for 10-20 minutes. You should
never apply ice directly to the skin.

Strengthening exercises conservative treatment combining manual
techniques and/or specific strengthening exercises are very helpful
in this condition

Non steroidal anti-inflammatory drugs (NSAID) Diclofenac or
Ibuprofen may offer short term relief but it is strongly advised to
consult your doctor prior using any medications.

Orthotic device ( tennis elbow clasp/brace) can be use to reduce the
tension force of the affected muscles, potentially reducing pain during
activities.
The brace should be worn between five and ten centimetres after
the elbow or area of pain.

Corticosteroid injection or dry needling may be useful in reducing
pain if conservative treatment including physiotherapy is not
successful. Speak to your doctor or physiotherapist about this.



Page 3

Eccentric exercises

Begin gentle exercises within 48 to 72 hours of injury, as long
as it doesn't cause excessive pain.

Place a 50cl bottle of water or a tin in your hand on the affected side
and move your wrist up and down either eccentrically.








Page 4


Concentric exercises

Concentric exercises should be started after three to four weeks of
performing eccentric exercises or when pain has considerably
subsided.

Place a 50cl bottle of water or a tin in your hand on the affected side and
move your wrist up and down either eccentrically.







Eccentric exercise
Use your free hand to pull your
wrist and the bottle or tin back up.

Gently let go with the supporting
hand and slowly let the bottle or tin
pull your wrist down towards the
floor.
You will need to do this exercise
15 times, rest for a minute, do 15
more exercises, rest for a minute,
do a final 15 exercises.

It is normal to feel minor pain in
your elbow toward the end of the
exercises session
Concentric exercise
Your free hand doesnt do anything
anymore.

Gently bring the bottle or tin back up
using your affected hand and slowly
let your wrist down towards the floor.
You will need to do this exercise
twenty times, rest for a minute, do
twenty more exercises, rest for a
minute, do a final twenty.

Progressively increase the number of
repetitions or the weight as pain
allows.