Treating Tennis Elbow Without Surgical Intervention

Stretching exercises
Approximately 80% to 95% of patients get better without resorting to surgery if they use proper stretching exercises. The main purpose of the stretching exercises is to gradually increase the load which is transmitted through the tendon and its attachment—but not beyond the limits of the existing pain. Some of these stretching exercises are the following:

• Wrist extensor stretch
  The arm is placed in front with the hand pointing downward. Pull your hand towards your body to feel the stretch at the back of your wrist, forearm, and elbow. Your forearm can be rotated inwards to increase the stretch on the outside of your elbow. You can do this for 20 seconds and repeat up to 5 times.
• Partner tennis elbow stretches
  Your arm should be out to your side and rotated inwards and downwards. Flex your wrist to increase the stretch. This is more easily done with the help of a partner. Hold and stay in this position for 30 seconds and repeat it 5 times. Stretch this way at least 3 times per day.
• Neural stretch
  It is possible that the elbow pain you have been experiencing is caused by tension in your neck. This neural stretch in conjunction with sports massage could help you in releasing your neck tension.  The neural stretch is done by extending your forearm and then turning it inward as far as you can. To increase its effect on your neck, turn your head to the opposite side. Hold neural stretches initially for a maximum of 5 seconds and do so only if this causes no pain. If you experience pain or a tingling sensation in your arm or hand, then stop it immediately. Gradually increase the duration of the stretch to 10 seconds.

Strengthening exercises
Apart from stretching you can also do strengthening exercises. These initial physical exercises will serve later on as the very foundation of your rehabilitation program. As soon as pain has subsided, start performing these exercises and continue until you achieve full fitness.

• Isometric wrist extension
  To contract your muscles isometrically or statically, you need to have a partner to help you resist your movements. If you cannot find a partner, you can use your other hand or a table to provide the resistance. Position your arm with the forearm and palm facing downwards and supported by your assistant if available.
  With resistance from your assistant, attempt to extend your wrist by lifting your fingers toward the ceiling. Maintain the contraction for 5 seconds, rest for a minute or two and then repeat 10 to 15 times. You should make sure that the resistance from the partner or table is enough so that the wrist does not move and is held in static tension.
• Finger extension
  Bring all your fingertips together as if you are making a beak shape. Place a rubber band over your fingers holding the tips together. Move your fingers away from each other against the resistance offered by the rubber band. Do this 10 to 20 times.
• Dynamic wrist extension
  Dynamic wrist extension is one of the more common tennis elbow exercises. If you do not experience pain after doing the isometric wrist extension and the finger extension, then you are ready for dynamic exercises. There is no need for you to rush your program. If you experience pain after starting the dynamic exercises, then you need to take a step backward.  Dynamic exercises can be performed using a light weight of about 1 kg or 2lbs. Move the wrist from flexion to extension, starting with 1 set of 10 repetitions daily and increase gradually up to 3 sets of 20 repetitions.  The same exercise can be performed using a resistance band. Rest your forearm on your knee with one end of the band under your foot. Wrap the other end of the band around your hand, start with the wrist in a flexed position (with the palm facing the floor), and the band pulled taut. Extend your wrist, keeping the forearm still. Slowly return back to the starting position and repeat for 10 to 15 times. Gradually, increase the number of repetitions that you perform per day.

Rest
One of the obvious, but sometimes neglected steps in healing is to rest the troubled part of your body. You will need to refrain from sports and heavy work for several weeks. Rest will facilitate healing of your painful elbow.

Use Non-steroidal anti-inflammatory drugs (NSAIDs)
To relieve the pain and inflammation, your doctor may prescribe NSAIDs like mefenamic acid, celecoxib, diclofenac potassium, ibuprofen, paracetamol, naproxen sodium, or etoricoxib. Ibuprofen seems to be the most appropriate drug because it could relieve the pain by preventing inflammation and by relaxing the affected muscles. Celecoxib and etoricoxib could very well relieve your inflammation and pain, but they could cause the development of edemas in your lower extremities or your whole body, and they are very expensive.
Mefenamic acid is very affordable and effective for relieving pain. However, it does not have the muscle-relaxing effect. Hence, ibuprofen may be superior to mefenamic acid. Diclofenac potassium, naproxen sodium, and paracetamol are good analgesics, but they could cause gastric irritation, nausea, vomiting, or even gastric ulceration. It is often suggested that you take these medications with food to reduce gastrointestinal side effects.

Adjust and adapt your equipment
Ergonomics states that equipment must be designed according to the needs of the worker and not the worker adjusting to the existing equipment. In line with this principle, there may be a need to modify the design of your existing equipment so that your current tennis elbow would be healed sooner or that it will not recur.
First of all, you need to find out from experts if the racquet that you have been using is a good fit for you. If the head of your racquet is too large, it will significantly burden your forearm, causing inflammation and pain. In addition, the racquet must be stiff and looser-strung so that the stress on your forearm will be reduced. In effect, your forearm does not have to work as hard as it used to.

Physical therapy
To strengthen the muscles of your forearm, you need to start with some specific exercises. You may need to consult a physical therapist who could guide you. To improve muscle healing, your physical therapist may perform ultrasound, ice massage or muscle-stimulating techniques.

Braces
A brace limits the movement of your muscles and tendons. Thus, if it is attached to the back of your forearm, it may relieve the symptoms of your tennis elbow. A brace is often used for up to 6 weeks, but how long it will be used will depend on your medical provider.

Steroid injection
If NSAIDs fail to relieve your symptoms, your doctor may resort to injecting a steroid such as cortisone in your elbow. In most instances, you may not like this procedure as it is uncomfortable and has side effects, but it is highly effective at reducing pain. Steroid injections are considered when oral drugs no longer work.  Steroid injections are generally safe to use. However, this injection is limited to two or three times a year. If the frequency is higher it may weaken your tendon, making it more likely to rupture. The rule of thumb is this: if the first injection did not help you and did not alleviate your pain, then additional injections are also unlikely to work.

Extracorporeal shock wave therapy
Shock wave therapy creates and sends sound waves to your painful elbow which create “microtrauma”, that promotes your body’s natural healing processes. This is still considered experimental by many doctors, but many consider it to be an effective treatment.

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