Tennis Elbow: How Physiotherapy and Shockwave Therapy Can Help

Written by: Dr. Richard Domenic Simeoni | Nano Physiotherapy | Hornsby, NSW

Despite the name, you definitely don't need to play tennis to develop tennis elbow.

Tennis elbow, or lateral elbow tendinopathy, is a common cause of pain around the outside of the elbow. We often see it in people whose work, sport or hobbies involve repetitive gripping, lifting or wrist movements.

It can start as a relatively minor ache, but once it becomes persistent, even simple things like carrying shopping bags, picking up a kettle or shaking someone's hand can become surprisingly painful.

The good news is that most cases can be managed without surgery, and physiotherapy can play an important role in gradually restoring strength and reducing pain.

What Causes Tennis Elbow?

Tennis elbow involves the tendons that attach the muscles of the forearm to the outside of the elbow.

These muscles are heavily involved in gripping and extending the wrist.

Symptoms often develop when the amount of load going through the tendon exceeds what it is currently able to tolerate. This might happen after suddenly increasing an activity, starting a new sport, doing more gardening or DIY, or completing repetitive tasks at work.

Sometimes there isn't an obvious trigger at all.

Common symptoms include:

• Pain or tenderness on the outside of the elbow

• Pain when gripping or carrying objects

• Discomfort when lifting with the palm facing down

• Pain when using tools, a mouse or keyboard

• Reduced grip strength

• Pain during racquet sports or gym exercises

For some people the problem settles reasonably quickly. For others, the tendon can remain sensitive for months.

Should You Rest Tennis Elbow?

Usually, complete rest isn't the answer.

Reducing or temporarily modifying activities that are strongly aggravating the elbow can certainly help, particularly early on. But completely avoiding use of the arm for long periods can result in the tendon becoming less capable of handling load.

Instead, we usually look at managing the amount of load going through the tendon while gradually building its strength again.

That might mean temporarily reducing heavy gripping or repetitive lifting while continuing activities that don't significantly aggravate your symptoms.

Strengthening Is a Key Part of Treatment

Exercise is an important part of rehabilitation for tennis elbow.

Treatment will often include progressive strengthening of the wrist and forearm muscles. Depending on your symptoms and activities, this may start with relatively simple exercises before progressing towards heavier resistance and more functional movements.

We may also look at shoulder and upper-limb strength, particularly if your work or sport involves repeated lifting or gripping.

The goal is to gradually improve how much load the tendon can tolerate.

This is particularly important if you want to get back to tennis, golf, gym training, manual work or another activity that places repeated stress through the arm.

Where Does Shockwave Therapy Fit In?

For more persistent cases of tennis elbow, shockwave therapy may be considered alongside exercise rehabilitation.

Shockwave therapy uses acoustic pulses that are delivered into the painful tendon area. It is commonly used for a number of longer-standing tendon problems, including lateral elbow tendinopathy.

The aim is to help stimulate a biological response within the affected tissue and reduce pain, allowing the tendon to tolerate rehabilitation and loading more effectively.

Shockwave isn't usually something we use instead of exercise.

Rather, we may incorporate it into a broader physiotherapy program, particularly when symptoms have been present for some time or haven't improved as expected with basic management.

Physiotherapy for Tennis Elbow in Hornsby

At Nano Physiotherapy in Hornsby, we assess the elbow as well as the activities that are contributing to the problem.

Treatment may include manual therapy, advice around temporarily modifying aggravating activities, progressive strengthening and shockwave therapy when appropriate.

The important part is gradually getting the elbow used to load again rather than simply waiting for the pain to disappear.

If you've had pain on the outside of your elbow that keeps returning, or gripping and lifting are becoming increasingly uncomfortable, a physiotherapy assessment can help determine what's contributing to the problem and give you a structured plan for getting back to normal activity.