Treating Tennis Elbow with Manual Physical Therapy

BrianTwith Brian Tenenhaus, MSPT

It’s usually around this time of year when it happens, the change of seasons when players are transitioning from outdoor to indoor tennis, or har-tru to hard court, that’s when your elbow starts to hurt. Maybe you haven’t played in a while and your asked to join a doubles group that meets every week for the winter season. Perhaps you’re trying a new tennis racket. Another possible cause is that you haven’t played much lately, and suddenly, you get back to hitting 3x/week. Whatever the cause, whenever it comes, there is never a convenient time for tennis elbow pain.

Tennis elbow, also known as “lateral epicondylagia” is not always related to tennis. It is an overuse injury which is related to musculature on the back of your forearm that occurs in up to 40 % of all tennis players. Manual laborers who are frequently using heavy machinery (especially vibratory types), or hammers and screwdrivers can also suffer from tennis elbow.

The problem is not always related to external factors though, in fact, in many cases, it can be related to areas of the body like the cervical thoracic junction which is the region where your lower neck and your upper shoulders meet. In this case, a Certified Functional Manual Physical Therapist TM would be best suited to assess your cervical-thoracic mobility, look at your shoulder girdle, and measure your core stability in order to create a treatment plan to get you back on the tennis court, in time for that “Weekend Round Robin” that you were looking forward to.

Other deficits would be tightness in your wrist musculature, or muscular imbalances, at your shoulder, elbow, and wrist. These internal factors could present to be a huge problem as well since the muscular imbalance could be pulling at your elbow with different forces. Think of your elbow like a “tug of war contest.” If you want to make an even match, you would want to ensure that there is an even pull from either side, based on number of participants, and approximate weight and/or strength of pull between all of the people tugging at that rope. However, if you put 8 adults on one side and 4 kids on the other, you could guarantee to find an imbalance, and eventually pull all those kids right into that mud pit. That is why it is important to have relatively similar strength and flexibility on all muscles that attach and surround the elbow joint.

When treating tennis elbow, there are often many factors that need to be modified, while there are other things that cannot be changed. In most cases, a short rest of 2-4 weeks, off away from the aggravating activity is the first step.  Certain stretches and strengthening exercises would be prescribed and addressed by your Certified Functional Manual Physical Therapist TM next.

Lastly, and most importantly, there are times when your shoulder, wrist, or elbow joint could be “off axis” when various mobilization techniques will help guide the joint into better position to alleviate stress that is ultimately causing pain. That “pain” is what limits you and your functionality in your occupation or sport. That is where your Certified Functional Manual Physical Therapist TM comes in to play with specific techniques to help you get back to your pain free life.

Elite Health Services, located in Old Greenwich, CT is a world-class provider of certified functional manual physical therapy, personal fitness, golf & triathlon performance training, massage therapy and wellness related services.  Our team of highly skilled and dedicated professionals take a no-excuses approach to providing exceptional care, and delivering exceptional results. To learn more visit

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