The 3-Step Process to Fixing Tennis Elbow

Tennis elbow can be an incredibly frustrating injury. Sometimes it resolves itself on its own and other times it seems to hang on for what can feel like forever. We’ve seen individuals in both camps. From this, we have found three things that – when combined together – can get someone back to playing tennis, weightlifting, gardening, or playing pickleball pain-free. Those three things are doing enough activity (but not too much), progressively strengthening the muscles in question, and getting some hands-on treatment. We’re going to dive a little bit deeper into each one of those.

Adhere to Appropriate Amounts of Activity

Ensuring that you continue to use your elbow is very important to prevent disuse and worsening of symptoms. However, it’s just as important to not use your elbow too much (which also makes things worse). This is a gray area and it is the area we see individuals trip up in the most. You want to hit the sweet spot of just enough activity to get better, but not so much activity that you move backwards. Essentially, how much activity is too much?

While this can seem like a tricky question to answer, in reality it’s not. The tricky part is that most people don’t know what amount of discomfort is acceptable. When they learn what amount of discomfort is okay before they start to slide backwards, they often do really well at navigating this gray area.

Tennis Elbow Pain that Is Acceptable

At Resilience RX, we use a stoplight analogy to describe how much discomfort is okay. A green light means “go”. This corresponds to a 0-3/10 pain on a 0 to 10 scale. (For reference, 0 is no pain, and 10 is pain so intense that you have to go to the ER). If you don’t like the scale or prefer to use words to describe how you’re feeling, this level of discomfort corresponds to the word “mild.”

Mild means you can go about your day without modifying your activities. You may be aware of your discomfort, but it’s not impacting your ability to function. This level of discomfort is perfectly fine and won’t impact healing. In fact, we’d argue if you aren’t entering this level of discomfort, you likely aren’t doing enough activity to help your muscles heal.

Tennis Elbow Pain that is a Warning

When pain should start to become a yellow light or a warning signal is when it becomes “moderate” or a 4-5/10. This means that if it’s your last bit of activity for the day, it’s okay to finish. But, if you’re just starting something, it’s not in your best interest to continue. Moderate discomfort means your function is impacted a little. You can do your normal tasks, but you may need to break them up a bit to get them done. At this level of discomfort, you are definitely aware of it, but you aren’t compensating due to discomfort.

When Pain is Too Much

After pain goes above a 5/10, it becomes a red light or “severe.” At this level of pain, you’re compensating (using your other hand, limping, entirely avoiding tasks) due to discomfort. You’re not doing damage to the tissue, but you are making it take longer to heal. This level of pain is the level we advise individuals to stay away from. That means during activity, right after activity, and a full 24 hours after activity, we recommend not tipping into the “severe” level of discomfort.

There are times where it is appropriate to flirt with this much discomfort. If you’re an athlete near the end of your season and willing to tolerate discomfort, you may find yourself an exception to this rule. However, about 99% of the time, severe discomfort that causes you to move differently is too much. If you avoid this level of discomfort, it will go leaps and bounds in helping your tennis elbow (or any injury really) to heal.

Progressively Strengthen the Tennis Elbow in Question

Everything that you read above in regards to what amount of discomfort is okay and what isn’t okay applies to strengthening the elbow. The goal is to load it so the muscles become stronger (and thus tolerate the load you currently want to place on it so you can do that amount of load pain-free). However, if you load it too much, you won’t get very far. Below are the exercises we see the best success with in regards to tennis elbow.

Wrist Extension

Farmer’s Carry

Get Some Hands-On Treatment

Last but not least, hands-on treatment goes a LONG way in treating this injury. The muscles that cause discomfort in tennis elbow are small, close to the surface, and easily targeted with dry needling and cupping. If you’re curious as to what dry needling looks like, you can check out the videos of Dr. Sarah doing the technique below. If you have questions as to what dry needling or cupping do or how they can help, check out our dry needling and cupping blog posts.

Dry Needling for Tennis Elbow – Short & Sweet

Dry Needling for Tennis Elbow – All the Details

Wrapping It Up

Tennis elbow can be a very frustrating injury, but it doesn’t have to be. When you stay within the guidelines of continuing to move but not causing too much pain, gradually loading it, and getting some hands-on treatment, things tend to improve. It may take some time, but you’ll get there.