Do you have elbow pain with lifting, gripping, typing, or working? Is it a nagging pain that is getting worse over time and just won’t go away? Feel stiffer in the morning?
I bet it’s really freaking annoying considering you likely work with your hands all day. Gosh, that can’t be fun.But the good news? It’s possible that if you can relate to much of what I describe in this post that there’s hope. Because elbow tendonitis pain is treatable! And 90% of the time, you can treat elbow tendonitis successfully with conservative treatment (See Resource). As a physical therapist, I can attest to that (See Related: About Me)
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What is elbow tendonitis?
What is elbow tendonitis? What happens is these muscles are overused, causing the tendons (ends of the muscles that attach to the bones) to exceed their tolerance to stretch (See Resource).
The normal course of limitation by this injury ranges from 12-18 months long (See Resource).
Today, let’s dive deep into two types of elbow tendonitis: medial and lateral. They’re also called golfer’s elbow and tennis elbow. I’m also going to share with you the best exercises for elbow tendonitis, so keep reading.
Let me just clear up their names first.
Medial (inner) elbow tendonitis = medial epicondylitis medial epicondalgia = golfer’s elbow
Lateral (outer) elbow tendonitis = lateral epicondylitis = lateral epicondalgia = tennis elbow
Side Note: Tennis elbow is a common overuse injury that around 3% of people experience (See Resource).
Common Causes of Elbow Tendonitis
The most common cause of medial and lateral elbow tendonitis is repetitive movements. Let’s break down the differences.
Medial elbow tendonitis typically occurs in middle aged people, often those involved in sports or occupational activities that require a strong hand grip and an adduction of the elbow (like golf or tennis).
Lateral elbow tendonitis typically occurs in people who play racket sports without an ideal grip or swing in the dominant swinging arm.
Location & Muscles Affected by Elbow Tendonitis
Below are the main muscles affected by elbow tendonitis:
Muscles affected by golfer’s elbow (medial): pronator teres, flexible carpi radialis (occasionally the palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis). Simple terms: the wrist flexors.
Muscles affected by tennis elbow (lateral): extensor carpi radialis brevis (occasionally the extensor digitorum, extensor carpi radialis longus, extensor carpi ulnaris). Simple terms: the wrist extensors.
I know those are some strange names for muscles so here’s the simple version.
Stand with your palms facing forward. The inner elbow closest to your torso is where the elbow flexors are. The outer elbow farthest from your torso is where the elbow extensors are.
All of these muscles will be stretched and strengthened in the best exercises for elbow tendonitis program shared below.
Testing for Elbow Tendonitis
Testing for elbow tendonitis typically begins in Physical therapy with some range of motion (ROM) tests, manual muscle selective tissue tensioning tests (testing tendon strength), muscle length tests (testing flexibility), manual muscle testing, palpation tests, and special tests (like Cozen’s and Mill’s).
Typical test results: tenderness to palpation, decreased and painful flexibility, strong but painful strength testing, decreased grip strength, swelling/warmth, and sometimes numbness/tingling into the fingers due to pressure on the nerves.
Elbow tendonitis is often easily diagnosable with the tests above. So from there, it’s typically suggested you perform 6-8 weeks of Physical therapy. Then if there is no improvement, your Physician may suggest further testing like getting an Xray, MRI, or ultrasound.
Conservative Treatment for Elbow Tendonitis
Disclaimer: The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Now that you better understand what elbow tendonitis is, what causes it, and which muscles are involved let’s now cover what you’re likely most interested learning about: treatment for elbow tendonitis.
Physical therapy treatment should always be 100% customized to you: the stage of your injury (recent/acute or chronic), your history, your activity level, your job, your impairments, your abilities, and your goals.
With that said, the below treatments are general treatments often prescribed by Physical therapists for elbow tendonitis, including many exercises for elbow tendonitis. Always consult your Physician before beginning any new exercise program.
Treatments for elbow tendonitis (from basic to advanced):
Rest (less or modified repetitive activity)
NSAIDs (non-steroidal anti-inflammatory drugs)
Joint mobilization (level depends on stage of injury; plus mobilization with movement (MWM))
Range of motion exercise (without a painfree range)
Stretching (plus contract-relax technique)
Strengthening exercise (including isometrics)
Manual/Massage: soft tissue massage, deep tissue massage, cross friction massage (if not an acute injury), dry needling
Modalities: Ice, Ultrasound, Acupuncture
Splinting or elbow straps
If those conservative treatments don’t help then PRP injections, corticosteroid injections, botox injections, or even surgery may be needed.
Below are some products from Amazon that are often useful for addressing elbow tendonitis pain:
Physical Therapy Exercises for Elbow Tendonitis
In the following videos, I share how to test for elbow tendonitis, how to feel for tenderness, how to improve range of motion for the elbow and wrist, how to stretch the forearm, how to improve wrist mobility, and finally some strengthening exercises for elbow tendonitis.
How to Palpate (feel) for Elbow Tendonitis
- Medial elbow tendons
- Lateral elbow tendons
You can also perform self massage directly on those tender spots using your hands or a massage device.
How to Mobilize the Wrist
See this Instagram video to learn one way to mobilize your wrist if you suspect your wrist has limited joint mobility.
Range of Motion for Elbow Tendonitis
- Passive range of motion
- Active assisted range of motion
- Active range of motion
Stretching for Elbow Tendonitis
How to Improve Wrist Mobility
Check out some of the best mobility exercises for your wrists here.
Strengthening Exercises for Elbow Tendonitis
Mission: Mobilize, Modify, Move
It’s my goal to ensure you learn three things with every blog post: how to mobilize your body, how to modify exercise, and how to optimize your movement.
Above I shared a video for wrist mobility and how having good mobility with any joint may help you prevent injury. This is especially true for tendonitis injuries since they’re often due to the tendon being taken beyond its normal range of motion.
Now, let’s cover some ideas for how to modify exercise if you have elbow tendonitis:
- Consider adjusting your workout split to focus more on lower body and core more often temporarily until your elbow feels better.
- Modify upper body exercises by working within a comfortable range of motion, using lighter loads, slowing things down, and adjusting your grip. [Have wrist pain weight bearing? Try some of these modifications]
- Adjust how you grip onto a barbell or pull-up bar in case that is exacerbating the injury. Learn how here.
- Throughout the day, modify your wrist position while working to be in neutral.
Finally, if you plan to continue to strength train, I suggest you try these things out to move more optimally:
- Warm-up appropriately prior to lifting. Try using a band to do some light, high rep bicep curls, wrist curl, and tricep presses.
- During strengthening exercises, an eccentric-accentuated focus is shown to be effective for elbow tendonitis. This systematic review looked at 12 past studies. 326 total subjects received eccentric treatment for their tennis elbow. Of the subjects that received eccentric treatment, the majority reported reduced pain and also had improved function and grip strength. For those who don't know what eccentrics are, it's a form of strengthening while lengthening a muscle under load. So picture yourself doing a dumbbell wrist curl with the palm down. As you raise the dumbbell up, that's the concentric. Then as you lower it back down slowly, that's the eccentric. Here's an example.
If any of what I said is confusing or you want additional help with addressing your impairments, be sure to watch the webinar “Outsmart your Injury” to learn more about exercise modification and how you can take control of your injury instead of letting it control you. Then reach out and let’s chat!
Thanks for reading!
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