General info

Data about the condition

Lateral epicondylitis, also known as “Tennis Elbow”, is the most common overuse syndrome in the elbow. It is a tendinopathy injury involving the extensor muscles of the forearm. These muscles originate on the lateral epicondylar region of the distal humerus. In a lot of cases, the insertion of the extensor carpi radialis brevis is involved.


  • Pain and/or stiffness in the dominant armPain and/or stiffness in the dominant arm
  • Pain, burning, or stiffness that gradually worsens over time
  • Pain that increases with activity but improves with rest
  • Pain, burning, and/or stiffness in both elbows and/or forearms
  • Pain originating in the elbow that radiates down the forearm
  • Elbow stiffness and aching in the morning
  • Difficulty gripping or holding items in the hand
  • Elbow and/or wrist that is tender to the touch
  • Difficulty turning or flexing the wrist
  • Pain triggered by squeezing motions
  • Pain during athletic activity


  • Not warming up before strenuous activity
  • Improper use of sports equipment
  • Playing tennis or other racket sports in inclement weather
  • Direct trauma to the elbow
  • Working in physically repetitive occupations
  • Playing non-racket sports or engaging in other recreational activities that involve repetitive use of the arm and wrists


  • Not warming up before strenuous activity
  • Improper use of sports equipment
  • Playing tennis or other racket sports in inclement weather
  • Direct trauma to the elbow
  • Working in physically repetitive occupations
  • Playing non-racket sports or engaging in other recreational activities that involve repetitive use of the arm and wrists

The objectives of the Recovery Program

  • Pain relief
  • Local relaxation
  • Mechanical rearrangement of the joint
  • Restoring the range of motion
  • Increased muscle strength and endurance
  • Gesture restoration of movement

The content of the Recovery Program

Deep Transverse Frictions

Deep transverse friction is a specific type of connective tissue massage applied precisely to the soft tissue structures. The therapist must try to reach an analgesic effect applying the DTF at the point of the lesion for 10 min till a numbing effect has been reached. An interval of 48 hours between two sessions is necessary.

Ice massage (cryotherapy), in which ice is applied with circular pressure directly onto the skin over the affected area. Unlike some other types of ice therapy, ice massage does not place a cloth between the ice and the skin. Patients are advised to limit ice massage/cryotherapy to less than five minutes per session, only once or twice per day to reduce the risk of skin damage.


  • Elbow and forearm position: begin with flexed elbow and forearm in supination, then progress by increase elbow extension angle.
  • Fingers flexion vs extension: beginning with fingers in flexion then progressing to extension to load the long extensors.
  • Adding weights: whether by an exercise band or dumbbells
  • Functional training exercises and targeting the whole upper limb.

Methodical Indications

  • Long-term warm-up before physical exertion
  • Avoiding elbow hyperextension
  • Avoiding sudden movements at the elbow

Did you know?

People age 30 and older are at increased risk of developing tennis elbow. The risk accelerates even more after age 40.

You can also read about Hand joints, Carpal Tunnel Syndrome.

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  11. Jump up↑Manickaraj N, Bisset LM, Ryan M, Kavanagh JJ. Muscle Activity during Rapid Wrist Extension in People with Lateral Epicondylalgia. Medicine and science in sports and exercise. 2016 Apr;48(4):599-606.
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