Physiotherapy management of epicondylitis: tennis elbow and golfer’s elbow. 

Physiotherapy management of epicondylitis: tennis elbow and golfer’s elbow. 

Being unable to hold your coffee cup or your hair brush with adequate strength can be extremely frustrating. Maybe it’s other activities like gardening in the spring, that are made impossible by your tennis elbow symptoms. 

The Canadian Medical Association has estimated that up to 3% of Canadians can have tennis elbow and they fall within the age group of 30-50 years. Let’s take a closer look at the condition and how physiotherapy can help you get your life back on track. 

What is Epicondylitis: Tennis elbow and Golfer’s elbow? 

  • Let’s look at the anatomy of the elbow join to begin with. One of the bones forming the elbow joint is the one that runs the length of your arm, also called the humerus. The end of the humerus is called epicondyle and it has two sides- the medial (inner)epicondyle and the lateral (outer) epicondyle. 
  • Tennis elbow, also known as lateral epicondylitis, is caused by the inflammation of the tendons on the outer side of your elbow. 
  • Golfers elbow, also known as medial epicondylitis, is caused by the inflammation of the tendons on the inner aspect of the elbow. 
  • Tendons are tough chords that connect your muscle to the bone, in this case the lateral epicondyle. An overuse or improper use of the muscles involved will lead to an inflammation of the tendon. 
  • The muscles that originate at the elbow are responsible for movement of the wrist and finger joints. When your hands and wrists are unable to tolerate a certain load or just positioned poorly their tendons can get strained. 

It’s a common misconception that elbow pain is always a result of direct insult to the elbow. As in the case of tennis elbow, poor wrist and hand ergonomics contribute to pain at the elbow. 

What are the causes of epicondylitis? 

  • The muscles that originate from the lateral aspect of the elbow are responsible for extension of wrist and fingers. There are several activities that would require using the wrist in extension, the most obvious example being tennis.  
  • Similarly, the muscles that originate from the medial epicondyle are responsible for flexion/closing action of the wrist and fingers. 
  • Let’s take tennis as an example, the commonly used backhand stroke requires the wrist to be in neutral or slightly extended while impact of the ball is felt on the racquet and transmitted directly to the muscles responsible for that position and subsequently the tendon. The ball hits the racquet repetitively, and the load is taken on by the muscles each time.  
  • This repetition, if the muscle is weaker than required, can cause the muscle to tire out, leaving it up to the tendon to take over all that load. This can cause microtears in the tendon. Additionally, this overloading results in inflammation and pain.  
  • For epicondylitis, the key factors are overload and repetition.
  • Other activities that require similar mechanics include, gardening, plumbing, carpentry, playing a musical instrument, etc. 

In some cases, due to injury to the shoulder or arm, compensatory strategies used with the forearm and wrist can also result in epicondylitis. 

What are the symptoms of epicondylitis? 

Symptoms are often felt at the elbow, but functionality is limited at the wrist and fingers. 

  • Pain when the arm and wrist are extended (tennis elbow) or flexed (golfer’s elbow). 
  • Stiffness, limitation of movement 
  • The area around the lateral or medial elbow is swollen, warm and tender-painful to touch. 
  • Pain when twisting or rotation of the arm to open bottles or doors. 
  • Increase in pain at the end of the day. 
  • Decrease in grip strength which looks like an inability to hold on to heavy objects or squeeze as much as before. 
  • Numbness and tingling in severe cases. 

Physiotherapy management of Tennis elbow: 

The physiotherapy principle for managing epicondylitis is to manage the load on the tendon, and then focus on a progressive strength and stabilization program. With that in mind, your physiotherapist will use the following strategies to relieve your pain and improve functionality. 

  • Intramuscular stimulation: Dry needles will be used to break down trigger points in the muscles around your forearm. If required, as is in most cases, your physiotherapist will also assess the shoulder and neck to contribute to overall functional use of the hand. The goal is to improve blood circulation, enable lengthening and a general resetting of the muscle. 


  •  Shockwave Treatment: Shockwaves are soundwaves that are delivered through a machine, over painful bony areas to facilitate the body’s natural healing process. This treatment is extremely efficient, with patients reporting significant pain relief in about 3 sessions.


  • Strengthening exercises: As mentioned previously, the only way to heal a tendon is progressively load and strengthen the muscle. With that in mind your physiotherapist will curate an exercise program which will involve progressively strengthening your muscles. Mentioned below are some of the commonly prescribed exercises. 


Disclaimer: All exercises mentioned here are for education only. Do not try them at home unless prescribed your physiotherapist.


Eccentric Wrist flexion: to strengthen your wrist flexor muscles.  

  Posture: sitting on a chair 

Instructions: rest your elbow on your thigh, hold on to a dumbbell with palm facing up, use your other hand to help the hand holding the dumbbell into flexion and then let go, allowing the injured hand slowly lower the dumbbell down.  



Eccentric Wrist extension: to strengthen wrist extensor muscles. 

Posture: sitting on a chair with elbow fixed on thigh.

Instructions: hold the dumbbell with your palm facing down. Use your other hand to help the hand holding the dumbbell into extension and then let go, allowing the injured hand slowly lower the dumbbell down. 



Supination: To strengthen twisting of forearm enabling palm facing up and down. 

  Posture: Sitting on a chair with elbow fixed on thigh, hold a dumbbell vertically facing down. 

Instructions: Turn forearm to bring dumbbell facing up and down 



Towel twist: To strengthen both flexors and extensors. 

Posture: Sitting on a chair holding a towel at shoulder width apart 

Instructions: Twist the towel as if wringing out water. 



Fist clench:

Posture: Sitting on a chair with both elbows resting on a table, palms facing up, holding a towel. 

Instructions: Clench your fist, squeeze the towel. 



Physiotherapy management of Golfer’s elbow: 

When starting out with these exercises you can expect some discomfort, however, with time you forearm and fingers will get stronger. 

At Revere, we understand the pain, discomfort and frustration that come from being unable to perform activities that are meaningful to you. We have the best team of physiotherapists who provide hands-on, individualized care while ensuring a thorough recovery.  

If you are struggling with symptoms of epicondylitis, reach out to us at We are offering a free 10-minute consultation call with our expert physiotherapists. Call us at (604) 566-5108   

If you feel ready, book an appointment with our expert physiotherapists. Share this article with friends and family who also have tennis elbow or golfer’s elbow and could benefit from the best physiotherapy services at Revere Physiotherapy.  

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