Tennis elbow and repetitive strain
Elbow pain from doing the same thing.
Treated by changing how you do it.
Tennis elbow, golfer's elbow, carpal tunnel, and wrist tendinopathies are usually called overuse injuries. That is true. What is also true is that the elbow or wrist is overusing because the shoulder, scapula, or grip mechanics are underused. We treat the chain, not just the spot.
The condition
The elbow rarely fails on its own. It fails when the shoulder and grip stop sharing the load.
Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow) are tendinopathies at the elbow where the forearm muscles attach. The mechanism is repetitive load: gripping, typing, lifting, racquet sports. What makes some people develop it and others not is how the shoulder and trunk distribute the load during those activities.
Carpal tunnel and wrist tendinopathies follow a similar pattern. Sustained grip and wrist positions, combined with poor scapular control, create excess load at the wrist that the tendons cannot sustain. The diagnosis is at the wrist or elbow. The cause is usually upstream.
How we treat it
Manual work on the tendons. Then retraining the chain that overloaded them.
Manual therapy targets the irritated tendon, the surrounding soft tissue, and the joint mobility at the wrist and elbow. Soft-tissue work on the forearm extensors or flexors releases the muscle tension that is maintaining the load. Joint mobilization restores movement that has been lost.
Then the load redistribution: scapular control, shoulder mechanics, grip pattern correction, and an eccentric loading program for the affected tendon. Eccentric loading has the strongest evidence for resolving tendinopathy. The exercises are short, specific, and progressive. Sport or work return is built into the plan.
Why it works here
Not a strap and an ice pack. An actual evaluation of why the elbow is overloaded.
Most tennis elbow treatment is a strap, anti-inflammatories, and time. That sometimes works, often does not, and rarely changes the underlying mechanics. Recurrence is common because the cause was never addressed. Here, the evaluation includes the shoulder, scapula, and grip pattern, and the treatment addresses whatever is feeding the elbow load.
One clinician, one hour, hands-on for the majority of the session. The home program includes the eccentric loading work that resolves the tendon, plus the mechanical changes that prevent recurrence. Most patients return to symptom-free function within six to ten sessions.
Questions
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I have been wearing a brace and it has not helped. Why?
Bracing offloads the tendon during use but does not address why the tendon was overloaded to begin with. For some patients it is enough; for most, the symptoms return once the brace comes off because the underlying mechanics are unchanged. The brace is a tool, not a treatment.
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My doctor offered a cortisone injection. Should I do PT first?
Most current evidence suggests that cortisone injections provide short-term relief but worse long-term outcomes than PT alone for tennis elbow. Many surgeons and orthopedists now recommend PT as the first-line treatment. The injection is sometimes useful for acute flares, but PT addresses the actual mechanism.
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Can I keep playing tennis or golf during treatment?
Usually, with modifications. The goal is not to stop activity but to reduce the load on the irritated tendon while we strengthen and reorganize the mechanics. We will work with you on technique adjustments, equipment considerations, and a return-to-play progression.