By Kelly Frick, PT, Peak Sports Spine & Physical Therapy

Since we are all tennis players, I wonder how many of you have had tennis elbow? What was the treatment for it and how long did it take to improve, or did it even get better?

Therapy has changed a lot over the past 30 years and one of the greatest changes is tendinopathy loading protocols. Tennis elbow is a tendon problem, usually caused by overuse when you play often. We must also remember that as we “age” our tendons age also. When this occurs, they are not able to take as much load as they could before. Load means the force the muscle is exerting through the tendon to make your wrist move.

So, how do I load my tendon, you ask?

Well, there is a protocol that I have patients follow in the clinic, but it is VERY dependent on how symptoms present and how they act.

So, we will start with the worst-case scenario. You have constant elbow pain at a level 4-5/10 which is more painful with squeezing, grasping, and lifting with an outstretched elbow. This pain can be 7+/10 but does not linger at that intensity.

I would start that patient with wrist extension (palm down and raise hand) isometrics. You can use the other hand or place your hand under a counter or table and push the hand up. You are trying for a 45 second hold, keeping pain at 4/10 or less. You rest 2 minutes and go again. This is done 5x. It is a bit time consuming but works. You do this daily unless, the day after you do it, your pain at rest is worse or pain with use is worse.

If so, you use ice 2-3x that day and recheck tomorrow. How do I recheck, you ask? I ask my patients to pick a motion or activity that is consistently painful. That will be the “daily check”. If the pain level is equal to or less than the day before, proceed on with the isometrics.

Once the pain at rest is gone, we must start loading with weights. Again, we want pain at 3-4/10 while doing the exercises but not necessarily after. So, to be safe, start with 1-2 lbs. and do wrist extension with your elbow bent to 90 degrees and with it almost straight. (Wrist extension: hold weight in hand and lift hand only in palm down position, allowing the hand to fall all the way down each time). You’ll do 3×10; 3x a week with a day in between. If there is no pain and no fatigue, move the weight up by 1 lb. until you achieve pain at 3-4/10 or fatigue. You will do this each time if necessary.

Now if you never had pain at rest and your pain level with provocative activities is 5 or less, still do the isometrics daily and start the weights straight away.

As your ability to use more weight continues the pain should start coming down. You may also need to do biceps and triceps as well as supination and pronation with a hammer. (YouTube can show you how).

Occasionally people have lateral elbow pain that is not a problem at the elbow. That is out of the scope of this article but if loading is not working, please come see us at Peak Sports and Spine PT for additional treatment.

Kelly Frick earned her Bachelor of Science in Psychology at the University of Washington and her MPT at
University of Southern California in 1994. She is a Washington native, living up north in Lake Stevens
near the mountains. She loves the outdoors and has been a hiker and skier for 30+ years. She has 28
years of experience working with orthopedic populations including post operative care, spinal
stabilization programs, athletic injuries, and geriatric populations.