Research-Based Treatment of Tennis Elbow

Even though lateral epicondylitis or, if you prefer, lateral epicondylalgia has a well-defined clinical presentation, treatment of the condition has not been well defined.(9)  Most systematic reviews have reported insufficient evidence to support one treatment technique over another.(8)  A recent literature review reported short-term positive effects of acupuncture, local manipulation, and deep tissue massage combined with exercise.(8)  

Research-Based Massage for Tennis Elbow

Nagral, et al. reported positive effects of deep transverse friction massage and Mill’s manipulation.(8)  In this randomized controlled trial, sixty patients received treatments 3 times per week for 4 weeks.  The experimental group received 10 minutes of deep transverse friction massage 3-5 mm distal to the lateral epicondyle followed by Mill’s manipulation, which consists of end-range elbow extension with the wrist fully flexed and forearm pronated.  (see below)

Deep Transverse Friction Massage on Lateral Epicondyle


Mill's Manipulation

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Outcome measures included pain intensity, pain-free grip strength and functional status, which were collected at onset of study (baseline), immediately after treatment, at 2 weeks, at 4 weeks and an 8-week follow-up.  Pain was measured with a Visual Analog Scale, pain-free grip strength was measured with a hand-held dynamometer, and function was measured with the Tennis Elbow Function Scale (TEFS).(8) The control group received phonophoresis (ultrasound with topic steroid anti-inflammatory) for 5 minutes around the lateral epicondyle.  The control group also participated in stretching and strengthening exercises.  Stretches for the Extensor Carpi Radialis Brevis were held for 30-45 secs and strengthening exercises consisted of eccentric wrist extension 3 sets of 10 repetitions with a 30 second rest in between sets.(8)

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Results showed a steady improvement of both groups over the 4 week intervention period. The deep transverse friction with manipulation group had significantly better scores than the control group over the course of treatment.(8)
There was a slight regression of treatment effect at the 8-week follow-up, but patients were still significantly improved when compared to baseline.

Summary of Research-Based Massage for Tennis Elbow

In most cases, 80% of patients with tennis elbow report symptomatic improvement at one year regardless of the treatment.(6) According to the research, significant improvements can be expected with the use of deep massage, especially deep transverse friction, Mill’s manipulation, stretching exercises and strengthening exercises, especially eccentric.(6-9)  For cases that do not respond to conservative treatment, surgical intervention shows promising results.(6)  Dr. Uridel uses a combination of deep massage techniques, eccentric strengthening and stretching  exercises to treat tennis elbow with good results. The supplemental video on page 1 demonstrates the applied anatomy and massage techniques for tennis elbow. 


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