How Effective Is Physical Therapy For Treating Tennis Elbow?

And what if P.T. doesn't help you? – Can you still do your own rehab at home – (Perhaps even more effectively?)

If you have Tennis Elbow and see your Doctor for it, there's a good chance you'll be prescribed a series of Physical Therapy treatments (along with Anti-inflammatory pills and a brace.)

Now, there's no doubt that P.T. or 'Physiotherapy' treatment helps some Tennis Elbow and Golfer's Elbow sufferers recover...

However, it also seems to let a lot of people down – And in many cases that's after dozens of visits, MONTHS of hard work and lost time and energy that's gone forever.

It also seems to be a common misconception that Physical Therapy is synonymous with “exercises” – but there's more to it then that, which we'll cover...

And see also the Tennis Elbow Exercises page for the key principles involved

So, if you have one or more of the following PT-related questions, this article is for you:

Table Of Contents (Links jump down the page to various sections of this article.)

• Is Physical Therapy Right For You? – How effective is it in treating Tennis Elbow? Is PT right for you?
  
  
• How is Tennis Elbow treated in P.T.? – The Top 5 Physical Therapy Modalities For Lateral Epicondylitis The top 5 PT Modalities
  
  
• What if you've tried P.T. and it didn't help? – (Or didn't help you fully recover) – WHY didn't it? What should you do NOW?
  
  
• Is there a missing, “key ingredient?” – Here's the essential thing that's not usually offered in P.T. treatments The missing link
  
  
• Are there Tennis Elbow rehab exercises you can do on your own? – As in, "home Physical Therapy?" Absolutely! DIY home rehab exercises

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Is Physical Therapy Right For You?

Of course, no one can gaze into a crystal ball and give you a definitive answer on whether Physical Therapy will help you with your specific injury or not.

There are too many factors involved, naturally – Just the same, it can really help to look at the big picture.

Because a lot of time, effort and potentially money will be involved if you decide to pursue a course of P.T. for your elbow.

You may assume that you will receive “state of the art treatment” in Physical Therapy, however, there may be a very critical piece missing from your care: 'Manual Therapy' (more on that shortly.)

And even if you have great insurance that covers your series of prescribed P.T. visits, entirely, there is still the cost of all your time, travel and effort.

It's true that there are always a few Tennis Elbow sufferers that do not seem to be helped by ANY “conservative measures” – (as medicine refers to them – which includes P.T.)

And that small minority often seems to end up (apparently) needing surgery.

Article on the question of "When is it time to consider surgery?"

And I know I'm probably going to catch some flack for this from Physical Therapists!…

But, in my experience, there does seem to be a very significant number of people who are not helped by Physical Therapy – But DO go on to make a full recovery later.

How do I know this?

Many of the people I've treated personally, over the past 10-15 years have already been through a series of PT visits unsuccessfully before finding me.

And for what it's worth, I'm able to help the vast majority who have not had multiple Cortisone shots.

I do realize, that isn't exactly scientific evidence, but in a minute I'll share my theory on why PT fails to help so many sufferers.

First, to pave the way, let's look at how Tennis Elbow is typically treated in PT

The Top 5 Physical Therapy Modalities For Lateral Epicondylitis Treatment

When most people think of Physical Therapy they picture exercises; rehab exercises, strengthening exercises, stretches and so forth.

And, although it's true that exercise is an essential part of ones recovery, Physical Therapy is a system for rehabilitation that has many components.

These different components are usually known medically as 'Modalities' and the ones most often used to treat Tennis Elbow are:

1. Therapeutic Exercise – Rehab exercises that you do in the clinic or at home with machines, weights or various resistance devices
   
   
2. Cryotherapy (Ice Therapy) – Ice and cold packs to “reduce” nonexistent “inflammation” (Here's why chasing inflammation is counter-productive – Here's why you shouldn't ICE! )
   
   
3. Ultrasound / Ultrasonography – Therapeutic Ultrasound uses sound waves to heat or stimulate the tendons involved
   
   
4. Extracorporeal Shockwave Therapy – A more powerful sound or “shockwave” that's used to stimulate the tendons
   
   
5. E-stim / Electrical Stimulation – (Or Electrotherapy) Electrodes are attached to your skin that pulse current through your muscles causing them to involuntarily contract (Yes, really!)

The first three: Ice, ultrasound and exercise seem to be almost universal when it comes to Tennis and Golfer’s Elbow treatment, while E-stim and Shockwave seem to be somewhat less common – At least here in California.

As far as ice goes, in this clinical pilot trial the authors, P Manias and D Stasinopoulos conclude that:

"Ice as a supplement to an exercise programme offers no benefit to patients with LET." [Lateral Elbow Tendinopathy / Tennis Elbow]

A Controlled Clinical Pilot Trial To Study The Effectiveness Of Ice...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491915/

There doesn't seem to be a great deal of medical-study-type evidence to show that any of these modalities has a significant, effect when it comes to healing Tennis Elbow (which is also true of most treatments)…

With the exception of Therapeutic Exercise…

And there seems to be some evidence that Eccentric Exercise may be the most effective type.

Here are my thoughts on Eccentric Exercise)

Make no mistake, I'm sure we all recognize that at some point we're going to need to do some strengthening exercises if we have Tennis or Golfer's Elbow - But...

WHEN is the right time to begin those rehab exercises?

And is it effective to combine exercise with these other modalities – all at once – in a Physical Therapy setting?

All my experience, which includes treating people with Tennis and Golfer's Elbow for the past decade as a specialty, (as well as running this site) suggests that exercise should rarely if ever be the first method of treatment.

I believe exercise should be the second or third priority and should often be deferred until one has made some progress releasing muscle and tendon 'Adhesions' and reducing ones symptoms considerably.

And by “reducing symptoms” I do NOT mean by suppressing them with ice, pills, Cortisone shots or any other “symptom chasing” methods!…

But, rather, by making progress healing ones injury, so that ones pain is decreased as a result!

What If You've Tried P.T. And It Didn't Help You Recover? – NOW What?

If I imagine that I've just had surgery; a knee or hip replacement, for example, or some kind of major accident, I can't imagine turning anywhere else than to Physical Therapy.

But despite P.T.s highly favorable track record with hip and knee replacement rehab and other similar post-surgical and post-acute-injury rehabilitation situations…

Chronic tendon injuries like Tennis and Golfer's Elbow are much more challenging problems to deal with.

These are different animals. Total beasts.

I'm going to put it out there that the first reason most treatments, remedies and approaches to healing so often fail (including Physical Therapy)…

Is that they often misidentify and mistreat the problem.

Starting with the fact that Tennis Elbow is almost always a Chronic, Degenerative injury process and NOT an Acute injury, like a sprain or strain.

PT is pretty good with sprains and strains and there may be some benefit to using the ice / 'Cryotherapy' modality for these kinds of injuries while they're Acute; hot, swollen and really inflamed.

But that's not the issue with Tennis Elbow – Inflammation is NOT the problem. Period.

And ice is more likely to inhibit circulation and healing in tendons that are usually in desperate need of more circulation.

Another common modality often used to treat it is Ultrasound.

This type, known as 'Therapeutic Ultrasound' uses sound waves to penetrate and heat up muscles and tendons.

(In contrast to 'Diagnostic Ultrasound' also known as 'Sonography', which is used to get an image of an area rather than to treat it.)

Ultrasound sounds great in theory, but it seems to be something that needs to be done frequently to have a significant effect…

Several times a day, I would think – Not twice a week.

(Think twice if you're tempted to buy one of those “home ultrasound” units, however – They are nowhere near as powerful as the professional ones used in PT clinics.)

And, although they've been using Ultrasound Therapy to treat all kinds of tendon problems for decades, medical studies don't seem to show much proof of a benefit.

(And I've never encountered anyone who thought is was the least bit helpful in their Tennis Elbow recovery.)

Shockwave Therapy is similar but utilizes more intense frequency.

But I'm convinced that the biggest problem with all these modalities is that they just don't do enough to “break the vicious cycle”

The vicious cycle of stagnation and degeneration that's at the root of what's going wrong in the tendon.

Tennis Elbow is not merely a weak muscle that needs to be strengthened or a minor muscle tear that should heal consistently, with steady progress over a few months.

It's a significant tendon breakdown and a failure of the body's healing process to repair it.

And, again, therapeutic exercise is proven helpful, and is certainly an essential part of any rehab program to turn this around.

But the problem, in my opinion, is that exercise is often begun too SOON!...

And instead of having a positive effect on tendon regeneration – It seems to be too aggravating in many cases, often causing painful setbacks.

Sadly, please don't be too surprised if you've done a course of a dozen or more P.T. visits, had all the usual modalities, and worked hard and diligently – And ended up making little or no progress.

I've heard this story a hundred times – You're not alone!

So, the question is: Is something missing?

The Key Ingredient That's Usually Missing From P.T.

What does it take to break that vicious cycle?

All the evidence I've seen, objective and subjective, points to the need to physically break up the stagnation at the root of Tennis and Golfer’s Elbow.

The “stuck stuff” like tendon degeneration and muscle and tendon adhesions and Scar Tissue.

The problem is this stuck stuff isn't released or minimized by icing the hell out of it – or shocking it (and probably not by hitting it with sound vibrations!)

And exercise seems to help a lot more once one has already made some progress breaking that stuff up.

I believe the fastest way to break up the sticky, stuck stuff (we're literally talking about layers of tissue stuck together or adhered – hence, adhesions!)...

Is by hands on manipulation – Muscle and tendon therapy performed by hand…

Advanced Massage Therapy Techniques

Isn't this something that Physical Therapists routinely do as part of the typical P.T. treatment?

Maybe in Europe or Australia – But very little of this kind of 'Manual Therapy,' (as it's officially known) is performed in a typical P.T. visit here in the United States.

Maybe 30-50 years ago… Perhaps in some smaller “Boutique” clinics – But rarely, now, in the big “Managed Care Mills!”

Why? I'm not sure. Perhaps because it takes too much time to do a thorough job of it?

Is this something you can seek out independently?

Sure. I will warn you it's rather expensive, though, if you're on a budget.

It can certainly be worth it if you can find someone like me who has a lot of experience with Tennis and Golfer's Elbow.

But you might also be wondering… What about learning to do this yourself…

Can you be your own therapist? Absolutely!

Teaching Golfer's and Tennis Elbow sufferers how to break the cycle using advanced muscle and tendon therapy techniques is a key part of my self-help programs.

Here's an article and video on the best self-massage techniques for Tennis and Golfer's Elbow

Are There Tennis Elbow Rehab Exercises You Can Do At Home?

Whether you have “formal” Physical Therapy treatment or not, you will need to do rehab exercises on your own at home at some point in your recovery.

Again, I believe that time is toward the latter part of ones rehabilitation.

And there is really no fundamental difference between the exercises you would do in a clinic and what you would be expected to do at home.

Except that you won't have the same equipment, and you'll probably have to improvise.

The good news is that everyone has some things around the house they can use to do those exercises!

It's not necessary to buy any special equipment in most cases.

(Although, for one exercise, you might want to get a small, hand-held weight, which is quite cheap.)

Remember That Exercises Are Not The #1 Priority, Though!

Again, everything I've learned suggests that exercise is not the way to begin and not the first priority.

I'm convinced you should be focusing on breaking the vicious cycle of stagnation and degeneration at first.

To break up and release those nasty, sticky adhesions and scar tissue in your muscles…

And to use heat instead of ice…

And to stretch frequently – But NOT like they teach in Physical Therapy!

I teach what I believe is a safer AND more effective way to stretch in my programs.

To learn more about that stretching method, the 3 simple Physical Therapy exercises you can do at home and, most importantly, how to become your own Manual “hands-on” Therapist, check out my Tennis and Golfer's Elbow self-help programs below:

Learn To Treat And Heal Your Own Tennis Elbow Or Golfer's Elbow At Home With This Video Program

You'll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!...

I'll be your personal tutor guiding you through step-by-step video lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)

Tennis Elbow sufferers: learn more about the Tennis Elbow self-help Program here

Golfer's Elbow sufferers: learn more about the Golfer's self-help Program here