Tennis Elbow: who to see and what helps

Tennis Elbow · Kitchener, Waterloo & Cambridge

Tennis elbow is pain on the outside of the elbow, where the tendon of the muscles that lift your wrist and fingers attaches to the bone. Many people who get it never play racquet sports. The recommended treatment is a strengthening program for those muscles, combined with hands-on care. A physiotherapist or a chiropractor is the first visit at CARESPACE, and both treat at that visit.

What tennis elbow is

Tennis elbow is the everyday name for lateral elbow tendinopathy, also written as lateral epicondylitis. The muscles that lift the wrist and straighten the fingers share one tendon, which anchors on the bony point on the outside of the elbow. Strong, repeated or jerky use of the hand and forearm can overload that tendon, and it becomes painful where it meets the bone.

Symptoms of tennis elbow

• Pain or tenderness on the outside of the elbow, which can spread into the forearm
• Pain when you grip, lift, bend the arm or move the wrist
• Pain when you lift the wrist or fingers against resistance
• Trouble fully straightening the arm
• Anything from mild discomfort when you use the arm to constant pain that disturbs sleep

What causes tennis elbow

The common thread is repeated gripping and twisting of the wrist and forearm.

• Work with tools. Handling tools heavier than 20 kg, bending the elbow or wrist repeatedly for more than two hours a day, and repeated twisting or screwing movements are all risk factors: plumbing, painting, driving screws, cutting meat. That covers a good deal of assembly and plant-floor work in Waterloo Region.
• Desk work. Typing and using a mouse are recognized causes, so the region’s tech offices are not exempt.
• Sports and hobbies. Racquet sports, playing a musical instrument, sewing.

It is more common between the ages of 35 and 54, and it can come on gradually or after one hard effort.

How tennis elbow is diagnosed

Tennis elbow is diagnosed from what you describe and what an examination finds. X-rays are usually normal and are kept for elbows that have not responded to treatment. Part of the examination is checking for look-alikes: an irritated nerve in the neck, a nerve trapped in the forearm, and problems inside the elbow joint itself.

When elbow pain needs urgent care

These signs come from the UK’s NHS advice for elbow and arm pain, with Ontario equivalents. Call 911 (999 in the UK) if arm pain comes on suddenly together with pressure, heaviness or squeezing across your chest: this could be a sign of a heart attack. Go to an urgent care clinic or an emergency department (the NHS says an urgent treatment centre or A&E) if you have severe pain in your arm and it is difficult to move, if you injured your arm and heard a snapping noise or the arm has changed shape, or if your arm tingles or feels numb. Get medical advice the same day (the NHS says its 111 service) if your arm hurts when you exercise and the pain goes away when you rest, or if it is swollen and you have a very high temperature or feel hot, cold or shivery. None of these should wait for an appointment with us.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating tennis elbow

• Reading this list. Most of these points come from a 2022 American guideline written for physiotherapists. “Recommended” below means its panel found moderate or strong evidence, “an option” means weak evidence or the panel’s own opinion, and where studies conflict it makes no recommendation.
• Strengthening is the main treatment. Resisted exercise for the wrist-lifting muscles is recommended once tennis elbow is past the acute stage, combined with other treatment such as hands-on therapy. One suggested dose is three sets of 15 repetitions for 6 to 12 weeks.
• The effect is modest. In 12 trials (1,124 participants) reviewed by Cochrane in 2024, manual therapy, prescribed exercise or both may have slightly reduced pain and disability by the end of treatment compared with little or no treatment. The reviewers add that the difference may not be clinically worthwhile and that it was not sustained.
• Joint and soft-tissue treatment gives short-term relief. Mobilization or manipulation of the elbow joint is recommended to reduce pain and improve pain-free grip in the short term, for people who tolerate it. Treating the neck, upper back or wrist as well is an option when the examination finds a problem there, and so are soft-tissue techniques once tennis elbow has become chronic.
• Dry needling and taping. Dry needling, into the tendon or into trigger points in the muscle, is recommended for pain and function, and rigid taping for short-term pain relief. The needling trials mostly measured short-term effects.
• Shockwave: the reviews disagree. Nine placebo-controlled trials (1,006 participants) pooled by Cochrane in 2005 showed little or no benefit for pain and function. A 2023 meta-analysis limited to trials with at least 12 months of follow-up pooled five shockwave trials and found a small reduction in pain compared with placebo or no treatment, with no significant difference in function. The physiotherapy guideline makes no recommendation on shockwave.
• Steroid injections help early and not later. Injections gave a short-term benefit at 4 to 12 weeks, worse outcomes at 3 to 6 months, and no benefit over the comparison group beyond 6 months.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit.

• A steroid injection, which cannot be used repeatedly; the benefit fades as described above.
• Surgery, which may be an option if you still have tennis elbow after 6 to 12 months.

How each CARESPACE service treats tennis elbow

Physiotherapy

A physiotherapist can press on the tendon, test your wrist and grip against resistance, and check the neck and the forearm nerves, since problems there can pass for tennis elbow. Treatment can be built around a loading program for the wrist-lifting muscles, started at a level the elbow tolerates and made heavier over the following weeks. When the elbow is easily flared, the first week or two may go to settling it with taping, a strap or joint mobilization.

See our physiotherapy team →

Chiropractic

A chiropractor can examine the elbow and wrist and also the neck and upper back. Treatment can include mobilization or manipulation of the elbow joint for short-term relief, with the neck, upper back or wrist treated as well when the examination finds a problem there, and the strengthening exercises that go with it.

See our chiropractic team →

Massage Therapy

A Registered Massage Therapist can work on the forearm muscles that attach at the sore tendon. Soft-tissue techniques are an option for improving pain and function in chronic tennis elbow, a position that rests on two low-quality studies. Deep friction massage across the tendon is a different matter: the studies conflict, and it does not appear to work as a treatment on its own.

See our massage therapy team →

Kinesiology

A kinesiologist can take over the exercise program once the elbow is no longer easily flared: heavier loading for the wrist and grip, shoulder and shoulder-blade strengthening where weakness was found, and a phased build-up to whatever set the problem off, whether a shift on the tools, a racquet season or an instrument.

See our kinesiology team →

Other services people ask about

Acupuncture has been tested in four small trials, which Cochrane reviewed in 2002 and found insufficient either to support or to refute its use for tennis elbow. Needle acupuncture relieved pain for longer than a placebo, but no benefit lasting more than 24 hours has been shown. CARESPACE offers acupuncture, but for tennis elbow the strengthening program comes first.

Where most people start

Book with a physiotherapist or a chiropractor. Either one assesses the elbow and treats it at that first visit.

How your team works together

A physiotherapist or a chiropractor can lead, setting the loading program and providing the hands-on treatment. Massage therapy can be added while the forearm is sore, and a kinesiologist when the goal is heavy work or sport. A physician or nurse practitioner comes in for medicines, an injection or a surgical opinion.

Browse by service: physiotherapists, chiropractors, registered massage therapists and kinesiologists.

What to expect at your first visit

1. Your history. When it started, which gripping, lifting and twisting tasks hurt, your job and sports, and what you have tried.
2. The examination. Pressing on the outside of the elbow, lifting your wrist and fingers against resistance, grip strength, and a check of the neck.
3. What they found, including whether anything should be seen by a physician.
4. Treatment at that visit, and a plan to leave with: your first exercises, and what to change at work or in your sport in the meantime.

What you can do at home

• Cut back on the activities that bring the pain on; rest from them is the most important treatment.
• Use a hot or cold pack wrapped in a towel for up to 20 minutes every 2 to 3 hours.
• Keep the arm moving with simple exercises, such as bending and straightening it.
• Ask a pharmacist about acetaminophen or an anti-inflammatory gel for pain.
• At work, use smooth movements, avoid working with the wrist bent, take breaks, and ask about tools that need less force.

In the UK, the NHS advises seeing a GP if the pain is still there after two weeks of rest and self-care, and says physiotherapy may help if six weeks of home treatment has not worked.

How long tennis elbow lasts

Tennis elbow usually goes away with rest, but it can last more than a year. Among people who sought general medical care for it, more than half still reported symptoms a year later, and up to 20% reported persistent pain three to five years after care. Many people have recurrences, and protecting the elbow from repeated irritation may help limit them.

Tennis elbow treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener, Massage Therapy in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo, Massage Therapy in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Should I see a physiotherapist or a chiropractor for tennis elbow?

Either one can assess the elbow, treat it at the first visit and prescribe the strengthening program, and joint mobilization or manipulation is something both may use.

Is tennis elbow the same as golfer’s elbow?

They are different. Tennis elbow is on the outer side of the elbow and hurts when you lift the wrist or grip. Golfer’s elbow is the same kind of problem on the inner side.

Should I wear a tennis elbow strap?

It is worth trying for the tasks that hurt. A forearm strap or a wrist brace, sold at pharmacies, is an option during activity for immediate relief of pain and a stronger grip. Whether a strap helps over the following months is unclear, because the studies conflict.

Can I keep working or playing while it heals?

With changes: reduce the activities that make it worse, adjust equipment, workstation and technique, and return to heavy or repetitive tasks in phases.

Where can I get tennis elbow treated in Cambridge?

CARESPACE offers physiotherapy in Cambridge; the location there is Hespeler Road. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Lucado AM, Day JM, Vincent JI, et al. Lateral Elbow Pain and Muscle Function Impairments: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy, 2022.
• Wallis JA, Bourne AM, Jessup RL, et al. Manual therapy and exercise for lateral elbow pain. Cochrane Database of Systematic Reviews, 2024.
• Buchbinder R, Green S, Youd JM, et al. Shock wave therapy for lateral elbow pain. Cochrane Database of Systematic Reviews, 2005.
• Chen Q, Shen P, Zhang B, Chen Y, Zheng C. Long-term effectiveness of conservative management for lateral epicondylitis: a meta-analysis. Journal of Plastic Surgery and Hand Surgery, 2023.
• Green S, et al. Acupuncture for lateral elbow pain. Cochrane Database of Systematic Reviews, 2002.
• Canadian Centre for Occupational Health and Safety. Tennis Elbow. OSH Answers fact sheet, revised 2024.
• NHS. Tennis elbow. Reviewed 2024.
• NHS. Elbow and arm pain. Reviewed 2024.

Related conditions

Golfer’s Elbow
Carpal Tunnel Syndrome
Neck Pain & Headaches

Ready to book?

Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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