Healing tennis elbow - start with total rest or start therapy soon

I am resting my tennis elbow now over the winter break and I have started with total rest combined with some icing, some heat, some compression and voltaren gel.

My question is - should I start first with total rest, and then do some exercises once the lateral epicondyle (where it attaches to the elbow) is pain-free, or if I should start with exercises right away?
 

Dartagnan64

G.O.A.T.
Depends. If you have pain during the day without use, then quieten it down rest and ice. If it's only uncomfortable for the first bit of the morning and gets better once you are warmed up, then start the Tyler Twists and stretching.
 

WestboroChe

Hall of Fame
You need to rest it completely until the inflammation goes away. Then you can gradually start doing some exercises. I find simply stretching the tendon and just flexing the wrist to be enough to get things going.

The gallon of milk test is a good gauge. If you can pick up a full gallon of milk without discomfort in your arm you’re ready to begin training again.
Make sure you also address the Cause of your TEor you’ll just be back here again. My advice is to use the heaviest and softest racquet you can play with and keep away from poly strings
 

happyandbob

Professional
I had terrible tennis elbow a few years back. I couldn't lift a coffee cup for months without excrutiating pain. The ortho told me to take 6 months off from tennis, and prescribed 2x weekly physical therapy. It helped me and got me back to playing, pain-free.

The therapist said there are two keys for recovering from tendonosis (the underlying cause of TE).

1) Breaking up the adhesions and scar tissue in the tendon
2) Strengthening the muscles around the tendon so they can take some of the load off your forearm tendon.

Re 1: the therapist would use a metal tool called a Graston tool and literally grind out from that point on your elbow down the tendon until about 60% down your forearm. It was extremely painful and it felt like they were dragging that tool through pebbles. You could literally feel it grinding out scar tissue. Over the course of the couple of months, it got smoother and smoother and less painful. Today, I replicate on my arm once a week using this https://www.amazon.com/gp/product/B00IWJDYP4. You can't buy those Graston tools, but if you could they cost $1000. That jade stone with a little vaseline and it keeps my tendon scar tissue free.

Re 2: this bar https://www.amazon.com/dp/B000KGOMBC and this exercise called the Tyler twist

The exercise in the video is clinically proven to work for tennis elbow -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971639

I do this combo at least 1x a week and it keeps me TE free.
 
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Fintft

Legend
I had terrible tennis elbow a few years back. I couldn't lift a coffee cup for months without excrutiating pain. The ortho told me to take 6 months off from tennis, and prescribed 2x weekly physical therapy. It helped me and got me back to playing, pain-free.

The therapist said there are two keys for recovering from tendonosis (the underlying cause of TE).

1) Breaking up the adhesions and scar tissue in the tendon
2) Strengthening the muscles around the tendon so they can take some of the load off your forearm tendon.

Re 1: the therapist would use a metal tool called a Graston tool and literally grind out from that point on your elbow down the tendon until about 60% down your forearm. It was extremely painful and it felt like they were dragging that tool through pebbles. You could literally feel it grinding out scar tissue. Over the course of the couple of months, it got smoother and smoother and less painful. Today, I replicate on my arm once a week using this https://www.amazon.com/gp/product/B00IWJDYP4. You can't buy those Graston tools, but if you could they cost $1000. That jade stone with a little vaseline and it keeps my tendon scar tissue free.

Re 2: this bar https://www.amazon.com/dp/B000KGOMBC and this exercise called the Tyler twist

The exercise in the video is clinically proven to work for tennis elbow -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971639

I do this combo at least 1x a week and it keeps me TE free.
I regulary work out with a chest expander and light weights and it helps, including with minore elbow pains...And wrist.
 

socallefty

Hall of Fame
Once you have rested it enough where the pain is bearable, it is always good to start therapy. However therapy does not mean going and playing tennis or other activities which will injure it again. Therapy should be exercises designed to strengthen the muscles around the tendon or to remove scar tissue and promote healing.
 

PKorda

Rookie
Have had a pretty severe case of tennis elbow, I'd start doing therapy right away, but cautiously. The Theraband is the best thing you can buy. I'd do a few sets twice a day. There's three levels of the Theraband, if you're pain is severe start with the red one, otherwise get the green one.
 
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nyta2

Professional
I am resting my tennis elbow now over the winter break and I have started with total rest combined with some icing, some heat, some compression and voltaren gel.

My question is - should I start first with total rest, and then do some exercises once the lateral epicondyle (where it attaches to the elbow) is pain-free, or if I should start with exercises right away?
my mental model for recovery (from my experience of getting acl replacement)...
1 rest until mostly pain free (let the connective tissue fully connect)
2 start mobility based exercises (no load/no stretching)... just to get more blood flowing to the injury (don't do if it hurts as it's still healing, and likely too fragile to be moved)
3 when completely pain free, start doing more vigorous mobility excercises to break up scar tissue, and stretch (because injuries often heal shorter than normal)
4 when full range of motion is mostly achieved, start adding resistance/load
if you're like me, i always want to jump from 1 to 4, and that's where reinjury has often happened for me...
 

Dartagnan64

G.O.A.T.
my mental model for recovery (from my experience of getting acl replacement)...
1 rest until mostly pain free (let the connective tissue fully connect)
2 start mobility based exercises (no load/no stretching)... just to get more blood flowing to the injury (don't do if it hurts as it's still healing, and likely too fragile to be moved)
3 when completely pain free, start doing more vigorous mobility excercises to break up scar tissue, and stretch (because injuries often heal shorter than normal)
4 when full range of motion is mostly achieved, start adding resistance/load
if you're like me, i always want to jump from 1 to 4, and that's where reinjury has often happened for me...
I think that is sound for an actual injury. It's debatable whether TE qualifies as an injury vs a degenerative process of failed tendon response to microtears. In the latter condition, getting blood flow and eccentric loading onto the tendon is important to get the collagen fibres regenerating in the proper alignment.
 

WestboroChe

Hall of Fame
I think that is sound for an actual injury. It's debatable whether TE qualifies as an injury vs a degenerative process of failed tendon response to microtears. In the latter condition, getting blood flow and eccentric loading onto the tendon is important to get the collagen fibres regenerating in the proper alignment.
Isn’t TE a repetitive stress injury?
 

happyandbob

Professional
Isn’t TE a repetitive stress injury?
yes, but with TE the injury isn't what causes the majority of the pain. as @Dartagnan64 noted it's actually degenerative so the pain is caused by all of the scar tissue that forms from the microtears caused by the repetitive stress -- TE is tendonosis vs tendonitits where a lot of the pain is caused by inflammation and rest is the first remedy.

that's why TE lingers for so long and the pain persist long after the inflammation is gone.

exercise and deep manipulation to break up the scar tissue seem to be the only clinically proven ways to attack it.
 

BallChaser

New User
yes, but with TE the injury isn't what causes the majority of the pain. as @Dartagnan64 noted it's actually degenerative so the pain is caused by all of the scar tissue that forms from the microtears caused by the repetitive stress -- TE is tendonosis vs tendonitits where a lot of the pain is caused by inflammation and rest is the first remedy.

that's why TE lingers for so long and the pain persist long after the inflammation is gone.

exercise and deep manipulation to break up the scar tissue seem to be the only clinically proven ways to attack it.
Adding on to this happyandbob's post, the chiroproctor I know said electronic "shock therapy" worked well with his TE patients. Shock therapy does break up these scar tissues.
 

WestboroChe

Hall of Fame
Adding on to this happyandbob's post, the chiroproctor I know said electronic "shock therapy" worked well with his TE patients. Shock therapy does break up these scar tissues.
Yeah there’s a whole bunch of stuff like that. I’ve mostly used the sonic ones at the PTs office. Personally I just massaged the hell out of it and did strengthening exercises and then started out using really old soft racquets from the 80s. Total healing time until I was completely recovered was probably 2-3 months. However I was able to begin playing tennis after about a month as long as I used a really soft racquet.
 
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