Tennis Elbow & Elbow Pain Treatment

What Causes Tennis Elbow

Tennis elbow, or lateral epicondylitis, is pain at the bony bump on the outside of the elbow where the muscles that lift the wrist and fingers attach. Despite the name, it is a tendon overload problem, not an inflammation that comes and goes. Repeated gripping and wrist extension cause tiny areas of breakdown in the tendon faster than it can repair, and over weeks the tendon becomes thickened, weakened and painful.

Most of the patients we see with it at 201 Broadway have never held a racquet. The common causes are:

• Repetitive gripping and typing. Mouse use with the wrist cocked up, long hours on a laptop, pipetting in a Kendall Square lab, and handwork like carpentry, painting or playing an instrument.
• A sudden increase in load. A weekend of yard work, moving apartments, starting a climbing or lifting program, or picking up a racquet sport again after years off.
• Technique and equipment. In racquet sports, a late backhand, a grip that is too small, or strings that are too tight transmit more force to the tendon.
• Weakness and stiffness upstream. A stiff shoulder, a tight upper back, or a weak rotator cuff forces the forearm to do work the larger muscles should be sharing.

Golfer's elbow is the inner-elbow cousin. Medial epicondylitis affects the tendons on the inside of the elbow that flex the wrist and turn the palm down. It comes from the same kind of overload, often from lifting, throwing, climbing or hammering, and it is treated on the same principles. Many patients have a little of both.

The neck as a hidden source. Outer elbow pain is occasionally not an elbow problem at all. A nerve irritated at the lower neck, usually at the sixth or seventh cervical level, can refer pain to the outside of the elbow and forearm and weaken grip. It can also lower the tendon's tolerance so that genuine tennis elbow develops on top of it. We check for this on every patient, because weeks of elbow treatment will not help a problem that lives in the neck. Our post on tennis elbow and golfer's elbow treatment covers the distinction in more depth.

How We Diagnose It at 201 Broadway

Dr. Bromberg examines every patient himself. For elbow pain, the first visit begins with the history: when it started, what you do with your hands for work and recreation, what changed in the month before the pain, which movements hurt, and whether there is any neck pain, tingling or numbness in the hand.

The examination covers the elbow and everything that feeds into it.

• The elbow itself. Tenderness just in front of the outer bump is the hallmark of tennis elbow; tenderness at the inner bump points to golfer's elbow. He tests resisted wrist and middle finger extension, which reproduce lateral epicondylitis pain, and resisted wrist flexion and pronation for the medial side.
• Grip strength. Measured and compared side to side, both as a diagnostic marker and as the main number we track through treatment.
• Forearm and hand. Feeling the forearm muscles for the tight, tender bands that develop with overuse and keep pulling on the tendon.
• Shoulder and upper back. Shoulder range of motion, rotator cuff strength, and how the mid back moves. A stiff shoulder loads the elbow.
• Neck screening. Neck range of motion, tests that compress or open the nerve openings in the lower neck, and reflexes, strength and sensation in the arm. If neck movement changes the elbow pain, the neck is part of the problem.
• Other elbow structures. Ruling out the radial nerve where it passes through the forearm, the joint itself, and the biceps tendon, each of which can mimic tennis elbow and is treated differently.

Imaging is not needed for a typical case. Dr. Bromberg orders X-rays when there has been an injury, when the joint itself seems involved, or when pain is not responding. Ultrasound or MRI is reserved for a suspected tendon tear or for cases that have failed several months of treatment. When indicated, we refer to area centers through our imaging referrals and review the results with you.

How We Treat Tennis Elbow

The plan has three parts: restore healthy tissue in the forearm and tendon, manage the load so it can recover, and fix the upstream contributors so it does not come back. Injections and surgery are not part of what we do, and most patients do not need them.

Active Release Technique

Active Release Technique is the center of our treatment. Dr. Bromberg applies focused pressure to the forearm extensor muscles and the tendon while you move the wrist and elbow through specific ranges. This breaks up the adhesions that form between the overused muscles and restores normal glide, which lowers the pull on the tendon attachment. Most patients feel a difference in grip and tenderness within the first two or three sessions. The same approach is applied to the flexor side for golfer's elbow. More on our muscle therapy page and in our post on how Active Release Technique works.

Load Management

Tendons do not recover with total rest and they do not recover under full load. They recover somewhere in between. Dr. Bromberg works out with you what to reduce and what to keep: changing a mouse or keyboard position, swapping a grip, cutting racquet time or lifting volume for a few weeks rather than stopping entirely, and using a counterforce strap during the activities you cannot avoid. As the tendon improves, we add a progressive loading program, usually slow, heavy wrist extension work with a light weight, which is what rebuilds the tendon's capacity.

Adjustments to the Elbow, Wrist and Neck

Chiropractic adjustments are used where joint restriction is contributing. The radial head at the elbow and the small joints of the wrist often lose motion with chronic gripping, and restoring it reduces the strain on the tendon. When the lower neck is involved, gentle cervical adjustments and soft tissue work on the neck and upper back are part of the plan, and for some patients that is the part that finally resolves the elbow.

Upstream Strength

Shoulder and upper back stiffness and rotator cuff weakness get their own exercises. A shoulder that moves well lets the forearm stop overworking. These are a few minutes a day and make the difference between an elbow that heals and one that returns every spring.

What Your Visits Look Like

First visit. History, the examination above, and a clear explanation of whether this is tennis elbow, golfer's elbow, a neck-driven problem, or something else. Treatment usually starts the same day with Active Release Technique on the forearm and any adjustments that are indicated. You leave with a short exercise or two and specific changes to make at your desk, your workbench or your sport for the next week. No referral is needed, walk-ins are welcome during office hours, and we hold same-day slots for patients in pain.

Follow-up visits. Each visit begins with a quick recheck of grip strength, tenderness at the tendon, and pain with the movements that provoked it. Treatment is adjusted based on those findings. As the tendon settles, the hands-on portion shortens and the loading program takes over.

Visit count and span. A typical course is two visits a week for the first two weeks, then weekly. Most straightforward cases are discharged within four to eight weeks with a home program. Elbows that have been painful for six months or more, that involve both sides, or that have a neck contribution usually need longer, and Dr. Bromberg says so at the first visit rather than after.

How progress is measured. Grip strength compared to the other side, pain with resisted wrist extension, and the practical markers: can you lift a coffee pot, shake hands, carry groceries and type through a day without the elbow reminding you. Plans are reassessed on real progress; we do not sell prepaid packages.

What to Expect: Outcomes and Timelines

Tennis elbow that has been present for a few weeks to a few months responds well. Most patients notice less tenderness and a stronger grip within two to three weeks, and are back to normal use within one to two months. Tendons that have been painful for a year or more have usually changed structurally and recover more slowly, often over three to four months, but most still improve without injections or surgery.

What slows recovery:

• Continuing the provoking activity unchanged. This is the most common reason tennis elbow lingers. Treatment cannot outpace a daily overload.
• Complete rest. A tendon that is never loaded weakens further and hurts again as soon as it is used.
• Skipping the loading exercises. Hands-on treatment calms the tendon; the progressive loading is what rebuilds it.
• An unrecognized neck component. If the lower neck is irritating the nerve, the elbow will not fully settle until that is treated.
• Prior steroid injections. They often relieve pain for a few weeks, but repeated injections can weaken the tendon and make the long-term outcome worse.

Dr. Bromberg reassesses at about four weeks. If grip and tenderness are improving, the plan continues and visits taper. If not, he re-examines the neck and the radial nerve, considers imaging for a tear, and refers to an orthopedist or sports medicine physician when the case needs options outside our scope. Elbow pain with locking, significant swelling, or a sudden loss of strength is referred promptly rather than treated through.

When to See Someone Else First

Most elbow pain is safe to bring to us directly. See a physician, urgent care or the emergency room first if you have:

• Elbow pain after a fall or a direct blow, especially with swelling, deformity or an inability to bend or straighten the arm
• A hot, red, swollen elbow, or elbow pain with fever, which can signal infection or gout
• A sudden pop at the elbow followed by weakness or a visible change in the shape of the upper arm
• Numbness or weakness in the hand that is spreading or getting worse
• Elbow or arm pain that comes on with exertion and eases with rest, with chest pressure or shortness of breath, which needs emergency evaluation
• A known history of cancer, or pain that is constant and unchanged by rest or movement

If none of those apply, call (617) 494-1166 or walk in during hours. We are at 201 Broadway, First Floor, a six-minute walk up Broadway from the Kendall/MIT Red Line station, with free street parking on Broadway and the side streets.