Tennis Elbow: Best Treatments, Assessments, and Therapists for You

If you’re a client working with an occupational therapist for tennis elbow treatment, we want you to be as informed as possible—so we can truly partner to create the best course of treatment for YOU. 

In occupational therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll see the assessment and treatment options your therapist may use, along with the evidence that supports them. 

If your tennis elbow symptoms are new (i.e., they began within the last 2 weeks) and mild, you may want to first try some of the exercises/stretches at home. (We’ve also included self-assessments to help you determine how tennis elbow is impacting your quality of life—and thus, decide whether it’s time to seek out therapy.)

Please note that this page is for educational purposes and should not substitute advice from your medical provider. At the bottom of this page, you’ll find therapists near you who can support you in your tennis elbow treatment. 

A quick note on why to pursue therapy first

This post focuses on therapy treatment for tennis elbow. As with most conditions, conservative treatment like therapy is typically the first course of care. That is because therapy is safer and much more cost-effective than invasive options like surgery (which come with a host of risks/potential complications—not to mention long recovery times). 

Surgery for tennis elbow can cost between $10,000-$16,000, whereas therapy typically costs $75-$150 per session. 

The amount of therapy sessions needed will vary based on your initial evaluation. In general the higher your initial disability score the more frequent your sessions. Ultimately our goal is self-management with a personalized prescribed program. (Read more about this below in discharge.) 

Therapist-recommended assessments for tennis elbow

As you can see below, evaluating a case of tennis elbow involves much more than assessing the elbow itself. Often, other parts of the arm are involved—even when the pain seems localized to the elbow. The other benefit of a thorough examination is that it can help discern whether other diagnoses are involved. 

Assessments also serve as a point of comparison to track your progress and response to treatment. (Without an accurate and thorough baseline, it can be hard to discern how much the interventions are helping!) Your therapist may perform certain assessments at various intervals over the course of therapy.

Core Occupational Therapy Outcome Measures

Here are two metrics that many OTs collect with every patient. You’ll see that our top assessment is on your quality of life. At the end of the day, this is the most important outcome for us, we want our treatments to have a discernable impact on your day to day life. 

• Quality of Life Patient Reported Outcome Measure- The PROMIS Global 10
• Grip Strength

Tennis Elbow Specific Assessments

More patient reported outcome measures

Here are two more patient reported outcome measures that may be used as an objective way to track how this pain is impacting your day-to-day function. (You could actually do these before your appointment, and bring the assessment with you to your eval!)

These can also be used to help you think through how much your tennis elbow is impacting your day to day life, and if it is time to seek out a therapist. 

Assessment	Purpose	Link
Patient-Rated Tennis Elbow Evaluation (PRTEE)1	The PRTEE is a 15-item self-reported questionnaire created to measure forearm pain and disability in patients with Tennis Elbow specifically.	Take the PRTEE assessment here, and share your score with your provider.
QuickDASH2	The QuickDASH is an 11-item self-reported questionnaire and a shortened version of the Disabilities of the Arm, Shoulder, and Hand assessment (DASH), which measures the impact of a variety of musculoskeletal disease and injuries on function in the upper extremity.	Take the QuickDASH assessment here, and share your score with your provider.

More assessments that can be performed by your therapist. 

• Observe posture for abnormal movement patterns

• Neurological Assessments
  • Dermatomes, Myotomes, and Reflexes 
  • Radial Nerve Tension
  • NOTE: Tennis elbow straps that are applied too tightly can create a nerve compression at the Arcade of Frohse³ where the radial nerve passes through the Supinator muscle.
• Range of Motion (ROM) Measurements
  • Cervical ROM⁴
  • Shoulder ROM all planes
  • Elbow ROM all planes
  • Forearm ROM all planes
  • Wrist ROM all planes
• Strength Testing
  • Grip Strength bilaterally^{5,6, 7}
    • Grip Dynamometer costs roughly $275 on Amazon.
  • Manual Muscle Testing (MMT) bilaterally
    • Shoulder flexion, abduction, external and internal rotation 
    • Elbow flexion, extension
    • Forearm supination, pronation
    • Wrist extension (with hand in fist to isolate wrist extensors), flexion (with
      fingers extended to isolate wrist flexors), radial deviation
    • Finger extension (this doubles as a special test below)
• Special Tests
  • Maudsley’s Test 
  • Cozen’s Test
  • Mill’s Test
• Differential Diagnoses
  • C6-7 nerve root compression
  • Cervical radiculopathy 
  • Radial Tunnel Syndrome → 3 signs: diffuse lateral elbow pain, pain with resisted supination, pain with resisted long finger extension. 
  • Posterolateral Rotary Instability (PLRI) → usually the result of a FOOSH (fall on
    outstretched hand)
  • Arthritis

Setting goals for tennis elbow therapy

Therapy only works when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you. 

Therapy treatment interventions for tennis elbow

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program. 

• Aerobic warm-up for endorphin release
• Dynamic flexibility using Mills Stretch for the elbow and shoulder
• Manual therapy
  • Instrument Assisted Soft Tissue Mobilization (IASTM)^{8, 9}
    • Hawkgrips can be used on full body
      • Cost: $595
    • Evidence-based support:
      • Ligaments¹⁰
      • Nerves¹¹ 
  • Joint mobilization of radial head¹²
  • Mobilization with movement
  • Dry needling¹³ 
• Conditioning, aerobic, and strengthening exercises → According to the ACOEM Practice Guidelines for Elbow Disorders, strength and conditioning exercises are superior to static stretching in the absence of major range of motion deficits..¹⁴
  • Eccentric exercises for involved muscles, including wrist extension, radial
    deviation, supination, and elbow extension^{15, 14} 
  • Tyler Twist Exercise ^{16, 17}
  • Scapular stabilization exercise program
  • Rotator cuff strengthening program 
  • Core exercises 
• Self-care home management and activity modification
  • Lifting mechanics⁶
  • Ergonomic positioning and setup 
• Incorporation of functional tasks based on patient goals 
• Radial nerve glides/flossing¹⁸
• Orthosis (or brace) use may be appropriate in more severe cases. ¹⁴
• Additional pain management tools
  • Kinesiotape of extensor wad¹⁹
  • Modalities (heat, ice, ultrasound, iontophoresis)
  • Biofreeze
  • Salonpas topical patches
• Home program 

Discharge suggestions

Every individual is unique, and your response to therapy will also be unique. For some, it is not appropriate to continue therapy until the condition completely resolves. For others, pain may resolve before the entire rehabilitation program is established. In the latter’s case, it is important to remember that pain is a symptom – not a diagnosis, and that strength and endurance deficits must be addressed to prevent recurrences. 

• Follow your therapist’s discharge recommendations to maintain progress made in therapy. 
• Continue to use self-management and empowerment strategies to control any remaining symptoms
• Follow a home exercise program with proximal posture component for an additional 3 months to help establish good habits for body mechanics, even if you feel back to 100%
• Consult your therapist immediately if your condition worsens, or if you continue to have difficulty with your daily activities after 3 months.

Choosing a therapist for tennis elbow

Both occupational therapists and physical therapists can treat tennis elbow. In less severe cases, a generalist therapist from either discipline should be able to help you. 

It is important to note that both OTs and PTs can pursue advanced certification as a Certified Hand Therapist. To achieve this rigorous specialization of the hand, wrist, elbow, and shoulder, therapists must log 4,000 hours of experience treating the upper extremity and pass a formal examination. They also must complete various recertification requirements every 5 years. 

Below you can find occupational therapy professionals, who have tagged “hand therapy” as a focus area. The ones with a “CHT” in their credentials are Certified Hand Therapists.

Conclusion

Hopefully this article has helped you understand what therapy for tennis elbow entails, and if you will be a good candidate! 

This article is updated one time/month, based on new research that has come out. If you have any research you would like us to consider you can drop it in the comments. 

Therapists who would like more fleshed out information on tennis elbow treatment can join us as members of the OT Potential Club. 

References

Here’s the science that backs the assessment and treatment outlined above. 

1. Rompe JD, Overend TJ, MacDermid JC. Validation of the Patient-rated Tennis Elbow Evaluation Questionnaire. Journal of Hand Therapy. 2007.
2. Polson K, Reid D, McNair PJ, Larmer P. Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther. 2010.
3. Clavert P, Lutz JC, Adam P, Wolfram-Gabel R, Liverneaux P, Kahn JL. Frohse’s arcade is not the exclusive compression site of the radial nerve in its tunnel. Orthopaedics & Traumatology: Surgery & Research. 2009.
4. Sukari AAA, Singh S, Bohari MH, Idris Z, Ghani ARI, Abdullah JM. Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments. Malays J Med Sci. 2021.
5. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985.
6. Taylor SA, Hannafin JA. Evaluation and Management of Elbow Tendinopathy. Sports Health. 2012.
7. Chourasia AO, Buhr KA, Rabago DP, Kijowski R, Irwin CB, Sesto ME. Effect of Lateral Epicondylosis on Grip Force Development. Journal of Hand Therapy. 2012.
8. Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999.
9. Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997.
10. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther. 2009.
11. Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007.
12. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006.
13. Ma X, Qiao Y, Wang J, Xu A, Rong J. Therapeutic Effects of Dry Needling on Lateral Epicondylitis: An Updated Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2024.
14. Hegmann KT, Hoffman HE, Belcourt RM, et al. ACOEM practice guidelines: elbow disorders. J Occup Environ Med. 2013.
15. Andres BM, Murrell GAC. Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon. Clinical Orthopaedics and Related Research®. 2008.
16. Kazi F, Patil DS, Kazi F, Sr DSP. Effects of the Tyler Twist Technique Versus Active Release Technique on Pain and Grip Strength in Patients With Lateral Epicondylitis. Cureus. 2023.
17. Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial. Journal of Shoulder and Elbow Surgery. 2010.
18. Arumugam V, Selvam S, MacDermid JC. Radial Nerve Mobilization Reduces Lateral Elbow Pain and Provides Short-Term Relief in Computer Users. Open Orthop J. 2014.
19. Zhong Y, Zheng C, Zheng J, Xu S. Kinesio tape reduces pain in patients with lateral epicondylitis: A meta-analysis of randomized controlled trials. International Journal of Surgery. 2020.
20. Goodman CC. Screening for Medical Problems in Patients with Upper Extremity Signs and Symptoms. Journal of Hand Therapy. 2010.

OT Potential  does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.