Congratulations on taking the first step toward solving your TENNIS ELBOW! After working through our protocol, you should be able to:

Before we dive in, we want to appropriately set you up for a better way of thinking about your incredible body. First, understand that your elbows are extraordinary in design, are designed to be worked hard and last a hundred years. Second, tennis elbow is not a freak accident, it may be complicated, but the steps to solving this very annoying problem are quite manageable!

After going through our process, you should have a solid hypothesis about how this painful condition began in the first place. Keep in mind that human beings are incredible healing machines and your ability to heal and improve the function of your body doesn’t have an expiration date. We also want to make sure you understand that your elbow pain didn’t spontaneously occur. Movements that you’ve performed safely and without pain many times, can sometimes become sensitized and painful.

We have organized this protocol into three sections: Desensitize, Restore, and Prevent. In the Desensitize section you will find techniques that help you get out of pain. The Restore section contains mobilizations designed to restore the soft tissue function of your elbow. Lastly, the Prevent section goes over some environmental factors that can have a big impact on health and recovery.

To see the best results while working through this protocol:

  • Expect to spend 10 mins per day DESENSITIZING with videos 3-5
  • Expect to spend 10 mins per day (no more than 20min) RESTORING TISSUES with the mobilization work in videos 9-14
  • Expect to spend 5-10 mins per day RESTORING MOVEMENT with rotation drills in videos 15-17
  • Expect to work on controlling your SLEEP QUALITY and QUANTITY every day
  • Expect to work through this protocol in 6 days, and then continue by revisiting 1-2 mobilization techniques per day that you found most helpful until your symptoms feel better

1. Introduction

2. A Systems Approach

Our treatment model is organized around a few key concepts.

How can we influence the environment around the site of our pain? Are there methods with which we can DESENSITIZE the pain signaling in the elbow in a way that doesn’t slow or limit tissue healing? Can we remove congestion and swelling in the elbow tissues that may be slowing healing time and contributing to your symptoms when you use your arm?
Can we RESTORE the normal function and movement to your elbow? Rarely do we see mechanical based elbow pain that isn’t also associated with some kind of tissue restriction in the elbow joint. Improving global functional capacity of your arm may potentially unload an aspect of your sensitized elbow.
Are there particular shapes and positions that support better functioning of your arms day-to-day that might unload your elbow while it normalizes and heals? How can we PREVENT future injury by changing your movement patterns and better preparing your body for the rigors of dynamic movement?

3. Gua Sha

One of the oldest methods for desensitizing and improving blood flow to and around an injury site is a very old technique commonly called “Gua Sha.” People have been using various instruments like soup spoons, bones, and horns as tissue scraping devices for as long as there have been people. The modern equivalent is called Instrument Assisted Soft Tissue Mobilization or “IASTM.” As the name implies, the ultimate goal is to mobilize the affected tissue with whatever spoon, tool, butter knife, spatula, or scraping tool you might have lying around. Remember, the goal is to not irritate, but to desensitize and to improve tissue mechanics. This technique is very localized and often is an excellent way to improve blood/fluid flow at a specific site.

Rx: 1x per day while symptoms persist, 2-3 minutes max

4. Restoring Sliding Surfaces

Our Tennis Elbow Protocol is a pretty complete road map to understanding, healing, and preventing this all too common elbow problem. While we do want to help you improve your understanding about this problem overall, our primary goal is to give you the tools to address your daily pain and symptoms. The technique outlined in this video is an excellent way to quickly change how your body is perceiving your irritated elbow tissues. The temporary compression causes a big rebound in fluids and blood flow to the treated area that facilitate healing and better movement. This technique is also excellent at restoring movement into the elbow tissues globally.

Rx: 3x per day while symptoms persist, 10 minutes total

5. Turbo Charge Your Healing Response

This video will include some ideas about decongesting and boosting the healing around your elbow. Keep in mind that we can often eliminate painful sensations in a challenged tissue well before that tissue has a chance to completely heal. This means you may be able to return to normal activity while simultaneously continuing to normalize the native function of your elbow.

Rx: 2x per day while symptoms persist, 2-3 minutes max

6. NMES Therapy

The next level of decongestion might include the use of neuromuscular-electrical-stimulation or “NMES.” While this technology is advanced and may not be practical for everyone, it is a cutting edge technology that we would be remiss in not explaining.

7. Short-Term Support Strategies

It is completely reasonable to support a strained and painful tissue during the healing phase of the injury cycle. Changing or unloading a tendon with a splint, brace, or wrap, can give real and instant relief. The problem is that these devices never really resolve symptoms or improve your body’s movement quality. If you have a splint that is working, great! We just want you to know that ultimately splinted or braced structures become weaker and less resilient over time. And no one wants to wear an elbow brace 24/7.

8. Rethinking Old Tools

You may be asking, “Does the old Rest, Ice, Compression, Elevation—’R.I.C.E.’ still have a place in this protocol?” It turns out that rehabilitation science has come a long way since your mother started putting a bag of peas on that ankle sprain. We are much better these days at engaging with behaviors that support and facilitate the body’s healing. Your body is actually a pretty spectacular healing machine. The question we should be asking is, “Am I slowing down or facilitating my body’s natural and pretty complete healing response?” Often when we make choices about recovery, they are aimed at reducing pain, not creating a situation where the body can heal optimally. Watch the video, become better informed, and make the decisions that feel best for you.

As we noted in the introduction, the next phase of our protocol is designed to restore and improve the soft tissue function of your elbow. Unlike many common “internet solutions” that don’t work very well, you won’t see lots of traditional forearm and elbow “stretches” in this protocol. Your elbow protocol contains the most clinically advanced thinking around movements and mobilizations today. We can divide this section up into two different kinds of interventions. The first are what we call “position transfer exercises” or “mobilizations”. These interventions are designed to restore your body’s ability to do what it is supposed to do. Some of these exercises may be new to you, but rest assured, they represent the best of current sports performance thinking. The second category of interventions can be thought of as skill or technique-based interventions. Once you have restored the ideal ranges of motion of your elbow, it is important to restore your elbow’s natural movements.

We’ve organized these interventions into stand-alone sessions. It is critical that you accumulate many short sessions over the course of the week, rather than only a few longer sessions. We recommend that you work through the techniques in videos 9-14 in order, spending 10 minutes every day (and no more than 20 minutes per day). Once you have worked through each technique, continue working the techniques you found most helpful, 1-2 per day, until your symptoms feel better. In addition, you should spend 5-10 minutes every day working on the rotation drills in videos 15-17.

9. Improving Trunk Function: Part 1

Tools: 2 Lacrosse Balls, Tape (Peanut)
Time: 10 mins

10. Improving Trunk Function: Part 2

Tools: Lacrosse Ball
Time: 5 mins per side

11. Addressing Forearem Stiffness

Tools: Peanut Roller
Time: 5 mins per side minimum

12. Addressing Tricep Stiffness

Tools: Peanut Roller or Roller
Time: 3-4 mins per side

13. Connecting the Elbow to the Body: Part 1

Tools: Lacrosse Ball
Time: 5 mins max per side

14. Connecting the Elbow to the Body: Part 2

Tools: Peanut Roller or Lacrosse Ball
Time: 5 mins max per side

15. Restoring Elbow Rotation

Tools: PVC Pipe / Broom / Club
Time: 10-15 reps per arm

16. Loaded Rotation Drill

Tools: Barbell
Time: 3x 10-15 reps

17. Hanging Drill

Tools: Some place to hang
Time: 3-5 sets of 5-10 breaths per grip

As we noted in the introduction, the next phase of our protocol is designed to restore and improve the soft tissue function of your elbow. Unlike many common “internet solutions” that don’t work very well, you won’t see lots of traditional forearm and elbow “stretches” in this protocol. Your elbow protocol contains the most clinically advanced thinking around movements and mobilizations today. We can divide this section up into two different kinds of interventions. The first are what we call “position transfer exercises” or “mobilizations”. These interventions are designed to restore your body’s ability to do what it is supposed to do. Some of these exercises may be new to you, but rest assured, they represent the best of current sports performance thinking. The second category of interventions can be thought of as skill or technique-based interventions. Once you have restored the ideal ranges of motion of your elbow, it is important to restore your elbow’s natural movements.
We’ve organized these interventions into stand-alone sessions. It is critical that you accumulate many short sessions over the course of the week, rather than only a few longer sessions. We recommend that you work through the techniques in videos 9-14 in order, spending 10 minutes every day (and no more than 20 minutes per day). Once you have worked through each technique, continue working the techniques you found most helpful, 1-2 per day, until your symptoms feel better. In addition, you should spend 5-10 minutes every day working on the rotation drills in videos 15-17.

18. Preparation Strategy

Tools: None
Time: 10 reps per side, per movement

19. After Action Report

Thank you for working through our TENNIS ELBOW PROTOCOL

We hope that you found it helpful and are on your way to recovery. Take control of your movement and mobility by subscribing to our Virtual Mobility Coach to resolve pain, prevent injury, and improve physical performance.

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