Anyone have any tips for Tennis Elbow recovery?

RipGroove said:
So I've come to the conclusion that any type of tennis elbow stretches or exercises are a no-go for me current because anything I do with it is super painful. So I'm currently giving it a couple of weeks of rest, and by rest I mean still working but trying to avoid using it as much as possible, just not specifically exercising or stretching my arm and icing it after work until it stops hurting enough for me to start stretching it and exercising it again. Bit annoyed as it's been about 4 months since I injured it and it's still unuseable 😭
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You are absolutely correct that it is too early to start rehab exercises if it is acutely inflamed. The real question is why is it still acutely inflamed a good four months after appearing? That suggests either something that you are still doing at work or riding your 50 pound ebike is perpetuating it, or that your strengthening exercises were too vigorous to begin with.

So the two things that help when it's acutely inflamed are icing for 20 minutes four times a day or more, and a mild compression wrap to limit swelling at the elbow. An elbow sleeve that is snug but not too tight to be worn all day and night with a wadded up ball of Kleenex or toilet paper positioned directly over the sore spot are highly recommended for this. If the ball of TP hurts too much then your sleeve is too tight. Hopefully wearing this and icing for 7 to 10 days will bring down the acute pain and inflammation. If not you might consider a local steroid injection around this tendon but only one time. If it doesn't help the first time it's not going to help to keep getting it. Of course you could also try PRP, platelet rich plasma injection. Honestly I never saw any health side effects of a single steroid injection as long as you don't inject into the tendon itself. Any orthopedist or sports medicine doctor can do this.

When you do return to strengthening I can't emphasize enough that you have to begin with a 1 pound dumbell and never increase by more than 10% when you start going up or you will blow it up again. Nobody but the physical therapists start with 1 pound. Everyone else starts with a five or 10 pounder and they just perpetuate the inflammation. You must stay within the limits of the tissues. I'm talking about the reverse wrist curl exercise. For wrist curls you would start with a 2-3 pound dumbbell. Hope this helps.
 
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This stuff helped me (with physical therapy) recover from a catastrophic life changing injury. 6 friends with various injuries including tennis elbow all said it helped, you will need 2-3 weeks of application though.


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cjc.emtb said:
Carbon bar and don't stop riding...
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I stopped riding months ago, the injury didn't come from the emtb or from any repetitive motion, it was a one-off freak accident where I fell off my street trials bike and whacked the tendon on a wooden pole. It just so happened to have caused the exact same symptoms as tennis elbow because I damaged the tendon in the same place. I couldn't ride the emtb even if want to right now 😭
 
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Jeff McD said:
You are absolutely correct that it is too early to start rehab exercises if it is acutely inflamed. The real question is why is it still acutely inflamed a good four months after appearing? That suggests either something that you are still doing at work or riding your 50 pound ebike is perpetuating it, or that your strengthening exercises were too vigorous to begin with.

So the two things that help when it's acutely inflamed are icing for 20 minutes four times a day or more, and a mild compression wrap to limit swelling at the elbow. An elbow sleeve that is snug but not too tight to be worn all day and night with a wadded up ball of Kleenex or toilet paper positioned directly over the sore spot are highly recommended for this. If the ball of TP hurts too much then your sleeve is too tight. Hopefully wearing this and icing for 7 to 10 days will bring down the acute pain and inflammation. If not you might consider a local steroid injection around this tendon but only one time. If it doesn't help the first time it's not going to help to keep getting it. Of course you could also try PRP, platelet rich plasma injection. Honestly I never saw any health side effects of a single steroid injection as long as you don't inject into the tendon itself. Any orthopedist or sports medicine doctor can do this.

When you do return to strengthening I can't emphasize enough that you have to begin with a 1 pound dumbell and never increase by more than 10% when you start going up or you will blow it up again. Nobody but the physical therapists start with 1 pound. Everyone else starts with a five or 10 pounder and they just perpetuate the inflammation. You must stay within the limits of the tissues. I'm talking about the reverse wrist curl exercise. For wrist curls you would start with a 2-3 pound dumbbell. Hope this helps.
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Thank you, I'll definitely be following this advice. I've measured my arm and ordered a light compression elbow sleeve and I will continue icing it when I can. Unfortunately I can't avoiding using it at work, I'm a CNC machinist so I'm constantly picking up billets of steel and using hand tools all day but I'm doing my best to keep the stress away from the affected arm. My boss doesn't offer any kind of sick pay either so there's no chance of me even getting a few days off work to rest it.
 
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Wow, I feel for you. That is a rough job to be recovering from this kind of injury. And that severe a hit on the tendon complex is the type that just takes forever to heal, the people who take a year and a half. And the acute inflammation prevents rehab starting for months in the beginning. I hope for the best for you. That's a tough one. May require injection of PRP or repeated needling to calm down the inflammation so you can start rehab sooner, or even perhaps an injection of steroid. The steroidothers don't heal it, it simply lessens the inflammation enough to where are the strengthening exercises of physical therapy actually stimulate the healing process.

Only advice I can give is whenever you have to lift anything at work, lift with palms up, as opposed to the usual habit of grabbing it with palms down or sideways. Palms up relaxes those extensor tendons of the elbow and uses the flexor tendons to do the lifting, and you would even want to try to lift initially with the other hand and cradle other end on the anterior surface of injured arm rather than the hand.
 
Jeff McD said:
Wow, I feel for you. That is a rough job to be recovering from this kind of injury. And that severe a hit on the tendon complex is the type that just takes forever to heal, the people who take a year and a half. And the acute inflammation prevents rehab starting for months in the beginning. I hope for the best for you. That's a tough one. May require injection of PRP or repeated needling to calm down the inflammation so you can start rehab sooner, or even perhaps an injection of steroid. The steroidothers don't heal it, it simply lessens the inflammation enough to where are the strengthening exercises of physical therapy actually stimulate the healing process.

Only advice I can give is whenever you have to lift anything at work, lift with palms up, as opposed to the usual habit of grabbing it with palms down or sideways. Palms up relaxes those extensor tendons of the elbow and uses the flexor tendons to do the lifting, and you would even want to try to lift initially with the other hand and cradle other end on the anterior surface of injured arm rather than the hand.
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I've the compression sleeve on for a few days now and I've been icing it when I can and I believe it's making a difference, I was getting a fair bit of pain even when just stood still with my arm straight down by my side but that seems to be going away now which I assume is down to the sleeve and icing keeping inflammation at bay so I'll keep it up for the full 10 days and see what it's like after that 😎👍🏻
 
I fractured my elbow socket 18months ago. Daily Vit D (2,000mg), cod liver oil liquid in a table spoon and Iron tablets daily all played their part. Plus....milk.
 
Jeff McD said:
Wow, I feel for you. That is a rough job to be recovering from this kind of injury. And that severe a hit on the tendon complex is the type that just takes forever to heal, the people who take a year and a half. And the acute inflammation prevents rehab starting for months in the beginning. I hope for the best for you. That's a tough one. May require injection of PRP or repeated needling to calm down the inflammation so you can start rehab sooner, or even perhaps an injection of steroid. The steroidothers don't heal it, it simply lessens the inflammation enough to where are the strengthening exercises of physical therapy actually stimulate the healing process.

Only advice I can give is whenever you have to lift anything at work, lift with palms up, as opposed to the usual habit of grabbing it with palms down or sideways. Palms up relaxes those extensor tendons of the elbow and uses the flexor tendons to do the lifting, and you would even want to try to lift initially with the other hand and cradle other end on the anterior surface of injured arm rather than the hand.
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The way things are going I may have to consider the steroid injection because I'm having a lot of trouble sleeping at night due to pain every time I move my arm and currently there's no way I can even begin to start any stretching or exercises. I'll see how it is after the full 10 days of wearing the compression sleeve and icing it and go from there. I have had the injection before but it made zero difference, the doc said it would be 50/50 whether it would work because it's a tricky thing to administer to the exact area that needs it but maybe I'll get lucky this time and it'll work and allow me to start light strength exercises and more importantly actually be able to sleep at night again.
 
RipGroove said:
The way things are going I may have to consider the steroid injection because I'm having a lot of trouble sleeping at night due to pain every time I move my arm and currently there's no way I can even begin to start any stretching or exercises. I'll see how it is after the full 10 days of wearing the compression sleeve and icing it and go from there. I have had the injection before but it made zero difference, the doc said it would be 50/50 whether it would work because it's a tricky thing to administer to the exact area that needs it but maybe I'll get lucky this time and it'll work and allow me to start light strength exercises and more importantly actually be able to sleep at night again.
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Like I mentioned, research peptides, BPC-157 & TB-500. As you are in acute pain go for BPC-157 daily for 4 weeks. You will likely notice a huge change after a week. Once it settles down I would then get on TB-500 for another 4 weeks to aid recovery and muscle growth.
Do your own research there is lots of information online. It will get you back on the bike in no time.
 
Hardtail said:
Like I mentioned, research peptides, BPC-157 & TB-500. As you are in acute pain go for BPC-157 daily for 4 weeks. You will likely notice a huge change after a week. Once it settles down I would then get on TB-500 for another 4 weeks to aid recovery and muscle growth.
Do your own research there is lots of information online. It will get you back on the bike in no time.
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I've found so much conflicting information online, some physios and doctors swear by Rest, Ice and Compression etc while other say that's nonsense and you need heat and constant stimulation of the tendons to keep blood flow. So much of it is conflicting so I don't know where to start. My own doctor believes in total rest (saw him a few years ago when I had it in the past). Nothing I seem to do at the minute seems to help.
 
had it in both elbows for over 22 years with almost no breaks in the pain etc, just a variation in how much pain I get.
probably all from heavy work plus playing guitar.
I've tried everything apart from surgery and nothing gives any decent relief so now I have refined managing it to:
stretches - you'll find the ones that work for you
TENS machine - occasional use
ice - frequent, I know when its going to flare up and its usually if I have had a hard time at work, usually with a lot of rotational effort from forearms or shoulders. i ice the elbows before they get bad, it helps.

if you're really lucky like some, it will go away but not in my case so just learn to manage it and as a result you might be lucky.
 
I have a long term Achilles tendon issue which constantly varies. Nothing seems to have worked longer term with it despite trying many things and trying to monitor what does and doesn't affect it.

One thing I've recently noticed is that wearing thicker socks actually "irritates" it. It's a tiny difference, but presumably the slight increase in temperature over longer periods of time doesn't help. So with compression, I think I used to leave it on too long and I know with icepacks, sometimes I'll forget and leave them on until I've warmed them up :)

Depending on the circumstances, having less clothing around it might help over longer periods ?
 
After some more investigation (IE, me paying more attention to where the pains were coming from) I realized I've also must have upset my Brachioradialis muscle in my arm when I fell off and whacked my tendon, this muscle is near the tennis elbow tendon and has very similar symptoms, the difference is they are treated differently apparently. I definitely still have tennis elbow pain (which seems to be slowly getting better)but also very sharp pain from the Brachioradialis when I grip anything or try to straighten my arm. I've not found any stretches that target that muscle so for now I've bought a hard spikey deep tissue massage ball which I use 3 times a day which is definitely helping.
 
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Outstanding, if you are slightly better with the tennis elbow pain that is all that can be expected this early but it means you are on the right track! Basically the same strengthening exercises should also help brachioradialis eventually. Remember, average is one and a half years to full recovery. So keep up the good work. Google stretches for the brachioradialis.

Also remember that if your problem has gone on this long it means a more severe strain that requires strengthening 2-3 x/week for the entire rest of your life to avoid re-injury. However, stretches must remain 2x/d.

Also remember you must avoid handlebar rotated too forward or rearward which can perpetuate pain in spite of adequate rehab. You must experiment with slight forward or rearward until you find the optimum for your unique arm alignment. How far forward or rearward you can rotate depends on whether you are a relaxed rider with a more straight up position and levers around 45° w/ some elbow bend, or an aggressive rider with lower chest more bend in the elbows w/ slight drop also, & higher brake levers around 60°-80°.

You simply have to experiment to see which feels better for you.
 
RipGroove said:
The way things are going I may have to consider the steroid injection because I'm having a lot of trouble sleeping at night due to pain every time I move my arm and currently there's no way I can even begin to start any stretching or exercises. I'll see how it is after the full 10 days of wearing the compression sleeve and icing it and go from there. I have had the injection before but it made zero difference, the doc said it would be 50/50 whether it would work because it's a tricky thing to administer to the exact area that needs it but maybe I'll get lucky this time and it'll work and allow me to start light strength exercises and more importantly actually be able to sleep at night again.
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Make sure he doesn't inject the steroids in the tendon
 
Get yourself some sort of a stress ball and get squeezing. I had a sore elbow from over doing it on a road bike that didn't fit well, it got so I could just about ride but was sore all the time. A few minutes a few times a day of stress ball squeezing eventually got me back to being pain free.

3 years on, no reoccurrence. I used a selection of 3 egg shaped balls I bought on amazon. There was a soft, medium and firm option and I worked my way through the lot.
 
Dipityro said:
I eased it by resting the arm, icing after rides, and doing light wrist curls and grip work every day. A physio showed me a slow, controlled eccentric wrist drop that helped most.
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I’m also recovering by doing eccentric exercises, supported by shoulder strengthening and thoracic mobility work.

If it doesn't work for you and you’re desperate and have already tried everything, a friend of mine is getting some benefits from this brace. Unlike many others, it doesn’t work through compression but through counter‑tension. Basically, it prevents full arm extension, you have to wear it 24 hours a day, and it takes at least 2 months to see the first improvements.

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Prophecyonot said:
Reviving this thread because I’ve dealt with the same tendon issue after a crash, and the one thing that helped most was slow, daily eccentric wrist exercises with very light weight. I also eased my grip on the bars and adjusted my lever angle to cut strain. Did anyone here try shockwave therapy? I’m curious whether it made a real difference for others.
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I was treated with (I think, sorry, I'm not up on the translation from German term for it, but a loud vibrating thing applied to the problem area) shock-wave therapy for tennis elbow about 5 years ago, from memory I had 4 quite painful sessions but it improved after each session and I was pain free by a month after the last one and it has never come back:). More recently I injured my right shoulder, severe sprain on an old skiing injury, (humerus cracked at the shoulder joint) and again had the same treatment which helped but 3 years later some movements still give me pain! So for me very good and not bad!
 
As an ex heating engineer/plumber I used to suffer from tennis elbow for a while but I had a steroid injection in the elbow and that was that, I’m going back at least 15 years maybe even 20, it’s never come back and I’ve never had any issues with it, of course I’ve just jinxed myself 😁
 
Platelet-rich plasma (PRP) injections helped me with tennis elbow a few years back. Now I'm taking them for golfer's elbow.

@Greg Watts - please elaborate PRP Injections
 
BikeBert said:
Platelet-rich plasma (PRP) injections helped me with tennis elbow a few years back. Now I'm taking them for golfer's elbow.

@Greg Watts - please elaborate PRP Injections
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Happy to. PRP is genuinely one of the more interesting treatments to emerge from sports medicine in the last decade.

The basic principle: they draw your blood, spin it in a centrifuge to concentrate the platelets (typically 5-10x normal levels), then inject that concentrate directly into the damaged tendon. Platelets are packed with growth factors — PDGF, TGF-β, IGF-1 — that signal the body to repair tissue. For tendons, which have notoriously poor blood supply and heal slowly, you're essentially delivering a concentrated repair signal right where it's needed.

For lateral epicondylitis specifically, the evidence is reasonably solid. A well-cited 2013 JAMA study found PRP outperformed cortisone at the 24-week mark. Cortisone wins in the short term (faster pain relief in the first 4-8 weeks), but PRP tends to produce more durable results because it's actually addressing the underlying tissue rather than just suppressing inflammation.

A few things worth knowing:

— It works better for chronic tendinopathy (3+ months) than acute injuries. Fresh trauma heals better on its own.
— Expect an initial flare-up of pain for 1-2 weeks post-injection as the inflammatory response kicks in. This is normal and a sign it's working.
— Most protocols are 1-3 injections, 4-6 weeks apart. Not a one-shot fix.
— Reduced activity for 4-6 weeks post-injection is important — you need to let the tissue remodel.
— The transition from tennis to golfer's elbow (lateral to medial epicondylitis) is not unusual when compensating for one arm — worth mentioning to your practitioner so they assess both.

One caveat: results vary depending on the centrifuge protocol and injection technique. Worth finding a sports medicine doctor who does a decent volume of these rather than a GP doing it occasionally.
 
BikeBert said:
Platelet-rich plasma (PRP) injections helped me with tennis elbow a few years back. Now I'm taking them for golfer's elbow. @Greg Watts - please elaborate PRP Injections
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I've already covered PRP in detail in my previous post, so I won't repeat myself. But since you're now dealing with golfer's elbow after previously having tennis elbow, that's worth addressing specifically.

The lateral-to-medial progression is a common pattern, especially when you've been unconsciously compensating with a different grip or arm position to protect the original injury. At 85kg on a Levo with that custom coil setup of yours, you're riding a bike that's supremely planted but not exactly featherweight, so grip fatigue on longer descents is a real factor.

A couple of things worth considering on the bike side: your lever reach and angle can make a genuine difference. A slightly inboard brake lever position (closer to the grip centre) reduces the lever arm on the medial epicondyle. If you haven't already, try running your levers with a bit more reach dialled in so you're braking with fingertips rather than hooking with the whole hand. Also, given you're running Trickstuff Direttissimas, the bite point and power should be adjustable enough that you're not death-gripping to get stopping force.
 
Greg Watts said:
Happy to. PRP is genuinely one of the more interesting treatments to emerge from sports medicine in the last decade.

The basic principle: they draw your blood, spin it in a centrifuge to concentrate the platelets (typically 5-10x normal levels), then inject that concentrate directly into the damaged tendon. Platelets are packed with growth factors — PDGF, TGF-β, IGF-1 — that signal the body to repair tissue. For tendons, which have notoriously poor blood supply and heal slowly, you're essentially delivering a concentrated repair signal right where it's needed.

For lateral epicondylitis specifically, the evidence is reasonably solid. A well-cited 2013 JAMA study found PRP outperformed cortisone at the 24-week mark. Cortisone wins in the short term (faster pain relief in the first 4-8 weeks), but PRP tends to produce more durable results because it's actually addressing the underlying tissue rather than just suppressing inflammation.

A few things worth knowing:

— It works better for chronic tendinopathy (3+ months) than acute injuries. Fresh trauma heals better on its own.
— Expect an initial flare-up of pain for 1-2 weeks post-injection as the inflammatory response kicks in. This is normal and a sign it's working.
— Most protocols are 1-3 injections, 4-6 weeks apart. Not a one-shot fix.
— Reduced activity for 4-6 weeks post-injection is important — you need to let the tissue remodel.
— The transition from tennis to golfer's elbow (lateral to medial epicondylitis) is not unusual when compensating for one arm — worth mentioning to your practitioner so they assess both.

One caveat: results vary depending on the centrifuge protocol and injection technique. Worth finding a sports medicine doctor who does a decent volume of these rather than a GP doing it occasionally.
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As a more elderly rider I am probably more prone to both muscle and tendon strains. What works for me is firstly to take preventative measures. The main one being a series of exercises done twice a week on my multigym and a pull up bar. Using relatively light weights with multiple weights helps keep muscle fit and connective tissue healthy (tendons and ligaments) . I can do a maximum of 10 pull ups in one set on my pull up bar....which at 75 is about the limit.
Even so I can get strains. My fix is a combination of heat and the use of a massage gun.
Getting the ergonomics of a bike right is also important. Wrists need to be straight, elbows slightly bent and body weight equally supported by legs and arms or arms and backside when seated.
 
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