Tennis elbow can be a frustrating and painful condition, which, despite its name, is not limited to tennis players. Clinically referred to as lateral epicondylitis, tennis elbow can affect people engaged in a variety of recreational activities that involve repetitive arm, wrist, and hand movements. Activities commonly associated with tennis elbow include tennis or other racquet sports, golf, rowing or paddling, fishing, or even gardening.
When dealing with medical conditions it is easy to get overwhelmed by all the treatment options out there. How do you know what really works?
What does letter-graded evidence mean?
Medical advice is often ranked by “letter-graded evidence,” which tells us how strong or reliable the research is behind each treatment or recommendation. For example, Grade A evidence is rock-solid, usually backed by well-designed studies. On the other hand, lower grades might indicate that the treatment is more experimental or based on expert opinion rather than hard data. Understanding these grades can help you make smarter decisions about your health.
What does the evidence support for treating tennis elbow?
In this blog, we’ll explore different treatment options, categorized by the strength of evidence supporting them, and explain how physical therapy can be an essential part of managing tennis elbow.
Grade B: Reliable and Recommended Treatments
Grade B evidence is considered solid and should form the core of managing tennis elbow.
This grade supports the use of specific exercises often combined with manual therapy, elbow joint manipulations, rigid taping and/or dry needling.
- Resistance exercises (Isometric, Concentric, Eccentric): These exercises are a top choice for managing tennis elbow, especially if it’s been bothering you for a while. By focusing on strengthening your wrist extensors, these exercises help reduce pain and improve function over time.
- Manual therapy combined with exercises: Adding manual therapy, like specific hands-on techniques, can make your exercise routine even more effective. It’s like giving your muscles and joints an extra boost to heal and strengthen.
- Elbow joint manipulations or mobilizations: If you’re looking for quick pain relief and better grip strength, having your elbow joint gently manipulated or mobilized can help. This technique offers short-term relief, making it easier to get through your day.
- Dry needling: This involves inserting thin needles into the tendon or trigger points to help reduce pain and improve how well you can move. It’s backed by solid evidence and can be a great addition to your treatment plan.
- Rigid taping: Applying rigid tape to the affected area can give you immediate, short-term pain relief. It can also make moving around less painful, which is a win when you’re trying to stay active.
Grade C: Treatments with Potential Benefits
Grade C evidence is slightly weaker, but these treatments can still be beneficial, particularly when tailored to your specific situation.
- Strengthening Exercises for Shoulder and Scapular Issues: If your shoulder and upper back are part of the problem, strengthening these areas alongside your wrist can help. It is about building a stronger foundation to support your arm.
- Cervical, Thoracic, or Wrist Manipulations: Similar to elbow joint manipulations, working on your neck, upper back, or wrist can also offer short-term pain relief. It is like giving your body a little reset to ease discomfort.
- Soft Tissue Mobilization with Exercise: This involves using hands-on techniques or tools to work on your muscles and tissues, paired with exercises to keep improving over time. It is helpful, especially if your symptoms have stuck around for a while.
- Kinesiology Taping: This stretchy tape is applied to help support your muscles and joints. It’s not as strong as rigid tape but can still offer some relief, especially when combined with other treatments.
- Cryotherapy with TENS: Using ice and electrical stimulation together can help ease pain and inflammation. It’s a good option if you need something extra to feel better.
- Topical Treatments (Phonophoresis or Iontophoresis): These involve applying medication through the skin using ultrasound or electrical currents. They’re less common but can be useful in managing long-term symptoms.
- TENS over Trigger Points and Laser Therapy: Using electrical stimulation or laser therapy on painful spots can offer short-term relief, especially if you’ve had symptoms for more than four weeks.
Grade D: Proceed with Caution
Treatments supported by Grade D evidence have mixed results and should be approached cautiously and ideally used as part of a broader treatment plan rather than the focus. The research here is conflicting, meaning some studies support the treatment while others don’t.
- Cross-Friction Massage: This involves rubbing the affected area in a way that’s supposed to help, but the results are mixed. Some people find it helpful, while others don’t notice much of a difference.
- Forearm Counterforce Brace or Wrist Orthosis: Wearing a brace might help, but the evidence isn’t strong. It could give you temporary relief, but it’s not a guaranteed fix.
- Ultrasound: This treatment uses sound waves to relieve pain, but on its own, it doesn’t seem to work well for tennis elbow. It might be better when combined with other therapies.
When it comes to treatment that is graded below a D, it is important to remind yourself what the letter grades mean when it comes to the evidence supporting the approach.
Grade E evidence is more about theoretical foundations — ideas that make sense in theory but aren’t strongly backed by research. Ergonomic and workstation changes fall into this category. The concept is that by adjusting how you sit, stand, and move at work, you can reduce strain and avoid injury. While these principles are sound, the research doesn’t strongly prove their effectiveness. So, while ergonomic changes can be helpful, they should be part of a larger, evidence-based approach.
Finally, Grade F evidence is mostly based on expert opinion rather than solid research. Using a counterforce brace or wrist orthosis during activities to quickly relieve pain and boost strength falls into this category. While some clinicians might recommend these devices to manage symptoms that worsen with activity, the scientific backing is weak. They might provide temporary relief, but they’re not proven to deliver consistent benefits, so they should be used with caution and as part of a broader treatment strategy.
Summary: choosing the right treatment for tennis elbow
When it comes to treating tennis elbow, the strength of the evidence behind each treatment varies. Grade B treatments, like specific exercises and manual therapy, are well-supported by research and should form the foundation of your care. Grade C treatments can also be beneficial, especially when tailored to your situation. However, approaches with Grades D, E, and F evidence should be used cautiously, understanding their limitations. The key is to find a balance of treatments that work for your specific needs and to stay informed about the latest research.
How physical therapy can help tennis elbow?
Physical therapists are experts in the musculoskeletal system, meaning they are specially trained to diagnose and treat conditions like tennis elbow. When you see a physical therapist for tennis elbow, they will start by assessing your specific situation, including the severity of your symptoms, your daily activities, and any other contributing factors.
One of the key benefits of working with a physical therapist is their ability to offer a comprehensive treatment approach. This includes:
- Targeted Exercises: Your physical therapist will design a personalized exercise program to strengthen the muscles around your elbow and improve flexibility. These exercises might include isometric, concentric, and eccentric resistance exercises that specifically target the wrist extensors, helping to alleviate pain and prevent future injury.
- Pain Relief Techniques: Whether it’s through rigid taping, ultrasound, or other modalities, physical therapists have a range of tools to provide immediate pain relief, allowing you to move more comfortably and participate in your favorite activities.


- Manual Therapy: Hands-on techniques like joint manipulations or mobilizations can help relieve pain, improve mobility, and restore function in your elbow. These techniques are especially useful when combined with other treatments.
- Dry Needling: If your physical therapist is trained in dry needling, they may use this technique to target trigger points or tendons, helping to reduce pain and improve muscle function.
- Education and Guidance: Beyond the physical treatments, your physical therapist will also provide valuable education about your condition, teaching you how to modify activities, improve ergonomics, and prevent re-injury. This might include advice on posture, body mechanics, and activity modifications to reduce strain on your elbow.
By offering a broad spectrum of treatment options and personalized care, physical therapists can help you recover from tennis elbow and return to the activities you enjoy. Whether it’s through targeted exercises, manual therapy, or education, physical therapy offers a holistic approach to managing and overcoming tennis elbow.

Take the Next Step in Managing Tennis Elbow
If you’re dealing with tennis elbow, don’t let it keep you from enjoying your favorite activities. Physical therapy can offer you the relief and support you need. Contact a physical therapist today to start your personalized treatment plan and get back to doing what you love, pain-free.