This phase is normally the first 24-72 hours after the event that triggered the pain and its aim is to settle any swelling and pain, whilst maintaining the range of motion and function you have and shows you how to cure elbow pain fast. You may find the steps in this phase not applicable depending on the level of movement and pain you have, or you may find only a number of points helpful in showing you how to fix elbow pain. If you have no swelling and full range of movement of the elbow in all directions, you could simply miss this step and start on Phase 2.

RICE

RICE stands for Rest, Ice, Compression and Elevation and is an easy method on how to relieve elbow pain for many elbow pain causes. These steps are helpful for when you have an injury in the acute phase and shows you how to relieve elbow pain and also help with the healing process. 

Rest: You need to reduce the activity level you are performing and let your body have time to heal. The aim here is to pace your activities throughout the day and cut back on anything unnecessary or that particular increases your symptoms. 

Ice: This can help reduce the pain you are experiencing and also reduce some of the swelling. Using some frozen peas wrapped in a damp cloth for 20 minutes will work well here and do this every hour or two. Do not apply the ice directly to your skin, make sure you have a barrier which is preferably damp, and keep an eye out for any ice burns onto the skin. If you notice this stop immediately. 

What can be helpful here is having a specifically designed ice pack you can reuse over and over again. You still need to have that damp cloth as a barrier with these packs as well. 

Compression: This relates to the use of the ice being compressed onto the elbow. This can be achieved by simply wrapping a cloth around your joint, but more bespoke equipment offers this ability which would be more comfortable and effective, such as this elbow ice pack. 

Elevation: Having your elbow rested on an object and raised above your shoulder will help reduce the amount of swelling in the area. This may help reduce some of the symptoms you are experiencing. Aim here for a similar time frame as applying ice and go for up to 20 minutes. Although this is a lot harder to achieve and can be impractical and perhaps discomforting. Do not compress and elevate at the same time, as the volume of fluid returning towards your heart may put too much pressure on it.

Medication

In the initial phase the use of over the counter medication may be an option. Medication such as paracetamol and ibuprofen may allow this acute phase to be more manageable. Please consult your family doctor if you have any concerns with this impacting your current medication, or if any medical history may be impacted by the option of including this medication. 

Exercises

The aim here is to make sure you are able to move the elbow well and maintain the range you have of the elbow joint. 

Don’t forget to keep your wrist, shoulders and neck mobility up during this time as well. The tendency is to stiffen up and not move as much in general due to the discomfort. Keeping the joints above and below the elbow mobile will help. 

Some things to consider with the exercises:

• The first two exercises are good stretches for elbow pain relief and improving the mobility of your joint is why these basic movements can be the best exercises for elbow pain.
• The rotation exercise is one of the movements that tends to be forgotten. It is really important for a lot of activities people do when preparing food, playing certain sports or if you enjoy DIY or craft hobbies. 
• How long and how often you do the exercises at this stage is not too important. The key is little and often, and as long as you get something done every couple of hours to maintain the range that will be beneficial. 
• Listen to your body if it starts to ache throughout the day as you do more, and don’t forget it’s healing so will need time to rest. 
• Don’t forget to keep your wrist, shoulder and neck moving throughout the day so they don’t get too stiff. 
• You may find it helpful to do these exercises in a circuit type fashion, where you do exercise 1 for 1 set, followed by exercise 2 for 1 set, then exercise 3 for 1 set, and then restarting.

This would be roughly the first 6 weeks of your recovery.

Education

The aim here is to start reintroducing more daily activities and slowly increase the strength work. You may find it takes up to a week before you can start the new exercises or start reintroducing certain activities into your daily routine. 

We also want to start loading your wrist extensor and flexor tendons progressively if you are suffering from either tennis or golfers elbow. If you have elbow pain outside of the joint it may be tennis elbow, and inside of the joint it may be golfer's elbow. The difference between tennis elbow and golfer's elbow are the tendons which are irritated. With both of these conditions you may have elbow pain when gripping or elbow pain when bending arm, as the tendons are being used in these activities.

Tendons love load but it needs to be the right level for what they can tolerate for that period of time. You want to reintroduce load to the tendon and now progressively load it so it can tolerate more. This ability to tolerate more load will mean you can perform more tasks day-to-day. 

Often people want to know how long does tennis elbow take to heal. Tendons can take up to 12 weeks and in some circumstances longer, depending on the severity and also the individuals specific activities they want to perform. Whilst you are rehabilitating your tendon you need to be cautious not to overload your tendon and cause a spike in pain and also irritation to the tendon. This may result in a backward step and delay in your recovery. Equally important is not loading the tendon enough. It is a balance to create and unfortunately you won’t get it right every time, however as long as you don’t keep getting it wrong, and each week you are loading the tendon more, then you are heading in the right direction.

Exercises

You can continue any exercises from the previous phase but you may find they have less value as you progress through your rehabilitation.

You want to make sure you get full range of motion and not to over do things initially. 

The aim of these exercises is to introduce some basic strength work. Remember to start off easy and only increase the intensity each week once the symptoms have settled. 

Some things to consider with the exercises:

• With all three exercises vary the position you have your wrist to offer some variation. 
• Aim to do two consecutive days on the same intensity before increasing the difficulty, and only increase the difficulty by roughly 10%. 
• If you are reintroducing general day-to-day activities remember this could be challenging enough and you may not need to do these exercises every day. 
• For the grip strength you can get a variety of equipment to help with your progression and also engagement. Simple stress balls, graded putty with various options of density, or even a gyroball for the end of this phase. Whichever way you choose to do it just make sure you get it done. This can be one of the best exercises for tennis elbow and best exercises for golfers elbow to start with before progressing to harder exercises.
• You may find it helpful to do these exercises in a circuit type fashion, where you do exercise 1 for 1 set, followed by exercise 2 for 1 set, then exercise 3 for 1 set, and then restarting.

Brace

One piece of equipment which could be helpful is a ‘Tennis Elbow Brace’. This is simply a thin fabric strap that wraps around your tendon at the top of your forearm. These are helpful for people who either have too much pain with day to day activities, or are unable to perform the exercises due to pain. As it is the exercises that will build up your tendon strength it’s important that you can perform these.
As with any brace you don’t want to build a reliance on it and overuse it. The advice would be to take the brace off on activities you know don’t cause you irritation, and if you are using it throughout the day try and wean off, progressively increasing the time without the brace on. 

Generally the fabric ones are more practical than the rigid plastic ones, and braces which are quite big covering more of the arm, don’t tend to offer more pain reduction. We have shared a link in the ‘Equipment’ section below for what we think is the best brace for tennis elbow, although brace choice is very individual and what may be the best elbow brace for one person, may not be for someone else.

General elbow braces such as neoprene sleeve may offer some low level support which if you are suffering an elbow sprain could alleviate some of your pain, however generally activity modification and some basic exercises may be more effective.

Symptoms

During this phase you should start noticing more times in the day when you are pain free, however it is not uncommon for there to be sharp spikes in pain if you are doing a specific activity. Your elbow pain when bending and straightening your arm should be settling, and the elbow pain treatment options taking an effect. This will improve and the activities which cause irritation should become less. If you continue to perform activities which consistently aggravate the elbow, it will continue to cause you pain and perhaps be affecting the end stage of healing. You need to alter the activities in some manner that are causing irritation until you have moved further along in your healing, and increased the range of movement and strength in your elbow. 

If you are struggling to wean off the medication, if you have elbow pain when resting, or elbow pain performing the exercises, this would be when to see a doctor for elbow pain to ensure you are on the right path. If they confirm it is a sprain or something similar, then you can continue on the phases in this rehab programme.

In this phase we are looking at between 6 to 12 weeks following the start of your rehab.

Education

Similar to Phase 2 the timelines here are merely a guideline and may vary. You may find that you are able to start this phase before 6 weeks if the symptoms have settled and you aren’t challenged by the exercises.

The aim of Phase 3 is to increase the intensity and specificity of the rehab exercises. You should now be looking at returning to full daily activities and depending on the severity of the sprain and your chosen hobbies, a return to sport also. If you initially have elbow pain during push ups, or sharp pain in elbow when lifting, progressively strengthening the muscles around the joint should help. These exercises show you how to strengthen weak elbow tendons. 

You should at this stage already have full range and be able to perform the exercises from Phase 2 with ease, and not reliant on any pain medication to perform tasks. 

For the vast majority it may be the case that we need to improve the strength of our elbow for some very specific day-to-day activities related to a hobby or our work. Others may have a specific long term goal in mind, such as returning to Tennis or another upper limb activity. If you have elbow pain after lifting weights, starting with these exercises will help build your overall strength. 

Exercises

Some things to consider with the exercises:

• On the press ups start with the easiest option and then progress upwards after 1 week. 
• For the bicep curls you can use dumbbells or resistance bands
• With all three exercises vary the position you have your wrist to offer some variation. 
• Aim to do two consecutive days on the same intensity before increasing the difficulty, and only increase the difficulty by roughly 10%. 
• As you are able to tolerate more weight or resistance you can reduce the repetitions on each of these exercises. 
• You may find it helpful to do these exercises in a circuit type fashion, where you do exercise 1 for 1 set, followed by exercise 2 for 1 set, then exercise 3 for 1 set, and then restarting.

Return to Sport or Activity

As a general rule, try and aim for two pain-free sessions at a reduced duration or intensity before increasing. 

For example, if you normally play 60 minutes of tennis, aim to play for 30 minutes in a non-competitive environment for two non-consecutive days. 

Having a day's rest between sessions allows you to have appropriate rest and for your body to repair and become stronger. 

Once you have found a duration or intensity you can tolerate with no flare up, aim to increase the next session by 10%. This can seem like a slow and conservative process however the research has shown this is the optimum level of increase to avoid an overuse injury. Increasing duration or intensity by more than 10% significantly increases your chance of injury. As you will have been away from your sport for a number of months, you will have lost some of your fitness conditioning in this time and will need to build this up slowly.

Over time you will be able to slowly return to your pre-injury level of activity without regressing back to any acute flare-up. 

Pacing

At this stage you should find you can do more day-to-day activities pain free. The temptation here is to go a bit overboard. A nice reminder to pace activities so that you don’t over do it, and that you spread these activities out as much as possible throughout the day.