A woman from Kannai developed persistent right elbow pain after playing tennis
A woman living in Kannai visited Spine Chiropractic after developing pain in her right elbow while playing tennis.
She had started taking tennis lessons twice a week approximately one year earlier. About one month before visiting our clinic, she noticed discomfort in her right elbow during a doubles match.
As the match continued, the pain gradually became stronger. However, because she was playing doubles and did not want to let her partner down, she continued playing until the end of the match. By the time the match was over, the pain in her right elbow had become quite severe.
After returning home, she applied ice, which helped reduce the acute pain. However, the discomfort remained and eventually began to interfere with her daily activities.
A few days later, she visited an orthopedic clinic near her workplace. She was diagnosed with tennis elbow and was prescribed pain medication and a topical pain-relief patch. She was also advised to attend the clinic once a week for electrical therapy.
She continued this treatment for approximately three weeks, but did not notice any significant improvement.
She then searched online for alternative treatment options and found Spine Chiropractic in Bashamichi. Because tennis elbow was listed among the conditions we address, she decided to visit our clinic.
[Initial Examination]
Medical Interview
During the first few days after the injury, she experienced a throbbing pain in her right elbow. Whenever the pain became noticeable, she used ice and pain medication to manage the symptoms.
The throbbing pain eventually subsided. However, she began experiencing a brief, sharp pain when performing movements that involved using her hand, particularly movements requiring rotation of the forearm.
She preferred to avoid medication whenever possible and therefore did not continue using pain medication. She continued attending weekly electrical therapy sessions, but because she did not feel that her symptoms were improving, she decided to seek another approach at our clinic.
Visual Inspection
No obvious abnormalities were observed.
There was no visible swelling, redness, or increased warmth around the elbow.
Static Palpation
Localized tenderness was noted over the lateral aspect of the right elbow, particularly around the lateral epicondyle.
Motion Palpation
Elbow flexion and extension were performed without significant pain or restriction.
However, forearm supination — turning the palm upward and rotating the thumb outward — reproduced significant pain, making it difficult for the patient to generate normal force.
When the practitioner passively rotated the patient’s forearm while she remained relaxed, mild pain was still reproduced, although it was less intense than during active movement.
Orthopedic Tests
- Thomson Test: Positive
- Chair Test: Positive
Muscle Strength Examination
- Forearm flexors: 5/5, with mild pain
- Forearm extensors: Strength testing was limited by pain
- Forearm pronators: 4/5, with mild pain
- Forearm supinators: Strength testing was limited by pain
[Treatment Content]
Based on the localized pain over the lateral epicondyle and the results of the orthopedic and muscle strength examinations, the presentation was considered consistent with lateral epicondylitis, commonly known as tennis elbow.
Approximately one month had passed since the onset of symptoms. Rather than considering the condition simply as an acute inflammatory problem, I considered the repeated loading associated with tennis and the continued stress placed on the tendon structures around the lateral epicondyle.
The muscles attaching around the lateral epicondyle, particularly the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor digitorum, showed differences in muscle tension between the affected and unaffected sides.
I considered this altered muscle tension to be contributing to increased mechanical stress around the lateral epicondyle and therefore focused treatment on reducing excessive muscle tension.
Fascial release was performed on the relevant forearm extensor muscles.
In addition, I assessed the mobility of the proximal radioulnar joint, which plays an important role in forearm rotation, and performed an adjustment with the aim of improving its joint mobility.
After the treatment, I asked the patient to repeat the movement that had previously reproduced her pain.
The pain was still present, but she reported that it had decreased from approximately 10/10 before treatment to around 5/10 immediately after the session.
The first session was therefore concluded, and she was asked to return five days later so that we could assess how the symptoms responded over time.
[Treatment Outcome]
Second Visit
At the second visit, I asked about her response to the initial treatment.
She reported that the pain had been noticeably reduced for approximately two days and that she experienced pain less frequently during her daily activities. However, by the third day, the pain had gradually returned to approximately its previous level.
Because her symptoms had already persisted for approximately one month, I had expected that a single treatment might not provide lasting improvement. We therefore repeated the initial treatment approach and planned to reassess her condition after one week.
Third Visit
One week later, she reported that the pain had remained at approximately half of its original intensity throughout the week, although it had not completely disappeared.
Based on her progress, I continued with the same treatment approach and added ultrasound therapy around the proximal radioulnar joint.
We then scheduled the next appointment for 10 days later to assess her response.
Fourth Visit
At the fourth visit, the patient reported that she had experienced almost no pain during the previous 10 days.
She was very pleased with the improvement, particularly because the elbow pain had previously interfered with her daily activities.
As her symptoms had almost completely resolved and she was able to carry out her daily activities without significant discomfort, I determined that no further treatment was necessary for the tennis elbow at that time.
After the tennis elbow symptoms had resolved, the patient expressed an interest in receiving regular care for other chronic musculoskeletal complaints, including shoulder stiffness and lower back pain.
She therefore chose to transition to a monthly maintenance schedule.
[Practitioner’s Opinion]
This case presented with findings consistent with a typical case of tennis elbow (lateral epicondylitis), including localized tenderness around the lateral epicondyle, pain with specific forearm movements, positive orthopedic tests, and pain-limited strength in the forearm extensor and supinator muscle groups.
Although the symptoms had persisted for approximately one month, the course of recovery could not be predicted precisely because individual responses to treatment vary. Some patients improve relatively quickly, while others require more time and repeated treatment.
Based on my experience with similar cases, I initially expected that the patient’s symptoms would require several sessions rather than resolve after a single treatment. Her actual progress followed a relatively typical pattern: an initial reduction in pain, some recurrence of symptoms, followed by more sustained improvement over subsequent treatments.
Ultrasound therapy was added at the third visit, after the patient had already shown gradual improvement with the initial treatment approach. Following this addition, she reported that the symptoms had almost completely resolved over the subsequent 10 days.
While this was a positive response in this particular case, the number of treatments and the combination of therapies required can vary considerably between patients. Treatment should therefore be adjusted according to the individual’s symptoms, functional limitations, and response over time.
At Spine Chiropractic, we do not approach musculoskeletal complaints simply as conditions that require temporary pain relief. We assess how the muscles, tendons, and joints are functioning together and tailor the treatment approach to the individual’s presentation.
If you are experiencing pain on the outside of the elbow after playing tennis, pain when gripping a racket, or persistent symptoms associated with tennis elbow, Spine Chiropractic is conveniently located just a 1-minute walk from Bashamichi Station, an 8-minute walk from Nihon Odori Station, a 7-minute walk from JR Kannai Station, and a 12-minute walk from JR Sakuragicho Station in Yokohama.