Case Study – Tennis Elbow (Lateral Epicondylitis)

March 22, 2014 | By | Reply

– Dr. Tanvi Madlani


Ajay Doshi (name changed), a 45 year old business man and a competitive Ten Pin bowler, walked in with complaints of pain in the outer side of the lower portion of the right arm as well as on the outer bony point of the right elbow that was bothering him for a couple of weeks. He could not recall any injury or event which triggered the problem. The severity of pain increased when lifting any heavy bag, particularly his office bag containing his laptop and documents, or when sleeping on the right side and while bowling. He did find some relief in Ice packs and Iodex, but much to his dismay the relief was short lived. He loved bowling and would indulge in his hobby for about 3-4 times a week. His major concern and expectation from physiotherapy was to get him to participate in his bowling tournament which was a month away from the day he walked in at Physio Rehab.

Tennis Elbow (Lateral Epicondylitis)


At Physio Rehab, Mr. Doshi underwent a thorough biomechanical chain evaluation that brought out some significant findings:

  • Severe tenderness over the muscle bellies on the outer and back portion of the lower part of the arm, bony point on the outer side of the elbow and over the outer and upper one third of the forearm over the muscle involved in extension (upward bending) of the wrist
  • He had rounded shoulders owing to his posture at work that required him to sit facing the laptop for 8 hrs a day
  • He also had minor degenerative changes in the X- Ray of his cervical spine
  • Tests specific to a condition known as Lateral Epicondylitis more commonly referred to as “Tennis Elbow” came out to be positive
  • Weakness of Scapular Stabiliser (upper back) muscles, arm and forearm muscles
  • Nerves passing in and around the involved areas revealed mild tension


Mr. Doshi had developed the symptoms due to excessive loading of the arm and forearm muscles on account of repetitive stress of throwing, these muscles were subjected to while Bowling. In addition he had weak Scapular Stabilizers – the group of muscles that hold the shoulder blades in optimal position and fuel the muscles of the arm and forearm thus providing major power required while bowling.


Mr. Doshi, like all our other patients was counselled regarding the causative factors, deviations from normal biomechanics and repetitive stress on his arm and forearm muscles while bowling. He enrolled for a tailor made programme designed by Dr. Anjana and team at Physio Rehab.


To be able to bowl effortlessly and to participate in the bowling tournament which was around 5 to 6 weeks away from the day he signed up for his rehab program.


As per his treatment plan, Mr. Doshi was called for his rehab thrice a week for the first three weeks and twice a week for the next three weeks.


Pain Management:
Ultrasound over the tender and inflamed areas

Tennis Elbow (Lateral Epicondylitis)


Soft Tissue Therapy:
To the Trigger Points within tight and tensed muscles over the arm, forearm and upper back area
A) Myofascial Release

Tennis Elbow (Lateral Epicondylitis)

B) Dry Needling

Tennis Elbow (Lateral Epicondylitis)


Manual Therapy:
Passive and skilled technique applied to the joint and related soft tissue at varying speed and amplitude

Tennis Elbow (Lateral Epicondylitis)
Stretching of the tight wrist extensor muscles

Tennis Elbow (Lateral Epicondylitis)


Muscle Strengthening:
A) Scapular Stabilisers

Tennis Elbow (Lateral Epicondylitis)


B) Wrist extensors

Tennis Elbow (Lateral Epicondylitis)Tennis Elbow (Lateral Epicondylitis)


C) Arm Muscles

Tennis Elbow (Lateral Epicondylitis)Tennis Elbow (Lateral Epicondylitis)Tennis Elbow (Lateral Epicondylitis)


Kinesio Taping:
A) To offload the over used wrist extensors

Tennis Elbow (Lateral Epicondylitis)

B) To facilitate Scapular Retraction

Tennis Elbow (Lateral Epicondylitis)


Neural Stretches:
To release the tension over the nerves involved

Tennis Elbow (Lateral Epicondylitis)


Core Strengthening:
As bowling is a sport where one has to bend which requires strong lower abdominal and oblique muscles. And core being the powerhouse needs to be strong to enable a bowler to throw with gusto

Tennis Elbow (Lateral Epicondylitis)

Technique Training:
During the course of his treatment, he was also trained for correct posture, position and during the course of his treatment, he was also trained for correct posture, position and muscle usage while bowling in order for him to bowl effectively and injury free.

Tennis Elbow (Lateral Epicondylitis)



At the end of a successful 6 week rehab program at Physio Rehab, this is what Mr. Doshi had to say: “I would like to thank Physio Rehab for the personalised treatment given to me. I was called for sessions if and when required and gradually reduced the sessions. I am really thankful to the Physio Rehab team for the life they have given to my right hand which is my working hand which has enabled me to continue with my passion of Ten pin Bowling.”

Tennis Elbow (Lateral Epicondylitis)


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Category: Case Studies

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