Tennis Elbow- Exercise, ASTYM, Inject, or Rest?

Tennis Elbow- Exercise, ASTYM, Inject, or Rest?

Tennis elbow (lateral epicondylitis) is typically described as an inflammatory condition of the connective tissue attaching to the lateral epicondyle secondary to repetitive strain. However, the term is a misnomer as there is no clear microscopic evidence of inflammation, but rather degeneration of the tendons inserting into the lateral epicondyle.1 This begs the question, should we be treating this condition with a traditional inflammatory reduction strategy?

What Does The Evidence Say?

A 2006 study by Besset L, et al1 looked at PT (exercise based) vs corticosteriod injections vs rest with follow-up outcomes at 6 and 52 wks. Injections showed superior outcomes at 6 wks but had the highest recurrence rates (72%) and higher use of medication over the 52 wks. Exercise fared better than rest at 6 wks but outcomes at 52 wks were similar.

Most published research analyzing traditional treatments for tennis elbow do not demonstrate a clearly effective strategy, especially when it comes to long-term outcomes.

There is hope! A recent study by Stover S, et al2 compared Astym + home exercises (HEP) vs HEP only. This study showed Astym outcomes were clearly superior to HEP alone with 78.3% of patients reporting “resolved” symptoms. This is consistent with reports from the national outcomes database for Astym treatment which reports a 80.9% resolution rate with an average of 10 treatments.

Our Clinical Experience

The majority of patients that we see describe very similar histories involving reduced pain with rest and medication but, whether it is 4 wks or 2 yrs later, as soon as they resume their preferred activities (work, sports, gripping, etc), their original symptoms return. Since we started incorporating Astym with strengthening and stretching in 2009, we have seen very exciting results.

  1. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. Nov 4 2006;333(7575):939.
  2. Stover S, Helfst B, Sevier T, Jansen C. The Effectiveness of the ASTYM System in Improving Treatment Outcomes in Patients with Lateral Epicondylitis: A Single-Blind Randomized Trial. Presented at the national American Society for Surgery of the Hand’s annual meeting 2010.


We are certified, credentialed Astym providers!

Astym treatment is a regenerative therapy using instruments to locate and treat dysfunctional soft tissues. The protocols, force, and direction of Astym induce a healing/ regenerative cellular response stimulating cell turnover, scar tissue resorption, and regeneration of dysfunctional soft tissues.