Patient Engagement Best Practices for Lateral Elbow Pain: 10 Evidence-Based Strategies for Clinicians

Lateral elbow pain, commonly referred to as lateral epicondylitis, or epicondylalgia, (tennis elbow), is a challenging musculoskeletal condition frequently seen in clinical practice, often resulting from repetitive wrist and forearm activities. While exercise and manual therapy are key interventions, long-term success depends on evidence-based strategies, patient engagement best practices, and a comprehensive approach to care that prioritizes both symptom management and functional recovery.

Each year, approximately 3 percent of adults in the United States develop lateral epicondylitis, with incidence rates increasing to 7 to 10 percent among individuals aged 40 to 60.¹ Even with treatment, recurrence remains a concern, with up to 54 percent of individuals experiencing symptoms again within two years.²

Given its high prevalence, prolonged recovery times, and risk of recurrence, clinicians must implement evidence-based interventions and patient engagement best practices to optimize patient outcomes. 

This article outlines ten evidence-based strategies, from assessment to treatment, designed to help physical therapists, occupational therapists, and rehabilitation specialists improve patient outcomes, reduce recurrence, and foster active engagement in lateral elbow pain treatment. These strategies are drawn from the Clinical Practice Guidelines published by the American Physical Therapy Association’s, Academy of Hand and Upper Extremity and Academy of Orthopaedic, featuring A-, B-, and C-level recommendations.

The role of QuickDASH in lateral elbow pain management

To support clinicians in streamlining patient assessments and integrating patient engagement best practices into their clinical workflow, we’ve created the QuickDASH PDF—a validated tool for tracking functional progress and guiding treatment decisions for individuals with upper extremity conditions, including lateral elbow pain.

Fill out the download form below and save the QuickDASH PDF to use at the start of your patient visits to help you evaluate and start tracking and start their functional outcomes. It can also help inform your differential diagnosis and refine your treatment strategies.

How QuickDASH works

The QuickDASH PDF consists of 11 core questions, compared to the 30-question DASH, making it a faster, more efficient tool for clinicians evaluating upper extremity function. Its streamlined design reduces patient burden while still capturing meaningful data on functional limitations, making it ideal for busy clinical settings where time is a factor.

• Difficulty performing daily activities such as opening jars, carrying bags, and using utensils.

• Work and recreation limitations due to arm pain, weakness, or restricted movement.

• Pain severity and its impact on sleep and daily function.

QuickDASH scoring and clinical interpretation

QuickDASH scores range from 0 to 100, with higher scores indicating greater disability. So, how do you use QuickDASH scores in practice?

• Evaluate functional improvement over time: Use QuickDASH at baseline, mid-treatment, and discharge to track changes.

• Identify meaningful progress: A 10- to 15-point change is typically considered clinically significant, which helps you determine whether your intervention strategies are effective.

• Support return-to-work or activity decisions: QuickDASH scoring provides objective data to justify work modifications, discharge planning, and ongoing therapy needs.

Incorporating QuickDASH scoring into your standard evaluation process can strengthen patient engagement best practices, demonstrate measurable progress, and ensure your rehabilitation approach remains data-driven and patient-centered.

Assessment and evaluation of lateral elbow pain

A thorough evaluation, complete with patient-reported symptom questionnaires and clear differential diagnosis, is key in treating lateral elbow pain. 

Along with the QuickDASH, the following three assessments are evidence-based and are recommended in the APTA’s Upper Extremity CPG, along with their levels of evidence, to help you effectively diagnose and treat this common condition.

1. Use validated outcome measures to track function and progress

(A-level recommendation: Outcome, activity limitations, self-report measures)

Assessing pain and functional limitations with standardized tools is a core patient engagement best practice that helps establish a baseline, track progress, and refine interventions. These measures provide objective data to guide clinical decision-making, improve patient adherence, and ensure rehabilitation strategies effectively improve functional outcomes.

Clinical application:

• Use the Patient-Rated Tennis Elbow Evaluation (PRTEE) to assess pain intensity and functional limitations specific to lateral epicondylitis.

• Implement the Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH to evaluate upper extremity disability in daily activities.

• Administer these measures at baseline and reassess at least one other follow-up point, including discharge, to track progress and refine treatment as needed.

2. Assess high-demand activity limitations with activity-specific measures

(A-level recommendation: Outcome, activity limitations, self-report measures)

General outcome measures may not fully capture sport- or work-specific impairments for athletes, manual laborers, and other high-demand individuals. Using activity-specific assessments ensures treatment is aligned with real-world demands.

Clinical application:

• Use the Patient-Specific Functional Scale (PSFS) for patients with high-demand activities to track individualized functional goals based on specific patient-reported limitations.

• If applicable, administer the DASH work or sports/performing arts module to assess activity-specific impairments related to occupational or athletic function.

• Reassess these tools at baseline and follow-up (including discharge) to document functional improvements and inform return-to-activity planning.

3. Measure key physical impairments affecting function

(B-level recommendation: Physical impairment measures)

Identifying and tracking physical impairments like grip strength deficits, range of motion limitations, and pain sensitivity is a critical patient engagement best practice. These objective findings help clinicians design personalized treatment plans that enhance adherence and patient confidence in rehabilitation.

Clinical application:

• Assess elbow and wrist range of motion (ROM) to detect joint stiffness or compensatory movement patterns.

• Measure pain-free and maximum grip strength to evaluate functional deficits and monitor improvements over time.

• Use pressure pain threshold testing to assess central or peripheral sensitization and guide pain management strategies.

• Monitor these impairments at baseline and throughout treatment to determine efficacy and guide clinical adjustments.

Differential diagnosis of lateral elbow pain 

You may see patients with lateral elbow pain all the time in your clinic, or it might be few and far between. However, a thorough clinical assessment is essential to rule out alternative causes and ensure that interventions target the correct pathology. While lateral epicondylitis is a common diagnosis, other conditions can present with similar symptoms, leading to misdiagnosis and ineffective treatment. 

The following conditions share overlapping characteristics with lateral elbow pain but can be distinguished through specific clinical tests and symptom patterns:

Radial tunnel syndrome (RTS)

• Primary cause: Compression of the posterior interosseous nerve in the radial tunnel.

• Pain pattern: Diffuse, aching pain along the forearm, worsened by repetitive pronation/supination.

• Key differentiator: There is no significant tenderness at the lateral epicondyle, and there is weakness in wrist and finger extensors without clear inflammatory signs. There also could be a positive Tinel's sign with RTS.

Cervical radiculopathy (C6-C7 nerve root involvement)

• Primary cause: Nerve root compression in the cervical spine.

• Pain pattern: Pain, numbness, or tingling that follows a dermatomal pattern. The pain may not seem as localized to the lateral epicondyle. Sometimes with numbness or tingling.

• Key differentiator: Positive Spurling’s test (pain reproduction with cervical compression and side bending) and sensory changes in the C6-C7 dermatome.

Osteoarthritis of the radiocapitellar joint

• Primary cause: Degenerative joint changes.

• Pain pattern: Persistent elbow pain and stiffness, often with crepitus during movement.

• Key differentiator: Limited passive elbow extension and flexion, worsened by weight-bearing activities.

Posterolateral rotatory instability (PLRI)

• Primary cause: Chronic ligament laxity or injury affecting the lateral ulnar collateral ligament (LUCL).

• Pain pattern: Instability, especially when pushing off a chair or performing elbow extension with forearm supination.

• Key differentiator: Positive lateral pivot-shift test (reproduction of instability when the elbow is extended from a flexed position with supination).

Misdiagnosing lateral epicondylitis can lead to ineffective treatments, prolonged symptoms, and patient frustration. By conducting a systematic clinical examination—including palpation, special tests, and neurological screening—you can confidently differentiate lateral epicondylitis from other conditions and ensure your patients receive targeted, evidence-based interventions.

How to incorporate patient engagement best practices to improve lateral elbow pain outcomes

Implementing patient engagement best practices into your lateral elbow pain treatment improves adherence, enhances the quality of your patient education, and reduces recurrence rates. Engaged patients are more likely to follow treatment plans, actively report progress, and sustain long-term improvements. Because lateral epicondylalgia typically comes on because of long-term, repetitive strain, it can take long-term adherence to treatment protocols and exercise programs to heal, which takes a great deal of commitment from your patient. 

To optimize patient participation in rehabilitation, incorporate the following engagement strategies:

• Shared decision-making: Collaborate with your patients when setting treatment goals, discuss prognosis, and select interventions that align with their daily activities and functional needs.

• Patient education and self-management: Provide clear guidance on tendon loading, symptom management, and activity modifications. Patients who understand their condition are more likely to adhere to their rehab plan.

• Objective tracking and feedback: Use validated outcome measures like QuickDASH and PRTEE to monitor functional improvements and provide tangible progress updates. Patients who see measurable gains are more motivated to continue treatment. 

• Encouraging long-term adherence: Prevent symptom recurrence by promoting gradual return-to-activity strategies, ergonomic adjustments, and ongoing strengthening exercises. Educate patients on the importance of maintenance exercises even after pain subsides.

By integrating patient engagement best practices into treatment, clinicians can enhance the effectiveness of rehabilitation, empower patients to take an active role in their recovery, and reduce the risk of persistent or recurring symptoms.

Evidence-based best practices for managing lateral elbow pain 

After assessing and ruling out similar conditions, an individualized and evidence-informed treatment program is the next thing your patient will need. The following seven evidence-based treatment strategies from the APTA’s Upper Extremity CPG outline treatment recommendations along with their associated levels of evidence.

1. Implement progressive wrist extensor exercises

(B-level recommendation: Therapeutic exercise)

Exercise is the foundation of tendon rehabilitation, but loading progression is critical for promoting tendon adaptation and preventing re-irritation. Isometric, concentric, and eccentric exercises should be tailored to symptom severity and tendon tolerance.

Clinical application:

• Start with isometric exercises in subacute or chronic LET to modulate pain and sustain muscle function.

• Progress to concentric and eccentric resistance exercises to enhance tendon strength and function.

• Adjust resistance, volume, and intensity based on symptom response and tissue loading capacity.

2. Combine wrist extensor strengthening with manual therapy

(B-level recommendation: Multimodal interventions)

Multimodal approaches integrating therapeutic exercise and manual therapy have been shown to improve pain, grip strength, and overall function more effectively than isolated interventions.

Clinical application:

• Pair therapeutic wrist extensor strengthening with joint mobilization or soft tissue techniques.

• Use manual therapy techniques to reduce pain sensitivity and enhance joint mobility, allowing better tolerance for strengthening exercises.

• Implement a phased treatment approach, modifying manual therapy intensity as the patient progresses through rehab.

3. Integrate shoulder and scapular stabilizer exercises

(C-level recommendation: Multimodal interventions)

Proximal weakness can increase stress on the elbow and perpetuate symptoms, making it essential to incorporate patient engagement best practices in rehabilitation. Addressing scapular and shoulder stability can improve load distribution and overall upper limb function, enhancing both recovery and long-term outcomes.

Clinical application:

• Add serratus anterior and rotator cuff strengthening if scapular dyskinesis or shoulder instability is present.

• Incorporate postural control exercises to reduce excessive strain on the forearm extensors.

• Include proximal strengthening in patients with chronic or recurrent LET.

4. Use local joint mobilization or manipulation for pain relief and grip strength

(B-level recommendation: Manual therapy)

Elbow joint mobilization can improve pain-free grip strength and overall function, making it a valuable short-term intervention.

Clinical application:

• Use humeroulnar or radiohumeral joint mobilization techniques to restore joint mobility, reduce discomfort, and address stiffness at the elbow.

• If tolerated, apply high-velocity, low-amplitude thrust manipulations for faster pain relief and neuromuscular response.

• Mobilizations can be used as a stand-alone or adjunct treatment to enhance short-term outcomes.

5. Utilize cervical, thoracic, or wrist joint mobilization as an adjunct intervention

(B-level recommendation: Manual therapy)

Dysfunction in the cervical, thoracic, or wrist joints can lead to compensatory movement patterns, contributing to increased stress at the elbow. Addressing these deficits can provide short-term pain relief and improved biomechanics.

Clinical application:

• Identify restricted cervical, thoracic, or wrist mobility that may be contributing to elbow dysfunction.

• Use mobilization techniques in these areas to restore movement and reduce compensatory strain.

• Combine with local elbow interventions for a more comprehensive approach to upper limb mechanics.

6. Incorporate dry needling for pain and functional improvements

(B-level recommendation: Dry needling)

A trigger point or tendon dry needling can improve pain and functional outcomes, particularly in chronic cases, making it a valuable addition to patient engagement best practices for optimizing rehabilitation.

Clinical application:

• Use either tendon or trigger point dry needling to release muscle tension and reduce pain sensitivity.

• Apply tendon-focused needling techniques to stimulate healing in persistent cases.

• Combine with exercise therapy to maximize pain relief and functional gains.

7. Use rigid taping for short-term symptom relief

(B-level recommendation: Taping)

Rigid taping can provide immediate, short-term relief by reducing strain on the wrist extensors and improving grip strength.

Clinical application:

• Apply rigid taping techniques to offload stress from the lateral epicondyle.

• Use as a temporary support to allow pain-free movement while progressing exercise therapy.

• Consider kinesiology tape as an alternative, though rigid taping is more effective for immediate relief.

Improving patient outcomes with evidence-based care

Lateral epicondylitis requires a comprehensive and patient-centered approach that combines evidence-based interventions—from assessment to treatment—with best practices for patient engagement. Utilizing validated outcome measures, progressive loading strategies, manual therapy, and additional treatments can improve patient adherence, optimize recovery, and decrease recurrence rates. Tools like our QuickDASH PDF can enhance your clinical decision-making by providing objective data to monitor functional progress and customize interventions.

For a deeper dive into best practices and rehabilitation strategies, explore our continuing education courses–with versatile, evidence-based education across disciplines and specialties, you’ll gain practical, high-quality insights in a variety of formats that you can access anytime, anywhere.

References

1. Sanders, T. L., Jr, Maradit Kremers, H., Bryan, A. J., Ransom, J. E., Smith, J., & Morrey, B. F. (2015). The epidemiology and health care burden of tennis elbow: a population-based study. The American journal of sports medicine, 43(5), 1066–1071. https://doi.org/10.1177/0363546514568087

2. Nilsson, P., Thom, E., Baigi, A., Marklund, B., & Månsson, J. (2007). A prospective pilot study of a multidisciplinary home training programme for lateral epicondylitis. Musculoskeletal care, 5(1), 36–50. https://doi.org/10.1002/msc.97