Tennis Elbow: how to boost healing with isometric loading.

A recent client at Unwind came to see me after four months of near-constant pain from tennis elbow. He’d done all the right things — researched exercises, worked with an NHS physiotherapist, and initially made great progress. His day-to-day pain reduced significantly.
Then it flared up again with a vengeance.
That frustrating feeling of “I’ve done everything — and I’m back to square one” is incredibly common with tendonitis (more accurately called tendinopathy). If you’re reading this, you may know that story well.
I do too. I’ve had tennis elbow (lateral epicondylitis) and, more recently, golfer’s elbow (medial epicondylitis) courtesy of some over-enthusiastic indoor bouldering. What I’d like to share is how I stopped my own golfer’s elbow before it fully took hold — and the approach I used with this client.

Upstream & Downstream of the Elbow

Renowned physiotherapist Kelly Starrett encourages us not to focus only on the site of pain, but to look at what’s happening “upstream and downstream.” In the case of tennis elbow, that means considering the relaxed position and function of the shoulder, head and neck, wrist, and hand.
Many extremity problems also stem from altered alignment in the spine and pelvis, often the result of old injuries the body has adapted around.
Since completing Kelly Starrett’s movement and mobility course in 2024, I use his assessment methods to identify areas of restricted motion and weakness. I also draw on Grey Cook’s Functional Movement Screen to help uncover the underlying drivers that often cause conditions like tennis elbow to keep returning just when you think they’ve resolved.

The hands-on chiropractic work I provide aims to improve structural alignment, changes that many clients notice from the very first session.
The “homework” I give is based on the research of Dr Keith Barr, Professor of Molecular Exercise Physiology, whose work focuses on how tendons heal and how to build their strength and resilience. If you’re interested in learning more, you can find several interviews with him on YouTube and Instagram where he explains his research in detail. 

This is exactly what my recent client did. He adjusted the exercises he had already been doing — which had stopped producing results — and applied Dr Keith Barr’s principles of tendon healing. After just one chiropractic session, he returned the following week reporting the most progress he’d experienced in months: his daily, near-constant elbow pain had reduced to being mostly pain-free, with discomfort only at specific and predictable times. 

​This was fantastic news and exceeded my expectations for how quickly he might notice improvement. That said, his elbow isn’t completely out of the woods yet. The biggest challenge now will be resisting the temptation to use the arm as normal too soon and risk setting the problem back. 

At the time of writing this blog it's still early days and with his permission I will add an update on his progress.