• Do not aim treatment of tennis elbow solely on the elbow
• Increased activation of the sympathetic nervous system 
• Unclear whether direct effects persist.

An oscillating manipulation of the fifth rib stimulates the sympathetic nervous system and reduces pain in patients with a tennis elbow, allowing them to squeeze harder. Thus, a tennis elbow does not seem a completely local problem. This is stated by Austrian researchers who performed an oscillating manipulation on fifteen patients and compared these to fifteen patients who underwent a placebo treatment using ultrasound. This effect occurs immediately, but researchers don’t know how long this effect lasts.