Tennis elbow doesn't have to keep you from the activities you love—discover evidence-based rehabilitation strategies that address the root cause and restore lasting function to your elbow.
Understanding Tennis Elbow and Its Impact on Daily Movement
You have persistent elbow pain that is causing you grief, especially during finger
movement, gripping, repetitive manual work, and your forearm muscles feel weak and
sore. You might have a condition called lateral elbow tendinopathy, also known as lateral
epicondylalgia or, more commonly, Tennis Elbow.It is a common overuse injury in people aged 30-54 years and is relatively prevalent in manual working populations with repetitive tasks, but can also occur in office workers or
during acute overloading of the tendon during sport and exercise activities or other manual
work. Although tennis elbow can resolve within 3-6 months, if not managed properly, it may
persist. Physiotherapy will assist you early with individualised treatment options, moving
strategies that help you continue work and sport and create a progressive prehab plan to
help you recover and prevent further injury.
What is Lateral epicondylalgia?
Lateral tennis elbow, more accurately termed lateral epicondylalgia (LE), is a painful
musculoskeletal condition affecting the lateral elbow, characterised by pain and
tenderness over the common extensor tendon origin. It often feels sore when gripping,
lifting, twisting, shaking hands, opening jars, or using the wrist repeatedly.
The tendon connects the muscle to the bone, helps transfer muscle force, generates
smooth movement, absorbs load, and sends sensory feedback to the brain.
What are causes and contributing factors to my elbow pain?
Lateral epicondylalgia usually develops when the tendon is asked to do more than it can
currently handle. This can occur from repetitive tasks, heavy or unfamiliar activity, sudden
increases in workload, sports, manual work, or reduced arm strength. It is not usually a
true “inflammation” problem, but more that the tendon has become irritated and less able
to handle load well.
The good thing is that the tendon is not ‘torn’ or permanently damaged — it just needs
some rest to calm down irritation and the right exercises to help it heal and get stronger.
Age-related changes in the body, stressful periods in life, lack of sleep or poor sleep
quality, decreased general physical activity, mood swings, fear of movement, lifestyle
changes, or metabolic conditions such as insulin resistance, obesity, or low-grade
inflammation in the body might be contributing to the intensity and duration of pain.
Signs and Symptoms of „tennis elbow“
• Pain or aching on the outside of the elbow
• Pain that may spread into the forearm or sometimes toward the wrist
• Pain when gripping objects such as a mug, steering wheel, racquet, tools, or shopping
bags
• Discomfort when lifting, pouring from a kettle, opening jars, shaking hands, or turning
a door handle
• Pain when using the wrist repeatedly, especially with typing, mouse use, tools, or sport
• A feeling of weakness in the hand or grip, even when the arm feels normal otherwise
• Tenderness if you press on the bony area on the outside of the elbow
• Stiffness or soreness after activity, sometimes worse the next morning
• Symptoms that build up gradually over time, though they can also start after doing too
much suddenly
How can Physiotherapy help and how long is it going to take?
With a thorough assessment, the physiotherapist examines the elbow and surrounding
structures, as well as posture, strength and movement strategies. We make sure there is
no serious underlying condition present so we can proceed safely with individualised
management.
Tennis elbow can improve with the right rehabilitation, but tendons usually recover
gradually rather than quickly. A tendon needs regular, gentle, repeated loading with
the right dosage to help rebuild its strength and tolerance. It is similar to training a muscle
— it adapts to load when given the right amount of exercise.
Physiotherapy helps by guiding this process safely.
Treatment may include exercises to improve tendon strength, grip strength and arm
function, advice on managing daily activities, reducing overload, and gradually returning to
work, sport, or hobbies. We also look at movement patterns and habits that may be
keeping the problem irritated. We will provide you with the right strategies to go forward
and keep doing what you love.
Our focus is to help you get back to what matters most to you, in a safe and steady way.
There is no instant fix, but consistent small steps often make a big difference.
FAQ
Do I need Imaging?
Usually, no. Lateral Epicondylagia is most often diagnosed from your symptoms and a
physical assessment. Scans such as ultrasound or MRI are usually only considered if symptoms are severe, not improving as expected, or if we need to rule out another cause of pain.
My imaging shows degenerative changes what does that mean?
This wording can sound worrying, but it usually does not mean the tendon is damaged
beyond repair. Think of a tendon like a rope — with repeated use, some fibres may
become irritated or less organised, but the rope itself is still very much intact. Tendons can
adapt, recover, and become stronger again. With the right rehabilitation and gradual
loading program, we can help the tendon build tolerance, improve strength, and better
handle everyday demands. Scan findings often describe common changes such as thickening or reduced tendon
quality. These changes are common, especially as we get older, and they do not always
match how much pain someone has.
Do I need injections?
Steroid injections are usually not recommended as first line treatment. They may
sometimes reduce pain in the short term, but research shows they may not give the best
long-term outcomes, and symptoms can return. It is also not fully clear how steroid
injections may affect the tendon’s long-term health, and repeated injections may weaken
tendon tissue over time.
Exercise-based rehabilitation and load management are generally preferred first-line
treatments. In some cases, injections may be discussed as part of a broader plan
depending on your goals and symptoms.
Do I need surgery?
Most people do not need surgery. The majority improve with time, activity modification,
and a structured rehabilitation program. Surgery is usually only considered in long-
standing cases that have not improved after extensive conservative treatment, structural
instability or more severe injuries to the elbow.
What else can I do to get better?
Activity modification
Relative rest but not complete rest
Increase general physical activity
Make sure you get enough high-quality sleep
Consider a work ergonomics assessment
A healthy, balanced diet with lots of fruit and vegetables, and reducing wheat, meat,
saturated fats, and dairy to a minimum, can help decrease systemic low-grade
inflammation in the body and is beneficial for recovery and overall health.
Literature
Bateman, M., Skeggs, A., Whitby, E., Fletcher-Barrett, V., Stephens, G., Dawes, M.,
Davis, D., Beckhelling, J., Cooper, K., Saunders, B., Littlewood, C., Vicenzino, B., Foster,
N. E., & Hill, J. C. (2024). Optimising physiotherapy for people with lateral elbow
tendinopathy – Results of a mixed-methods pilot and feasibility randomised controlled trial
(OPTimisE). Musculoskeletal Science and Practice, 69, 102905.
https://doi.org/10.1016/j.msksp.2023.102905
Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia.
Journal of Physiotherapy, 61(4), 174–181. https://doi.org/10.1016/j.jphys.2015.07.015
Bordachar, D. (2019). Lateral epicondylalgia: A primary nervous system disorder. Medical
Hypotheses, 123, 101–109. https://doi.org/10.1016/j.mehy.2019.01.009
Ikonen, J., Lähdeoja, T., Ardern, C. L., Buchbinder, R., Reito, A., & Karjalainen, T. (2022).
Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review
and Meta-analysis. Clinical Orthopaedics & Related Research, 480(4), 647–660.
https://doi.org/10.1097/CORR.0000000000002058
Zwerus, E. L., Somford, M. P., Maissan, F., Heisen, J., Eygendaal, D., & Van Den
Bekerom, M. P. (2018). Physical examination of the elbow, what is the evidence? A
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