Tennis elbow, known clinically as lateral elbow tendinopathy, is pain on the outer side of the elbow that’s brought on by gripping, lifting, twisting or repetitive wrist movements. It affects tradespeople, desk workers, gardeners, racquet-sport players and plenty of people who’ve just done too much of one task. It can be stubborn, but it responds to the right kind of loading.
Understanding tennis elbow
The tendon that attaches the wrist extensor muscles to the outside of the elbow is loaded every time you grip or lift. When the demands on it rise faster than it can adapt, such as a new job, a burst of DIY or a change in racquet or technique, the tendon becomes irritated and painful. As with other tendon problems, it’s mostly a problem of load tolerance rather than inflammation, which is why simply resting rarely fixes it.
Common contributors include:
- Repetitive gripping or wrist work, or a sudden increase in it
- Heavy or awkward lifting with the forearm turned palm down
- Weak or fatigued forearm and shoulder muscles
- Poor technique, equipment or workstation set-up
- Periods of reduced activity followed by a sudden return
Symptoms we commonly see
- Pain on the outer side of the elbow, sometimes spreading into the forearm
- Pain gripping, lifting a kettle or a coffee cup, shaking hands or turning a door handle
- Tenderness over the bony bump on the outside of the elbow
- Weak grip and pain with wrist extension against resistance
- Morning stiffness that eases with movement, then aches after use
Our evidence-based approach
Exercise-based treatment has the strongest support for lateral elbow tendinopathy. Evidence shows exercise generally produces better outcomes than passive treatments, although the size of the benefit is modest and different people respond differently. That’s why we tailor the plan to you. Our approach includes:
- Assessment of your elbow, wrist, shoulder and neck, to confirm the diagnosis and rule out other causes of arm pain
- Load modification, adjusting the tasks, tools and technique that provoke symptoms without stopping you working
- Progressive strengthening, starting with isometric holds for pain relief and building through to heavier and more functional loading of the forearm and grip
- Strengthening the shoulder and upper limb, since the whole arm shares the load
- Taping or bracing to reduce pain during gripping while you rebuild
- Hands-on treatment and dry needling where appropriate, to help manage pain alongside your exercises
- A graded return to your job or sport, with technique and equipment advice
Pain on the inside of the elbow instead? See our golfer’s elbow page.
What to expect: recovery timeline
- Early or mild cases: often improve over several weeks once the aggravating load is managed
- Established tennis elbow: typically needs three to six months of consistent, progressive strengthening for lasting change
- Long-standing cases: can take longer, and benefit from a careful review of what’s keeping the tendon overloaded
When to seek help urgently
Seek prompt medical attention if elbow pain follows a significant injury or fall, the elbow is hot, red, swollen or you have a fever, you can’t straighten or bend it, or you have pain, numbness or weakness spreading from the neck into the arm.
References
- Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. J Orthop Sports Phys Ther. 2015;45(11):938-949.
- Karanasios S, Korakakis V, Whiteley R, et al. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review of 2123 subjects in 30 trials. Br J Sports Med. 2021;55(9):477-485.
- Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7:1.