Understanding Tennis Elbow: Causes, Treatment, and Long-Term Management

Tennis elbow, medically referred to as lateral epicondylitis, is one of the most common overuse injuries affecting the elbow, and despite its name, it is not exclusive to tennis players. This condition can impact not only athletes but also office workers, manual laborers, and anyone engaged in repetitive arm or wrist activity.

In this blog post, we’ll delve into the science behind tennis elbow, explore its causes and symptoms, and discuss evidence-based treatment strategies that lead to lasting recovery.

What is Tennis Elbow?

Tennis elbow is an overuse injury involving the extensor tendons of the forearm, particularly the extensor carpi radialis brevis (ECRB), where they attach to the lateral epicondyle of the humerus (the outer part of the elbow). Repetitive stress to these tendons leads to microscopic tears, degeneration, and inflammation, resulting in pain and reduced function.

Despite its name, only a small percentage of those affected are actually tennis players. More often, it stems from repetitive wrist extension or gripping activities—typing, using tools, gardening, or even lifting heavy grocery bags can contribute to this condition.

Signs and Symptoms

Tennis elbow typically presents with:

• Pain or burning on the outer part of the elbow

• Weak grip strength, especially during activities like shaking hands or turning a doorknob

• Pain that worsens with wrist extension or lifting, especially with the palm facing down

• Symptoms that may radiate down the forearm but not into the fingers (which would suggest a different diagnosis like nerve involvement)

  
  

Risk Factors

While anyone can develop tennis elbow, certain risk factors increase susceptibility:

• Age: Most common between 35–55 years old

• Occupational and recreational activities: Jobs or sports involving repetitive wrist and arm motions

• Improper technique or ergonomics: Poor form during physical activity or inefficient workstation setup

• Previous injuries: Past trauma to the elbow can predispose the tendons to reinjury

Diagnosis

A diagnosis is typically made through a clinical examination, based on symptoms and physical tests. Common provocative tests include:

• Cozen’s test: Resisted wrist extension with a clenched fist

• Mill’s test: Passive wrist flexion while the elbow is extended

• Maudsley’s test: Resisted middle finger extension, targeting the ECRB

In persistent or unclear cases, ultrasound or MRI may be used to confirm the diagnosis or rule out other pathologies like radial tunnel syndrome or arthritis.

Treatment Strategies

1. Relative Rest & Activity Modification

Initial management includes avoiding activities that aggravate the condition. However, total immobilization is not recommended. We focus on relative rest—modifying rather than eliminating movement.

2. Physiotherapy

The cornerstone of effective management is a structured rehabilitation program, often including:

• Eccentric strengthening: Exercises that lengthen the muscle-tendon unit under load, proven to promote tendon remodeling

• Isometric holds: Helpful for early-stage pain reduction

• Stretching and mobility: To relieve tension in the forearm extensors

• Manual therapy: Soft tissue techniques and joint mobilizations can enhance function and reduce discomfort

  
  

3. Bracing or Strapping

Lateral epicondyle straps (counterforce braces) can reduce strain on the tendon during activity, offering temporary symptom relief.

4. Ergonomic Adjustments

Workstation evaluations and technique correction are crucial for preventing recurrence, especially in desk workers or tradespeople.

5. Adjunct Therapies

Depending on severity, adjunct treatments may include:

• Shockwave therapy: For chronic, non-responsive cases

• Dry needling or acupuncture

• Ultrasound therapy

• Corticosteroid injections: These may offer short-term relief but carry the risk of tendon weakening with repeated use

  
  

6. Surgical Intervention

Rarely required—reserved for persistent, debilitating cases unresponsive to 6–12 months of conservative care. Surgery typically involves debridement of degenerative tissue.

Prognosis and Prevention

Most patients respond well to conservative treatment within 6–12 weeks, though chronic cases may require longer. The key to long-term recovery lies in early intervention, compliance with physiotherapy, and addressing contributing factors.

To prevent recurrence:

• Warm up properly before activities

• Incorporate forearm strengthening into your routine

• Use ergonomic tools or racquets with proper grip size

• Take frequent breaks during repetitive tasks

• Listen to your body—pain is a signal, not a nuisance

Final Thoughts

Tennis elbow may seem like a minor annoyance at first, but if left unmanaged, it can severely impact quality of life and functionality. As physiotherapists, our goal is not just to relieve pain but to restore optimal movement and prevent future issues. If you suspect you have tennis elbow, don’t wait—early assessment and targeted intervention can make all the difference.

If you're dealing with elbow pain or want to optimize your recovery, consider booking a consultation with a qualified physiotherapist. A personalized treatment plan is the most effective route to full, long-term recovery.

Disclaimer: This blog is intended for educational purposes and should not replace personalized medical advice. Please consult your healthcare provider for diagnosis and treatment tailored to your individual condition.