Tennis elbow: what it is, and how to treat it

Tennis elbow, or lateral epicondylalgia, is one of the most common upper-limb overuse conditions we see, and most people who have it do not play tennis. It is a tendon problem on the outside of the elbow caused by repeated gripping, lifting and forearm work, and it responds well to the right loading programme. The best evidence supports a graded strengthening approach continued for at least 12 weeks, with injections and other passive treatments reserved for selected cases.

What is tennis elbow?

Tennis elbow is an overload problem in the common extensor tendon on the outside of the elbow, particularly the tendon of extensor carpi radialis brevis. Pain sits over the bony bump on the outside of the elbow, spreads down the forearm, and is worst when you grip, lift with the palm down, twist a doorknob or lift a kettle. It is a tendinopathy, not an acute inflammation.

Why does it happen?

Almost always, tennis elbow is a repeated-load story. Common triggers include a new job or task involving gripping and lifting, a change in tool or racquet, a new hobby such as DIY or gardening, or a spike in typing and mousing at a poorly set-up workstation. It is most common between the ages of 35 and 55.

How is it diagnosed?

Tennis elbow is a clinical diagnosis. A physiotherapist will reproduce the pain with specific tests, check grip strength, assess the neck and shoulder, and rule out the conditions that can mimic it, including radial tunnel syndrome, referred pain from the neck and, in older patients, elbow arthritis. Imaging is not routine. A diagnostic ultrasound scan is useful when a partial tear is suspected or when rehab has stalled.

How is it treated?

The most effective treatment is progressive loading of the wrist extensors and forearm, performed slowly and heavily two or three times a week for at least 12 weeks. Isometric holds are useful in the very early irritable phase, moving on to heavier slow resistance work with a dumbbell or a Theraband as symptoms allow.

Around that, we modify aggravating tasks rather than stopping them, look at grip size, tool weight and workstation set-up, address the neck and shoulder if they are contributing, and use a counterforce brace during heavier activities. Shockwave therapy has a role in stubborn cases and works best combined with loading. Steroid injections are used selectively; they give short-term relief but worsen 12-month outcomes and recurrence.

What does recovery look like?

Most people notice real change within 8 to 12 weeks, and recover fully within 6 to 12 months. Flare-ups during the process are common. They usually mean load has crept up too quickly and are settled with a step back rather than a full stop.

When should you see a physiotherapist?

Early. Elbow pain that has lasted more than a couple of weeks, or that is limiting work or training, deserves a proper assessment. Our physiotherapy team in Milton Keynes will diagnose what is going on, build the right loading programme, and adjust as you progress. If your pain is at the front or top of the shoulder rather than the elbow, see our companion piece on rotator cuff and shoulder pain.