What is tennis elbow?
Tennis elbow is a condition that affects the tendons on the outside of your elbow and particularly at the attachment point in your lateral elbow called the lateral epicondyle. These tendons carry the load from the activity of the wrist extensors which are activated while lifting your wrist, like in a tennis backhand, or on stabilising the wrist during gripping.
The tendon that carries most of that load is one called extensor carpi radialis brevis. When it gets loaded more than it can handle, small areas of the tendon near that attachment start to break down, and the area becomes painful and sensitive to use. This is most common in people through their forties and fifties, and in anyone whose job/sport requires a lot of repeated gripping.
The tendon is a dense connective tissue that does not have a contractile component and its role is to connect the muscles of the forearm to the bony attachment point.
Tendons are strong and very resilient and have a poor blood supply as they do not perform “work”. However when the tendon becomes damaged through repetitive strain, sometimes over periods of years, the tendon can begin to degrade. Because of the poor blood supply and the slow healing process, degenerative tendon issues can take longer to heal than other structures such as muscle.
An old term used was lateral epicondylitis, where the “itis" refers to inflammation in the tendon. However, it has been recognised that the condition tennis elbow is not inflammatory and instead degenerative, therefore clinicians may now use the term lateral epicondylealgia.
Common symptoms of tennis elbow
Most people notice pain on the outside of the elbow, and can often point to a tender spot right on the bony bump. The pain tends to show up with gripping and lifting, so the things that catch people out are picking up the kettle, shaking hands, turning a key or a doorknob, carrying shopping bags, or even lifting a full coffee cup. It can be sharp when you grip hard and then settle into a dull ache afterwards, and some people feel it spread down into the forearm.
Grip strength often drops off as well. That is usually not because the muscle has wasted away, but because the pain switches things off when you try to squeeze. Tennis elbow normally builds gradually rather than appearing after one moment of injury, though occasionally people can trace it back to a single heavy or unfamiliar task, like a weekend of painting or a big day in the garden.
Common signs include:
- pain or tenderness on the outside of the elbow
- pain when gripping, lifting or twisting the wrist
- discomfort that builds with activity and eases with rest
- a weaker or more painful grip
- pain that can travel down the forearm
- soreness or stiffness in the morning, or after the elbow has been still for a while
In most cases we can diagnose tennis elbow from your history and a couple of simple grip and resistance tests in the clinic, without needing scans. Imaging is usually only worth it when the picture isn't clear or things aren't settling as expected.
Why tennis elbow does not just affect tennis players
The name has stuck because the condition was first described in tennis players. In practice, only a minority of the people we see with it actually play tennis. The common thread is repeated gripping and wrist use, so the people who tend to develop it are tradespeople, mechanics, chefs, hairdressers, cleaners, new parents lifting a baby and a pram all day, and plenty of people who spend hours at a desk and mouse.
The tendon doesn't care whether the load came from a backhand, a screwdriver or a computer mouse. What matters is how much gripping and wrist work it is being asked to do, how quickly that work was introduced, and whether the tendon had time to adapt to it. A pattern we see often is someone whose load has recently changed, maybe a new job, a renovation, a different desk setup, or coming back to the gym and adding a lot of grip-heavy work in a short space of time. Often we see patients who may have taken to a task over holidays, either pruning all their trees, painting their house or after a week on the gurney.
Desk work is a common cause too. Long hours gripping a mouse, typing and repeating the same small wrist movements can load the tendon enough to bring it on, especially after something changes, like a new role, a busier stretch or a different workstation. It often surprises people that an office job can be behind it, but the tendon is responding to the total amount of gripping, not to whether the activity looks athletic.
How physiotherapy can help tennis elbow
The first job is to work out what is driving it, because the elbow is rarely the whole story. We will ask about your work, your training and your hobbies, and what has changed recently, then assess the elbow itself along with your wrist and forearm grip, and often your shoulder and neck, since stiffness or weakness further up the arm can change how hard the forearm has to work.
From there, treatment is built around settling the pain enough to get you moving comfortably, then rebuilding the tendon's capacity so it can handle your normal life again. The strongest evidence in physiotherapy points to a combination of progressive strengthening, including the slow eccentric loading tendons respond well to, paired with hands-on treatment to keep you comfortable while you work through it. For more involved cases we may run this through our structured clinical rehabilitation program.
Hands-on treatment has a clear role here. Soft tissue work through the forearm and gentle mobilisation of the elbow and wrist can ease pain and improve movement in the short term, which makes the strengthening work more comfortable to get through. We tend to use these techniques as a way to help you get on with the active rehab, rather than as a treatment on their own, because passive treatment by itself tends not to hold up over time.
People often ask about cortisone injections. They can settle the pain in the short term, but the research has fairly consistently shown that people tend to do worse over the following year than those who do exercise-based rehab, and sometimes worse than leaving it alone, so we usually steer towards loading the tendon first. Other patients may try PRP (platelet rich plasma injections), whether to have a corticone injection or a PRP injection is a conversation to have with your GP, however it does not stop you starting physiotherapy in the meantime.
Dry needling or acupuncture can help some people with pain and grip in the shorter term, and recent research supports that, so if it is something you have found useful before or want to try, we are happy to talk through where it fits alongside your strengthening.
Tennis elbow exercises and tendon loading
Tendons respond to load. That is the central idea behind modern tennis elbow rehab, and it is why a good program is built around gradually loading the tendon rather than avoiding it. The aim is to give the tendon a reason to rebuild, in doses it can cope with, and then slowly increase the demand as it gets stronger.
Most programs start with isometric exercises, where you hold a contraction without moving the joint. For a lot of people these take the edge off the pain and let them begin loading the tendon even while it is still quite irritable. From there we progress to slower, heavier strengthening through the wrist extensors, often with a dumbbell or a resistance band, working into the range the tendon needs to tolerate for your daily tasks. Eccentric work, where you control the lowering phase of a movement, has a long track record for tendon problems and usually features as the program builds.
This is also why complete rest tends to backfire. Resting the elbow entirely might ease things for a while, but it leaves the tendon weak and quick to flare up the moment you go back to normal activity. The better approach is a short period of complete rest or relative rest, where you ease off the things that really aggravate it while keeping the tendon working at a level it can handle, then build from there. A bit of discomfort during the exercises is normal and expected. We generally work to the rule that pain during loading can sit at a level you would describe as acceptable, and should settle back down within about a day, rather than flaring up and staying sore.
People usually want to know how long it takes. Most notice a meaningful change within about six to twelve weeks of starting a proper loading program, but tendons remodel slowly and a full recovery can take several months, particularly if it has been there a while. The pain almost always improves before the tendon has fully recovered, and stopping the moment it feels better is the single most common reason it comes back. Sticking with the program for the full course is what makes the difference between a short-term fix and a lasting one.
Work, sport and gym modifications
Rehab works far better when the tendon isn't being hammered for the rest of the day. That does not mean stopping everything. It means finding the level the tendon can handle and adjusting around it for a while.
At a desk, that might mean looking at how you use your mouse and keyboard, how your forearm is supported, and whether you can break up long stretches of gripping. For trades and manual work it might mean changing your grip, using a lighter tool or a different technique for a period, sharing the heavy tasks or spacing them out so the tendon gets some recovery between them. Where the problem is clearly tied to your job, our occupational physiotherapy team can help, including WorkCover Queensland claims.
In the gym the usual culprits are heavy pulling and grip-intensive lifts, and more often than not we can keep you training by adjusting grip, load or tempo rather than stopping altogether. If sport is the issue, our sports physiotherapists can look at technique and training load to get you back to it safely. A counterforce strap, the band you sometimes see worn just below the elbow, helps some people get through aggravating tasks by changing where the load sits on the tendon. It is not a cure and it does not replace strengthening, but it can be a handy tool while things settle.
Shockwave therapy for persistent tennis elbow
When tennis elbow has been around for a long time and hasn't responded to loading and activity changes, shockwave therapy (extracorporeal shockwave therapy) is one of the options worth discussing. It delivers pulses of energy into the tendon to stimulate a healing response, and for some people with stubborn tendon pain it can help, particularly when it is used alongside an exercise program rather than instead of one.
It is worth being straight about the evidence. The research on shockwave for tennis elbow is mixed, with some studies showing a benefit and others showing very little, and it does not work for everyone. We would usually consider it for cases that have stayed persistent despite doing the right things, and we would talk it through with you so you understand what it can and can't do before deciding whether it is worth trying.
When to see a physiotherapist
Tennis elbow responds well to physiotherapy, and seeing someone early tends to shorten the recovery and lower the chance of it returning, because you get a clear diagnosis and a plan rather than waiting and hoping. Left alone it does often settle, with most cases improving over time, but that can take many months and it has a habit of recurring if the load that caused it is never sorted out.
It is worth getting it looked at if the pain is interfering with your work or sport, if it has been hanging around for more than a few weeks, if it keeps returning, or if simple measures haven't made any difference. It is also worth a check if something doesn't fit the usual picture. Pain on the outside of the elbow can occasionally be referred down from the neck, or come from irritation of a nerve in the forearm, so pins and needles, numbness, a weak or clumsy hand, noticeable swelling, or pain that started after a fall or a direct knock all point to something that should be assessed in its own right rather than treated as straightforward tennis elbow.
Tennis elbow physiotherapy in Wynnum
At Advantage Healthcare and Physiotherapy in Wynnum, our physiotherapists assess and treat tennis elbow for people right across the Brisbane bayside, including Manly, Lota, Lytton, Tingalpa and the surrounding suburbs. We have been looking after the local community since 2004, and every clinician is a senior physiotherapist with well over a decade of experience, so you are assessed by someone who has managed plenty of these before.
We will take the time to understand what is loading the tendon in your particular case, give you a clear explanation of what is going on, and build a tennis elbow physio plan that fits your work, your training and your goals.
How long does tennis elbow take to heal?
Most people notice a meaningful improvement within about six to twelve weeks of starting a proper loading program, though tendons are slow to remodel and a full recovery can take several months, especially if it has been there a while. Because the pain tends to settle before the tendon has fully recovered, the thing that shortens the overall timeline most is sticking with the strengthening once you start to feel better.
Did you know that sometimes elbow pain can be referred from the neck? Click for more information about neck pain treatment.
