Tennis Elbow: Not Just for Tennis Players - What It Is and How to Fix It by APA Physiotherapist Ben Howie

“Tennis elbow,” clinically known as lateral epicondylitis, can affect anyone who repeatedly uses their wrist and forearm. From typing, gardening, and DIY tasks to lifting at work, everyday movements can overload the tendons that attach to the outside of your elbow. The result? Pain, weakness, and difficulty with everyday activities like opening jars, turning keys, or shaking hands.

What Causes Tennis Elbow?

Tennis elbow develops when the extensor tendons of the forearm are repeatedly stressed. Over time, this leads to microtears and changes in tendon structure, which can cause pain and weakness. Tendon overload, rather than inflammation alone, drives tennis elbow pain. This highlights the importance of load management and progressive strengthening in recovery.

Common Risk Factors:

  • Repetitive gripping, twisting, or lifting (work tasks, DIY, cooking, computer use)

  • Sudden increases in activity or workload

  • Weak or fatigued forearm muscles

  • Poor ergonomics or technique

Signs and Symptoms

  • Pain or tenderness on the outer elbow

  • Painful to palpate on the lateral epicondyle

  • Mild swelling and or heat might be present around the elbow

  • Pain when gripping objects, lifting, or twisting the wrist

  • Weakness in the forearm or wrist

  • Pain worsening with repetitive or sustained activity

When to seek Help

·      No improvement after 4 - 6 weeks: If rest and gentle exercises haven’t helped after about a month

·      Pain persists or worsens: If the pain doesn’t get better or gets worse despite trying treatments

·      Significant impact on daily life: If pain makes it hard to do everyday tasks, affecting your work or hobbies

·      Difficulty with specific movements: Pain with gripping, twisting, or extending your wrist

How Physiotherapy Can Help

Seeing a physiotherapist early can prevent chronic symptoms and is highly effective for tennis elbow, focusing on reducing pain, restoring tendon strength, and improving function.

Key Approaches:

  1. Load Management
    Early on, modifying activities that aggravate the tendon prevents overload while allowing healing. Gradual reintroduction ensures safe recovery.

  2. Exercise Therapy

·      Eccentric strengthening: Slowly lowering a weight with the wrist extended helps the tendon adapt to load.

·      Isometric exercises: Holding the wrist in a neutral position against resistance can reduce pain during activity.

·      Progressive strengthening: Gradually increasing resistance rebuilds tendon and forearm strength.

  1. Manual Therapy
    Soft tissue massage or gentle joint mobilization can reduce pain and improve tendon mobility.

  2. Education and Ergonomics
    Adjusting posture, grip, and technique in work, sport, or daily tasks reduces tendon stress and supports recovery.

  3. Over-the-counter pain relief
    Anti-inflammatory gels or tablets (consult a pharmacist or GP).

  4. Shockwave (ESWT)
    More appropriate for chronic cases – emits shockwaves deep into tissues, stimulating growth of new blood vessels and collagen, essential for tissue repair

Prevention Tips

  • Strengthen forearm and wrist muscles regularly

  • Warm up before repetitive tasks or heavy lifting

  • Take breaks and avoid prolonged gripping or lifting

  • Check technique in work or sport tasks

Conclusion

Tennis elbow is common—but highly treatable. Recovery depends on careful load management and progressive strengthening to allow the tendon to heal and adapt. Manual therapy, ergonomic adjustments, and education support this process, but the key to long-term recovery is controlled, progressive exercise.

With early guidance and a structured approach, you can regain strength, reduce pain, and return to your daily activities or hobbies—pain-free and confident in your elbow’s function.

References:

·       Alharbi, M 2025, ‘Comparative efficacy of extracorporeal shockwave therapy and ultrasound on pain and functional outcomes in lateral epicondylitis: a systematic review and meta-analysis’, European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, vol. 35, France, no. 1, p. 307.

·       Di Filippo, L, Vincenzi, S, Pennella, D & Maselli, F 2022, ‘Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews’, Healthcare, vol. 10, no. 6, p. 1095.

·       Kocheta, R 2023, ‘A Review of Therapeutic Management for Lateral Epicondylitis’, International Journal of Health Sciences and Research, vol. 13, no. 11, pp. 277–286.

·       Pathan, AF & Sharath, HV 2023, ‘A Review of Physiotherapy Techniques Used in the Treatment of Tennis Elbow’, Cureus, vol. 15, no. 10.

·       Taylor, L, Wiebusch, M, Bisset, LM & Coombes, BK 2024, ‘Adherence to exercise in lateral elbow tendinopathy, a scoping review.’, Musculoskeletal science & practice/Musculoskeletal science and practice, vol. 72, Elsevier BV, pp. 102978–102978.

Stuart McKayComment