Pain on the outside of your elbow when gripping, lifting or using your wrist may be a sign of tennis elbow.
Despite the name, you do not need to play tennis to develop it. Tennis elbow commonly affects people whose work, training or everyday activities place repeated or unfamiliar demands on the forearm.
Although it can take time to settle, you do not usually need to stop using your arm completely. Treatment commonly involves adjusting aggravating activities and gradually rebuilding strength and tolerance.
What is tennis elbow?
Tennis elbow is also known as lateral epicondylitis, although lateral elbow tendinopathy is often a more accurate term because the condition is not simply caused by ongoing inflammation.
Pain is usually felt near the common wrist extensor tendon, where several forearm muscles attach to the outside of the elbow. These muscles help control the wrist and support the arm during gripping, carrying and pulling.
Symptoms may begin after:
- increasing tennis or racquet-sport training
- starting or changing a gym program
- completing more manual work than usual
- repeatedly gripping or lifting objects
- using tools for prolonged periods
- gardening, painting or other unfamiliar activities.
There is not always one clear cause.
What does tennis elbow feel like?
The most common symptom is pain or tenderness around the bony area on the outside of the elbow. The pain may also spread into the forearm.
It can be aggravated by activities such as:
- gripping or shaking hands
- carrying shopping bags
- lifting a kettle, pan or dumbbell
- opening jars
- using tools
- pulling exercises at the gym
- hitting a tennis backhand
- prolonged keyboard or mouse use.
Some people also notice reduced grip strength or feel less confident lifting with the affected arm.
Do you need a scan?
Tennis elbow can usually be diagnosed by discussing your symptoms and examining your elbow. Your physiotherapist may assess the location of your pain, grip strength, wrist and elbow strength, movement and the activities that reproduce your symptoms.
Scans are not routinely required. Ultrasound or MRI may be considered when the diagnosis is unclear, there has been significant trauma or another condition is suspected.
Not all pain on the outside of the elbow is tennis elbow. Other possible causes include pain referred from the neck, an irritated nerve or a problem involving the elbow joint.
How do physiotherapists treat tennis elbow?
There is no single exercise, massage technique or piece of equipment that fixes every case.
Physiotherapy may help reduce symptoms and improve function, particularly in the short term, but the average benefits seen in research are modest. Treatment should support your recovery rather than be presented as a quick or guaranteed cure.
1. Adjusting aggravating activities
The first step is often identifying which activities are placing the greatest demands on the elbow.
This does not necessarily mean resting the arm completely. Instead, your physiotherapist may help you temporarily adjust the amount, intensity or frequency of aggravating tasks.
This might involve:
- reducing heavy or repeated gripping
- changing how you hold or lift an object
- temporarily modifying gym exercises
- spreading demanding tasks across the week
- adjusting your racquet, tools or workstation
- taking short breaks during repetitive work
- using both hands for heavier objects.
The aim is to keep you active while making symptoms more manageable.
2. Progressive strengthening
A progressive strengthening program commonly forms part of tennis elbow treatment.
Exercises usually target the wrist extensor muscles and may include static holds or controlled lifting and lowering movements. Clinical practice guidelines support isometric, concentric and eccentric wrist-extension exercises, although no single exercise or loading program has been shown to work best for everyone.
Your program may be progressed by changing:
- the resistance
- the number of repetitions
- the speed of movement
- the position of the elbow
- the amount of gripping involved
- how closely the exercise resembles your work or sport.
Rehabilitation may begin with controlled wrist exercises before progressing to heavier gripping, pulling, carrying or racquet drills.
Exercises do not necessarily need to be completely pain-free. The load should be adjusted according to how tolerable the exercise feels and how the elbow responds later that day and the following day.
3. Strengthening the rest of the arm
The elbow does not work in isolation. Depending on your assessment, rehabilitation may also include exercises for your grip, forearm, shoulder, upper back or broader upper-body strength.
Shoulder and shoulder-blade exercises may be useful when relevant weakness or movement limitations are identified. However, not everyone needs a long list of additional exercises.
4. Manual therapy
Manual therapy may include mobilisation of the elbow or nearby joints and selected soft-tissue techniques.
It may provide temporary pain relief or make gripping and exercise more comfortable for some people. However, any benefits are usually short term, and manual therapy should be viewed as an optional addition rather than the main treatment.
Hands-on treatment may be used when it helps you move or participate in rehabilitation, but it is not essential for everyone.
5. Braces and taping
A forearm strap, wrist support or taping may temporarily make certain activities more comfortable.
These options do not appear to improve longer-term recovery and will not help everyone. They may be trialled for short-term symptom relief but should not replace progressive rehabilitation.
6. Returning to work, exercise or sport
As your symptoms and strength improve, rehabilitation should become more specific to the activities you need to perform.
This might include gradually rebuilding:
- grip strength
- lifting and carrying
- pulling exercises
- manual work
- repeated tool use
- racquet speed and training volume.
Someone returning to occasional social tennis will need a different program from a tradesperson who grips and lifts throughout the working day.
Can you continue exercising with tennis elbow?
In many cases, yes.
You may need to temporarily modify exercises involving heavy gripping, pulling or repeated wrist movements, but stopping all upper-body training is rarely necessary.
Possible modifications include:
- reducing the resistance or volume
- changing your grip
- using a different range of movement
- substituting a less aggravating exercise
- allowing more recovery between demanding sessions.
Some discomfort during exercise does not automatically mean you are damaging the tendon. Your response over the following day, along with changes in strength and function, provides more useful information than pain during one exercise alone.
What about corticosteroid injections?
Corticosteroid injections may reduce pain temporarily, but current clinical guidance recommends against using them for tennis elbow because longer-term outcomes may be worse than with placebo or no injection.
Evidence for other injections, including platelet-rich plasma, remains uncertain. Decisions about medications or injections should be discussed with an appropriate medical practitioner.
How long does tennis elbow take to recover?
Recovery varies.
Some people notice meaningful improvement within several weeks or months, while others experience symptoms for longer. Progress is not always linear, and an occasional flare-up does not necessarily mean the condition is worsening.
An exercise program may continue for eight to twelve weeks or longer, but this is not a guaranteed recovery deadline. The more useful question is whether your pain, strength and ability to perform meaningful activities are gradually improving.
Recovery may be influenced by:
- how sensitive the elbow is
- how long symptoms have been present
- your work or sporting demands
- exposure to repetitive or forceful tasks
- whether aggravating activities can be adjusted
- other neck or upper-limb symptoms.
Most people improve without surgery, although recovery can take longer than expected in some cases.
When should you see a physiotherapist?
Consider arranging an assessment if:
- elbow pain is limiting work, exercise or everyday activities
- symptoms are not gradually improving
- your grip feels noticeably weaker
- pain returns whenever you increase activity
- you are unsure which exercises are appropriate
- you need help returning to tennis, gym training or manual work.
Seek medical assessment more promptly following significant trauma or if you develop marked swelling, deformity, fever, progressive numbness or weakness, locking, or a substantial loss of movement.
Tennis elbow physiotherapy in Sydney
Wild Physio Fitness in Neutral Bay provides individualised physiotherapy and strength rehabilitation for tennis elbow and other causes of elbow pain.
Treatment may include education, temporary changes to aggravating activities, progressive wrist and upper-limb strengthening, manual therapy when useful and a graded return to work, exercise or sport.
The aim is to help you understand your symptoms, improve your arm’s strength and return to the activities that matter to you.
Looking for an elbow pain physio in Sydney? Contact Wild Physio Fitness to arrange an assessment and develop a rehabilitation plan based on your symptoms, goals and activity demands.
This content provides general information only and is not a substitute for individual health advice. Speak with a qualified health professional about what is appropriate for you.
