What Is Tennis Elbow And How Can Physiotherapy Help?

Tennis Elbow (Lateral epicondylitis) is the most common injury around the elbow, but contrary to the name, only 5% of these injuries are attributed to tennis! Tennis elbow is caused by repetitive overloading of the extensor muscles of the forearm, often seen as an occupational injury. Although there can be referred symptoms from the neck/shoulder, we will focus on the muscles of the forearm in this article.


This is a chronic condition as it can often take weeks, months, if not years to manifest. It originates from high repetitive loading activities of the muscles around the elbow, such as computer use, heavy lifting, repetitive vibration; forceful rotation of the forearm (hence to tennis reference).

The exact cause on a cellular level is still hotly debated. Recent research suggests that there is micro tearing of the tendon coupled with a hypovasuclar (poor blood supply) environment, thus leading to cellular level inflammation (not visual to the human eye) that can be diagnosed on MRI. Does this mean that you need an MRI? The answer is, not necessarily, with the right questions and assessment tools tennis elbow can be diagnosed without costly scans.

Do I have Tennis Elbow and how can physiotherapy help?

Symptoms of Tennis elbow pain are typically localised to the outside (lateral) aspect of the elbow. Since it is an overload of the tissue, pain can be felt at different times throughout the day depending on your symptoms, e.g; stiff and achy in the AM; sharp on specific activities that involve gripping/rotation of the forearm; achy at night after a long day on the computer. The list goes on and on.

Your physiotherapist will start by taking a thorough subjective assessment to better understand your pain and what it means to you/how it affects you. Then they will move on to an objective assessment to physically see what movements/activities trigger or relieve your pain. After this they will discuss with you a treatment plan tailored to your needs and goals (this will come with homework so be sure to record/make notes/take pictures so that you don’t forget).

4 tips to start modifying your symptoms of Tennis Elbow

  1. Decrease the stress of exercise/loading around the elbow. I would suggest decreasing the aggravating activity by taking more frequent breaks and/or avoiding when pain starts to increase.
  2. Icing/heat therapy is easy to apply and can be effective in reducing the symptoms. Recommendations would suggest between 10-15 minutes of either an Ice or heat pack depending on which you find most beneficial.
  3. Medication for pain relief. This is a conversation to have with your Doctor/pharmacist. Medication often has a positive effect in allowing you to move/load the elbow with decreased pain, which in turn can accelerate recovery.
  4. Gentle loading exercises (Refer to images). These exercises will encourage movement and pain relief while you seek assessment from a professional on how best to approach recovery.

As mentioned before, Tennis Elbow is a chronic loading condition. This often means that we see patients who have been suffering with their injury for several months before seeking medical advice. We need to be mindful that if it takes several months to develop then it can take just as long to fully settle down! I some cases Physiotherapists may look to refer patients on to orthopaedic specialists to discuss further pain management strategies, such as steroid injections. But be sure that this will be a conversation had between you and your physiotherapist to be sure it is the best course of treatment for you.

Exercises For Tennis Elbow

Wrist Extension

Support the arm on a table. With the weight/resistance be sure to take 3-5 seconds to complete the movement. Start with 5 repetitions and 3 sets.

Pronation To Supination

Support the arm on a table. Move slowly throughout the movement from left to right, making sure you go to your full pain-free range of movement. Start with 5 repetitions and 3 sets.

Forearm Stretch

Make sure your elbow is straight before moving the wrist into a stretch. Hold the stretch for 20-30 seconds in reach directions and repeat 2-3 times.

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