Tennis Elbow (Lateral Epicondylitis)
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Tennis elbow is a term used to describe pain on the outside of the elbow, most commonly related to overload of the tendons that extend the wrist and fingers. Despite the name, it is far more often associated with everyday activities, manual work, or repetitive tasks than with playing tennis.
A common elbow pain pattern — rarely caused by tennis, and not always inflammatory
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In many cases, tennis elbow reflects changes in tendon load tolerance rather than active inflammation or a sudden injury. Symptoms can develop gradually and may persist if the demands placed on the tendon exceed its ability to adapt. Because of this, the condition is best understood as a pain and function problem rather than a simple structural diagnosis.
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Understanding what tennis elbow actually represents — and what it does not — is key to managing it effectively. Treatment decisions should be guided by symptoms, function, and how the elbow behaves under load, rather than assumptions based on the name alone.
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In A Hurry? - Shoulder Anatomy Page Quick Links:
The Elbow Joint
To fully understand tennis elbow, it's essential to grasp the complex anatomy of the elbow joint. The elbow is a hinge joint formed by the articulation of three bones, which work together to facilitate a wide range of movements.
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Bones of the Elbow Joint
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Humerus:
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The humerus is the upper arm bone that extends from the shoulder to the elbow. The lower end of the humerus features two prominent bony protrusions called the medial and lateral epicondyles. These epicondyles serve as crucial attachment points for muscles and tendons. The lateral epicondyle, located on the outer side of the elbow, is particularly relevant to tennis elbow as it is the site where the tendons of the forearm muscles attach.
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Radius:
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The radius is one of the two forearm bones and is situated on the thumb side of the forearm. It is the smaller of the two bones and plays a vital role in the rotational movement of the forearm. The top end of the radius, known as the radial head, forms part of the elbow joint and allows the radius to rotate around the ulna, enabling motions like pronation and supination (turning the palm up and down).
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Ulna:
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The ulna is the larger and longer bone of the forearm, located on the pinky side. It forms the main structure of the forearm and, together with the humerus, creates the hinge of the elbow joint. The upper end of the ulna features a prominent curved shape that fits snugly into the humerus, allowing for the bending and straightening of the arm.
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Soft Tissues of the Elbow
The elbow joint's stability and functionality are maintained by various structures, including muscles, tendons, and ligaments. These structures work in harmony to support and move the joint.
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Muscles:
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Several muscles cross the elbow joint, enabling a range of movements such as flexion, extension, and rotation. Key muscles include the biceps brachii, triceps brachii, brachialis, and brachioradialis. The extensor carpi radialis brevis (ECRB) muscle, which attaches to the lateral epicondyle, is often implicated in tennis elbow.
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​​Tendons:
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Tendons are tough, fibrous tissues that connect muscles to bones. In the case of tennis elbow, the tendons attaching the forearm muscles to the lateral epicondyle become inflamed due to repetitive strain. This inflammation leads to pain and tenderness on the outer elbow.
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Ligaments:
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Ligaments are strong bands of tissue that connect bones to other bones, providing stability to the joint. The medial and lateral collateral ligaments are the primary stabilizing ligaments of the elbow. The annular ligament encircles the head of the radius, holding it in place and allowing smooth rotation around the ulna.
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What structures are involved in tennis elbow
Tennis elbow refers to pain arising from the structures on the outside of the elbow, most commonly involving the common extensor tendon. This tendon attaches several forearm muscles to the lateral epicondyle of the humerus, the bony prominence on the outer aspect of the elbow.
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The muscle most frequently implicated is extensor carpi radialis brevis (ECRB). This muscle plays an important role in stabilising the wrist during gripping, lifting, and fine motor tasks. Because it is active during many everyday movements, it is particularly vulnerable to overload when demands increase or recovery capacity is reduced.
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Although the pain is felt at the elbow, tennis elbow is best understood as a problem of load transmission through the forearm and wrist, not just a local elbow issue. Grip strength, wrist control, shoulder positioning, and overall workload all influence how much stress is placed on the tendon.
Who gets tennis elbow — and why it’s rarely about tennis
Despite its name, tennis elbow is far more common in people who do not play tennis. It frequently affects individuals involved in:
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manual or repetitive work
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prolonged computer or mouse use
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gripping, lifting, or twisting tasks
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DIY, gardening, or tool use
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The condition often develops when the demands placed on the tendon exceed its ability to adapt. This may occur due to a sudden increase in workload, reduced recovery time, changes in technique, or gradual accumulation of strain over time.
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Age can also play a role, as tendon tissue generally becomes less adaptable with age. However, tennis elbow is not inevitable, and recovery is very achievable with appropriate management.
Symptoms — how tennis elbow typically presents
Symptoms of tennis elbow can vary significantly between individuals. Common features include pain on the outside of the elbow that may spread into the forearm, discomfort with gripping or lifting, and reduced strength or endurance in the hand and wrist.
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Pain is often aggravated by activities such as lifting a kettle, turning a door handle, shaking hands, or prolonged keyboard or mouse use. Some people notice morning stiffness or aching after activity, while others experience pain during the task itself.
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Because these symptoms can overlap with other conditions affecting the elbow, forearm, or even the neck, a proper clinical assessment is essential.
How tennis elbow is diagnosed
Tennis elbow is primarily a clinical diagnosis. A thorough assessment includes a detailed history, examination of elbow and wrist movement, strength testing, and evaluation of how symptoms respond to specific loading tasks.
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Imaging such as ultrasound or MRI is not routinely required and is often unnecessary. Tendon changes are common on scans and do not reliably correlate with pain or severity. Imaging may be considered in cases that are persistent, atypical, or not responding as expected, but it should support — not replace — clinical reasoning.
Treatment — why load management matters more than rest
The cornerstone of effective tennis elbow management is appropriate load management. This does not mean complete rest, but rather adjusting activity to allow the tendon to recover while gradually rebuilding its capacity.
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Short periods of relative rest can help settle symptoms, but prolonged avoidance of activity often leads to deconditioning and delayed recovery. The aim is to find a balance that reduces excessive strain while maintaining function.
The role of physiotherapy and rehabilitation
Rehabilitation focuses on progressively loading the tendon in a controlled way to improve its strength and tolerance. This typically involves carefully selected strengthening exercises for the wrist extensors, along with addressing contributing factors such as grip technique, shoulder control, and overall workload.
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Hands-on treatment may help reduce pain or improve movement in the short term, but lasting improvement depends on active rehabilitation rather than passive treatment alone.
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Education is also a key component — understanding why the pain is there, how to modify activities, and how to progress load safely helps reduce fear and improve long-term outcomes.
Injections — what to know
Elbow straps or braces can sometimes help reduce symptoms by altering how load is transmitted through the tendon. They may be useful as a temporary aid during activity, but they do not address the underlying issue and should not be relied upon as a sole treatment.
Bracing, supports, and taping
Injections may reduce pain in the short term, particularly when symptoms are severe. However, evidence suggests that while some injections can provide temporary relief, they do not improve long-term outcomes and may increase recurrence rates if used in isolation.
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If injections are considered, they should form part of a broader rehabilitation plan rather than being viewed as a cure.
Surgery — rarely needed
Surgery for tennis elbow is uncommon and usually reserved for a small number of cases where symptoms have persisted for many months despite appropriate, well-structured conservative management.
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Even then, surgery is not guaranteed to resolve symptoms and requires a prolonged period of rehabilitation. Most people recover well without surgical intervention.
Prognosis — what to expect
The outlook for tennis elbow is generally good. Most people improve with time and appropriate management, even when symptoms have been present for several months.
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Recovery is often gradual rather than immediate, and flare-ups can occur if load is increased too quickly. The goal is not simply to eliminate pain at all costs, but to restore function and resilience so the elbow can tolerate everyday demands.
Key points to take away
Tennis elbow is a common and often frustrating condition, but it is rarely serious. It reflects a mismatch between tendon capacity and load rather than structural failure or ongoing inflammation.
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Effective management focuses on understanding the condition, modifying load appropriately, and rebuilding strength and tolerance over time. With the right approach, most people return to normal activities without long-term problems.
Tennis Elbow FAQs
1. What is tennis elbow?
Tennis elbow is a pain pattern affecting the outside of the elbow, usually related to overload of the tendons that extend the wrist and fingers. Despite the name, it is rarely caused by tennis and is more commonly linked to repetitive or sustained use of the forearm in everyday activities or work.
2. Is tennis elbow an inflammatory condition?
In most cases, particularly when symptoms persist beyond a few weeks, tennis elbow is not primarily inflammatory. It is better understood as a tendinopathy, where the tendon’s ability to tolerate load has been exceeded, leading to pain and reduced function.
3. Why does it hurt to grip or lift objects?
The muscles affected in tennis elbow are heavily involved in gripping and stabilising the wrist. When these tendons are overloaded or sensitised, everyday tasks such as lifting a kettle, opening a jar, or using a mouse can provoke pain.
4. Do I need a scan for tennis elbow?
Usually not. Tennis elbow is diagnosed clinically based on symptoms and physical examination. Imaging is rarely needed unless symptoms are unusual, severe, or not improving as expected, as tendon changes on scans do not reliably correlate with pain.
5. Will tennis elbow go away on its own?
Some cases improve over time, but recovery is often faster and more reliable when load is managed appropriately and rehabilitation is guided. Persistent symptoms usually reflect ongoing overload rather than permanent damage.
6. What is the best treatment for tennis elbow?
There is no single best treatment. The most effective approach usually involves education, activity modification, and progressive strengthening to improve tendon load tolerance. Passive treatments alone are unlikely to provide lasting benefit.
7. Do elbow straps or braces help?
Elbow straps can reduce symptoms for some people by altering how load is transmitted through the tendon. They may be useful in the short term but do not address the underlying issue and should not replace rehabilitation.
8. Are injections recommended for tennis elbow?
Injections may provide short-term pain relief in some cases, but they do not improve long-term outcomes and may increase the risk of recurrence if used without rehabilitation. Their role should be considered carefully and on an individual basis.
9. When is surgery considered?
Surgery is rarely required. It may be considered only when symptoms have persisted for many months despite appropriate conservative management and are significantly affecting function or quality of life.
10. What is the long-term outlook?
The long-term outlook is generally good. Most people recover with appropriate management, even if symptoms have been present for some time. The aim is to restore function and resilience rather than eliminate every sensation of discomfort.
Why You Should Choose Chris Heywood Physio
The most important thing when seeking help is finding a practitioner you trust—someone who is honest, responsible, and clear about your diagnosis, the treatment you really need, and whether any follow-up appointments are necessary.
I’m not here to poach you from another therapist, but if you’re looking for a new physiotherapist in Northamptonshire or simply want a second opinion, here’s why many people choose to work with me (read my reviews):
Over 25 Years of Experience & Proven Expertise
With 25+ years of hands-on physiotherapy experience, I’ve built a trusted reputation for clinical excellence and evidence-based care. My approach combines proven techniques with the latest research, so you can feel confident you’re in safe, skilled hands.
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No two people—or injuries—are the same. That’s why I offer 60-minute one-to-one sessions, giving us time to:
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Thoroughly assess your condition
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Provide focused, effective treatment
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Explain what’s really going on in a clear, simple way
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Your treatment plan is tailored specifically to you, aiming for long-term results, not just temporary relief.
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I believe the best outcomes happen when you understand your body. I’ll explain your condition clearly, give you practical tools for self-management, and step in with expert hands-on treatment when it’s genuinely needed.
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On a Monday and Tuesday I work as a advance musculoskeletal specialist in primary care but I can still be contacted for enquiries. You are welcome to call but it is often faster for me to reply via an email or watsapp message, simply as my phone will be on silent in clinic. Either way, I will reply as soon as possible, which in the week, is almost always on the same day at the latest.
Clinic Opening Hours
The Clinic is located at 2 Old Road, Scaldwell, Northants, NN6 9LA
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Tel: 07576 473422 (Feel free to watapp)
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