What is tennis elbow?
Despite its name and the term “epicondylitis”, tennis elbow is usually a degenerative tendon problem (tendinopathy) rather than an inflammatory one. The forearm extensor muscles attach by a common tendon to the lateral epicondyle, a bony bump on the outside of the elbow. Repeated gripping and wrist extension overloads this tendon, which becomes painful. Only about 5% of cases occur in tennis players; most arise from work and daily activities such as computer use, manual work, plumbing, painting and carrying shopping.
Symptoms
- Pain and tenderness at the outer side of the elbow, sometimes radiating down the forearm.
- Pain gripping objects, lifting a cup, shaking hands, turning a doorknob or key, using tools.
- Pain when extending the wrist against resistance (the Cozen test).
- Reduced grip strength.
- Stiffness or aching at night in some people.
- Symptoms often build gradually over weeks.
Causes and risk factors
- Repetitive gripping, wrist extension and forearm rotation.
- Sudden increase in activity, new tools or equipment.
- Racquet sports with poor technique or an inappropriate racquet.
- Age 35–55, smoking and obesity.
- Neck or nerve problems in some people.
- Previous elbow problems.
Conditions that can mimic it
- Radial tunnel syndrome: deep aching pain in the forearm with nerve irritation.
- Cervical radiculopathy: neck-origin pain with tingling.
- Elbow arthritis or instability.
- Golfer’s elbow (medial epicondylitis) on the inside of the elbow.
- If your pain does not fit the pattern, seek assessment. See forearm exercises (Spanish).
Self-care and activity changes
- Reduce or modify the aggravating tasks; avoid forceful gripping with a palm-down wrist.
- Use two hands to lift objects, and lift with the palm facing up.
- Check ergonomics: mouse, keyboard, tool handles and racquet grip size.
- Short-term relief with paracetamol or topical anti-inflammatory gel; ice or heat for comfort.
- A counterforce brace (strap below the elbow) or a wrist splint may help some people with symptoms during activity.
- Continue gentle movement, avoid prolonged rest or immobilisation.
Strengthening exercises
- Isometric wrist extension: forearm supported palm-down, push the back of the hand against the other hand or a table, 5 × 30–45 seconds, once or twice daily for pain relief.
- Eccentric wrist extension: using the other hand to lift a light weight (1–2 kg) to the top, then lower slowly with the affected arm over 3–5 seconds, 3 × 10–15 daily.
- Heavy slow resistance: wrist extension with dumbbell or band, 3 × 8–12, 3 times a week, progressing load slowly.
- Forearm pronation-supination and grip strengthening using a hammer or squeezable ball.
- Shoulder and scapular strengthening to improve arm function.
- Pain should stay at 3–4/10 or below and settle within 24 hours.
Injections, shockwave and other treatments
Corticosteroid injections provide short-term pain relief but studies show worse outcomes at 6–12 months and a higher recurrence rate compared with watchful waiting or physiotherapy, so they are used cautiously. Platelet-rich plasma and autologous blood injections have inconsistent evidence. Extracorporeal shockwave therapy and acupuncture show mixed results. Surgery (debridement or release of the tendon origin) is considered only after at least 6–12 months of well-conducted conservative treatment.
How long does it last?
Tennis elbow is usually self-limiting, with most people recovering within 6–12 months and up to 90% improving with conservative care. Recovery can be slow and may take longer in people who continue repetitive activities or smoke. Setbacks are common; regular strengthening, activity pacing and ergonomic changes reduce recurrence.
When to see a doctor
- Pain after an injury or fall, or locking and instability of the elbow.
- Numbness, tingling or weakness in the hand.
- Pain at night or at rest that does not improve.
- No improvement after 6–8 weeks of consistent self-care.
- Redness, heat and swelling with fever (urgent).
- Diagnostic uncertainty or neck pain.
Three common situations
A plasterer with outer elbow pain when gripping tools: adjust technique and tool grip, use isometrics and a progressive strengthening plan.
A tennis player with pain on the backhand: check technique, racquet size and string tension, and strengthen the forearm.
An office worker with outer elbow pain after long mouse use: change workstation setup, take breaks and do the exercises daily.
Golfer’s elbow and other elbow tendinopathies
Pain on the inner side of the elbow, worse with gripping and wrist flexion, is called medial epicondylitis or golfer’s elbow, and it is managed in a similar way: load modification and progressive strengthening of the flexor and pronator muscles. Pain at the back of the elbow above the tip may be triceps tendinopathy, and pain at the front may involve the biceps tendon. A clinician can distinguish them by examination.
Key points to remember
Tennis elbow is a common overload tendinopathy that responds to load management and progressive strengthening, usually within months. Avoid repeated steroid injections and prolonged rest. See a doctor if pain is severe, follows an injury, or does not improve. Our physical therapy team can design an exercise programme for you.
This guide is for general information and does not replace an assessment by your own doctor or physical therapist.
Questions about tennis elbow
These answers are general information and do not replace an examination or individual medical advice.
How long does tennis elbow take to heal?
Most people recover within 6–12 months; some improve sooner.
Does rest cure tennis elbow?
Short relative rest helps, but prolonged rest is not recommended; progressive strengthening is key.
Should I wear a brace?
A counterforce strap or wrist splint can give relief during activity for some people.
Are cortisone injections good for tennis elbow?
They give short-term relief but are associated with worse longer-term outcomes and recurrence.
What exercises help tennis elbow?
Isometric holds, then eccentric and heavy slow wrist extension, plus grip and forearm strengthening.
Is surgery needed?
Rarely, after at least 6–12 months of failed conservative treatment.
Can I keep playing sport with tennis elbow?
Often yes, with modifications: reduce the loads that provoke pain, check technique and equipment, and keep pain at a tolerable level.
Sources
- AAOS OrthoInfo · Tennis elbow (lateral epicondylitis)
- NHS · Tennis elbow
- NHS · Tendonitis
- ACSM · Progression models in resistance training for healthy adults (2009)
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.