FAQ: Tennis elbow (Lateral epicondylitis)

Molly Clark 08/04/26

Injury: Most of us have heard the term ‘tennis elbow’ thrown around over the years. You might even know it by its official name, lateral epicondylalgia. However, it is not just pain in the elbow, and it does not only affect tennis players.

Lateral epicondylalgia is a common condition that occurs across a wide variety of populations, from gym goers and tennis players to tradies and individuals performing repetitive hand and forearm tasks. It involves irritation of the tendons on the outside of the elbow, mainly the wrist extensor tendons. These attach to a common tendon at the lateral elbow and help with gripping and wrist movement. The name ‘tennis elbow’ comes from this being a common condition in tennis players due to repetitive racket use and positioning.

Where will I feel pain? While pain is an individual experience and can vary from person to person, it is commonly felt on the outside of the elbow and may extend slightly down into the forearm. A hallmark sign is pain over the lateral elbow just below the bony edge.

It is often described as a dull ache or a sharp pain with gripping or lifting. The area is often sore to touch, and symptoms may be worse after activity rather than during.

What movements will I struggle to perform if I have injured this tissue or region?

Common aggravating movements include:
Gripping, such as holding weights, bags, or tools
Lifting objects, especially with the palm facing down
Wrist extension, such as pouring, typing, or using a mouse
Twisting movements, such as opening a jar, using tools, or turning door handles

Will I feel pain in any other regions of my body? Typically, lateral epicondylalgia is local to the elbow. However, it is common to see compensatory movement patterns in other regions of the body as you try to avoid pain. This may present as forward head posture, an internally rotated shoulder, and stiffness through the midback, neck, and wrist. This is especially common in individuals who also work at a desk.

How does it happen? Lateral epicondylalgia typically develops due to repetitive or excessive loading of the wrist extensor tendons, particularly when the load exceeds the tissue’s capacity to recover.

This often occurs with:

Repetitive gripping or wrist extension tasks
Sudden increases in training load, such as returning to the gym or increasing weights too quickly
Poor load distribution through the upper limb, where other areas like the shoulder or mid-back are not contributing effectively
Sustained or repetitive positions, especially in desk-based or manual work
Over time, this can lead to tendon overload and irritation. Rather than being a purely inflammatory condition, it is now understood as a tendinopathy, involving changes in tendon structure and reduced capacity to tolerate load.

What things should I try initially once I’ve hurt myself? If you suspect that you may have lateral epicondylalgia, it is recommended to seek an assessment and management plan, as this can support recovery and improve adherence to rehabilitation strategies. Initially, you can also try:

Modifying aggravating movements
Temporarily reducing load
Keeping the arm moving gently
Starting light and controlled strengthening exercises for the forearm
Addressing any other biomechanical compensations such as the neck, mid-back, and wrist

Tendons respond well to load. However, load management is essential. The goal is to strengthen the tendon while still allowing adequate time for recovery

What things should I try to avoid in the initial stages of injury? Try to limit:

Heavy lifting
Excessive gripping
Repetitive wrist extension
Sudden increases in training load
Pushing through pain

Tennis elbow is considered a self-limiting condition, meaning it will often improve over time on its own. However, without appropriate rehabilitation and load management, recovery can be slow and symptoms may return.

What type of exercises or movements do I need to learn, control, or be stronger at to rehabilitate the injury? Rehabilitation should focus on gradually reloading the tendon and improving overall upper limb strength and control. Key areas include:

Wrist extensor strengthening: Progressive loading of the wrist extensors is essential. This often starts with isometric holds and progresses to slow, controlled strengthening exercises such as wrist extension with a dumbbell
Grip strength: Improving grip strength helps build tolerance in the tendon. This can begin with low load holds and progress as tolerated
Eccentric and heavy slow resistance training: These are commonly used in tendinopathy rehabilitation to improve tendon capacity and resilience over time
Shoulder and scapular strength
Movement control and load distribution
Gradual return to aggravating tasks: Reintroducing previously painful movements in a controlled and progressive way is key to long term recovery

Rehabilitation should be individualised and progressed based on symptoms, with the goal of improving load tolerance rather than completely avoiding movement.

What other considerations contribute to the injury?

Desk ergonomics, particularly for individuals who spend long periods working at a desk
Workload demands, including repetitive tasks or sustained postures. Consider whether tasks can be modified or rotated to support recovery while maintaining productivity
Overall neck, shoulder, and wrist mobility, as tennis elbow can affect multiple regions along the kinetic chain

What treatments can help relieve pain or support rehabilitation? Treatment can be beneficial in helping manage symptoms and address any biomechanical compensations that develop.

However, in relation to manual therapy and tennis elbow management, there is no strong evidence showing a direct effect on tissue healing timeframes. Treatment can assist with pain relief and overall management, but it does not necessarily speed up tendon healing.

What are the expected timeframes of rehabilitation? Timeframes can vary depending on severity, load management, overall health, and consistency with rehabilitation. General guidelines include:

Acute or mild cases: 2 to 6 weeks, where most people experience symptom reduction or complete recovery
Moderate cases: 6 to 12 weeks
Persistent or chronic cases: 3 to 12 months

This condition commonly takes time to resolve, as tendinopathies are known for slower recovery due to their relatively limited blood supply compared to muscle tissue.

Other influencing factors include hormonal changes, particularly in postmenopausal women, where reduced oestrogen levels can affect tendon health.

Tendinopathies can also be frustrating to manage because pain is not always present during activity and may instead increase 12 to 24 hours later. This can make load management more challenging. Additionally, modifying aggravating tasks can be difficult when they are work-related.

Overall, tendon adaptation is a gradual process, which is why longer recovery timeframes are common.