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Tennis Elbow

Tennis Elbow also known as lateral epicondylitis or lateral epicondylalgia is the most common musculoskeletal condition affecting the elbow. It presents as pain over the outer aspect of the elbow joint. It is generally considered to be an overuse or repetitive strain type injury, where the muscles in the arm and forearm (particularly those that extend the wrist and fingers) can become inflamed and painful. Commonly the most painful point is on the lateral epicondyle (the bony prominence on the outside of the elbow) where the extensor tendons insert.

A very similar condition affects the flexor tendons at their insertion into the other side of the elbow (the medial epicondyle) and is know as medial epicondylalgia or golfer’s elbow.

Causes & Risk Factors

  • Typically presents in men and women aged between 35 and 55

  • Exposure to activities that involve prolonged or frequent gripping – such as racquet sports, gardening, repetitive tools use, crafting etc.

  • Tasks that involve repetitive use of power tools and exposure to levels of hand and arm vibration may also contribute to the development of symptoms.

  • Repetitive upper limb loading such as repeated heavy lifting, pushing and pulling.

  • Repeated fine hand movements such as typing or sewing may also place some additional strain on the small muscles of the forearm.

  • Changes in activity levels, such as an increase in work or sport intensity, frequency or duration may also be a contributing factor to the development of symptoms.

Signs & Symptoms

  • Pain travelling from the outside of the elbow towards the wrist

  • Tenderness to touch the lateral epicondyle on the outside of the elbow

  • Pain when lifting, or extending your wrist or fingers

  • Pain and difficulty gripping

  • Weakness with activities such as opening jars, twisting door knobs

  • Stiffness in the affected arm.


Lateral Epicondylitis is typically diagnosed clinically, on the basis of the history given, with consideration of some of the risk factors outlined above. This is reinforced by the presence of pain and tenderness on the outside of the elbow which may spread down the arm to the fingers and reproduction of the familiar symptoms with simple testing the physiotherapist will conduct in your initial assessment. In some cases, imaging such as ultrasound or MRI scans can be used to confirm the diagnosis and the presence of any small tearing in the tendons.

Here at 4 Life Physiotherapy, we have a holistic approach and will also complete a thorough physical assessment of the elbow, forearm and hand. Further examination of other contributing factors such as the cervical or thoracic spine and assessing shoulder and general upper limb function will also improve your outcomes. Other assessments may include observing the aggravating tasks and positions and improving body positioning and ergonomics which can be key to reducing any recurrence of your symptoms.


Physiotherapy Treatment

The initial aims of treatment are to reduce the associated pain and inflammation. So load management and addressing the aggravating factors are important to settle symptoms down early. This may include some physiotherapy treatment such as mobilization, soft tissue release techniques or dry needling. Other advice regarding hot or cold therapies, compression or braces / supports may also help reduce the intensity of symptoms. Shockwave therapy is also well researched at being effective in treating tennis elbow.


One of the other key strategies to improve both pain and function is finding the right exercise! Our experienced physiotherapists can help guide you to find the right movements and load for each stage of your rehab. These exercises need to be graded, increasing gradually over time to improve the strength and quality of the tendons. Addressing underlying factors such as your general upper limb or shoulder strength, the postures you spend time in and some technique adjustments will all go a long way to ensuring you remain symptom free.


Most cases will respond positively to conservative management such as physiotherapy and 90% of patients will make a full recovery within 12months. So, if you are experiencing any pain at the outer point of your elbow, have a chat with one of our team today.

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