Key Takeaways
- Tennis elbow is an overuse condition that affects the tendons attaching the forearm muscles to the outer part of the elbow.
- A physiotherapy programme for tennis elbow should be planned around your symptoms, daily activities, strength, and the demands placed on your arm.
- Our physiotherapists usually combine activity modification, progressive strengthening, movement retraining, and symptom management.
- Other treatments, such as bracing, injections, tenotomy, or surgery, may be considered if symptoms remain persistent despite rehabilitation.
- Recovery is often gradual, so treatment should progress according to how your elbow responds over time.
Introduction
Does the outside of your elbow hurt when you lift a cup, carry a bag, use a mouse, or grip a racquet? These everyday difficulties may be signs of tennis elbow, also known as lateral epicondylitis or lateral elbow tendinopathy.
At The Movement Laboratory, we do not use the same physiotherapy programme for every case of tennis elbow. Our physiotherapists consider when your symptoms started, which activities aggravate them, how much strength you have, and what you need your arm to do at work, during exercise, or in daily life.
What Is Tennis Elbow?
Tennis elbow is an overuse condition affecting the tendons that connect the forearm muscles to the outer elbow. It develops when these tendons are repeatedly placed under repetitive strain, leading to symptoms like elbow pain and discomfort or weakness when gripping objects. These symptoms may first appear only during activity, but can become more persistent if the tendon continues to be overloaded.
Although it is commonly linked to tennis, it can result from any activity involving repeated gripping, wrist movement, or forearm rotation. Common contributing factors include:
- Repetitive gripping, lifting, or tool use
- Prolonged mouse or keyboard use
- Racquet sports, gym exercises, or manual work
- A sudden increase in activity or training
- Reduced forearm or shoulder strength
How We Plan a Tennis Elbow Rehabilitation Programme
Tennis elbow often improves over time with rest and, if needed, pain management. However, if your symptoms persist or continue to affect daily tasks, physiotherapy may be the next step.
At The Movement Laboratory, our physiotherapists assess what is straining your elbow and how the pain affects your routine before creating a personalised tennis elbow physiotherapy programme.
1. Confirm Whether the Pain Is Likely to Be Tennis Elbow
We first determine where the pain is located and which movements bring it on. Your physiotherapist may test your grip strength, wrist movement, and forearm muscles.
This helps us confirm whether your symptoms are consistent with tennis elbow and identify the activities placing the most strain on the tendon. We also consider how sensitive the area is, as this affects how quickly treatment can progress.
2. Identify Which Activities Are Overloading the Tendon
Next, we look at how often and how heavily you use the arm. This may include the number of hours spent typing, the weight of tools you handle, your gym routine, or how often you play racquet sports.
Rather than asking you to stop all activity, we may adjust the specific tasks causing repeated flare-ups. This could involve:
- Reducing training volume or lifting weight
- Using two hands for heavier objects
- Changing your racquet, tool, or mouse grip
These changes are usually temporary. The aim is to reduce excessive strain on the forearm tendons while keeping the arm active enough to begin rehabilitation.
3. Choose Exercises Based on Your Pain and Strength
Exercise therapy is central to our sports physiotherapy programmes. However, the exercises we prescribe will depend on what your elbow can tolerate at the time. This may include:
- Radial nerve flossing to improve nerve mobility
- Wrist extensor curls to strengthen the muscles commonly involved in tennis elbow
- Supinator strengthening to build control when rotating the forearm
We may start with lighter resistance and gradually increase the load, repetitions, and range of movement as your symptoms improve. The aim is to rebuild strength and improve the tendon’s ability to tolerate gripping, lifting, wrist movement, and forearm rotation.
For a visual guide to some exercises commonly used for tennis elbow, you can also refer to this home exercise video.
4. Use Hands-On Treatment to Improve Comfort and Movement
Manual therapy refers to hands-on techniques used by a physiotherapist to improve movement and reduce discomfort. This may include joint mobilisation, where the joint is moved gently in a controlled way, and soft tissue massage to ease tension in the muscles around the elbow, forearm, and wrist.
In some cases, our physiotherapist may also use dry needling, which involves inserting a fine needle into tight muscle areas or trigger points. It may be used to help reduce pain, improve grip strength, and enhance overall joint function.
These treatments usually support the rehabilitation programme rather than replace strengthening and activity-based exercises.
5. Practise the Movements You Need to Return To
As your strength improves, we make the programme more specific to the activities you need to return to. An office worker may build tolerance for mouse use, typing, and carrying a laptop bag. A gym-goer may gradually return to pulling or lifting exercises. A tennis player may progress from controlled swings to drills and full play. For sport-related cases, rehabilitation may also include movement analysis, technology, and sport-specific exercises.
This allows us to adapt your tennis elbow physiotherapy programme according to your progress and the demands you need your arm to handle.
Other Treatments for Tennis Elbow
Depending on how long your symptoms have lasted, how much they affect daily life, and how you have responded to rehabilitation, other treatment options may also be considered:
- Bracing: A forearm strap or wrist brace may reduce strain during gripping or lifting. It is usually used as a short-term aid rather than a replacement for rehabilitation.
- Platelet-rich plasma: This involves injecting concentrated platelets from your own blood into the affected area. It is intended to support tissue healing, although results can vary.
- Corticosteroids: A corticosteroid injection may provide short-term pain relief.
- Tenotomy: This minimally invasive procedure uses a needle or small instrument to remove or break down damaged tendon tissue and help encourage healing.
- Surgery: Surgery is rarely needed and is generally considered only when symptoms remain significantly limiting after an extended period of conservative treatment.
Conclusion
There is no single exercise or treatment timeline that suits everyone with tennis elbow. Your recovery plan should reflect your pain, strength, work demands, preferred activities, and response to loading.
At The Movement Laboratory, our sports injury and physiotherapy services support both competitive athletes and active individuals recovering from their injuries. Our physiotherapists use a holistic, evidence-based approach to rebuild strength, restore movement, and reduce the risk of re-injury.
Book an appointment with us today.
Frequently Asked Questions
1. How long does tennis elbow take to recover?
Tennis elbow often takes around 6 to 12 months to recover. Mild cases may improve within a few weeks to 3 months, while more severe or long-standing symptoms can take 18 to 24 months. Recovery time varies depending on how irritated the tendon is, how long you have had symptoms, and how well the elbow responds to activity changes and rehabilitation.
2. Do I need an X-ray or scan for tennis elbow?
Imaging is not usually required because tennis elbow can often be identified through your symptoms and a physical assessment. An X-ray, ultrasound, or MRI may be considered if the diagnosis is unclear, your symptoms are not improving, or another condition is suspected.
3. What is the difference between tennis elbow and golfer’s elbow?
Tennis elbow usually causes pain on the outside of the elbow, while golfer’s elbow affects the tendons on the inner side. Despite their names, both conditions can develop through work, exercise, or other activities involving repeated wrist and forearm movements.
References:
- Buchanan, B. K., & Varacallo, M. A. (2023, August 4). Lateral epicondylitis (Tennis elbow). StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK431092/
- Ma, X., Qiao, Y., Wang, J., Xu, A., & Rong, J. (2024). Therapeutic Effects of Dry Needling on Lateral Epicondylitis: An Updated Systematic Review and Meta-analysis. Archives of physical medicine and rehabilitation, 105(11), 2184–2197. https://doi.org/10.1016/j.apmr.2024.02.713
- Sharma, V., Kumar, A., Parashar, A., Rai, V., Kumar, V., & Udiwal, H. (2024). Percutaneous Tenotomy for Chronic Tennis Elbow: A Minimally Invasive Technique with Better Outcomes – A Case Series. Journal of orthopaedic case reports, 14(2), 125–130. https://doi.org/10.13107/jocr.2024.v14.i02.4242