“What is Tennis Elbow?”

What is Tennis Elbow?

Tennis Elbow, also known as Lateral Epicondylalgia (or lateral epicondyle tendinopathy), is a condition characterized by pain on the outer side of the elbow, usually aggravated by gripping, lifting, or wrist and finger extension. It involves overload and degeneration of the wrist extensor tendons where they attach to the lateral epicondyle (outside of the elbow), most commonly the extensor carpi radialis brevis (ECRB) tendon.

It is now considered a tendinopathy rather than a classic inflammatory condition. Microscopic changes include collagen disorganization, neovascularisation, and increased tendon sensitivity, rather than active inflammation.

Physiotherapy can reduce pain and improve function more quickly than natural recovery alone.

Timelines of the Condition
Acute Reactive or early overload phase:
● Typically invoices a gradual onset and worsening of lateral elbow pain with gripping, lifting or resisted finger or wrist extension
● Often becomes tender at the lateral epicondyle
● Timeline of recovery: 2-8 weeks but may be shorter with load modification and exercise

Persistent/Degenerative Phase:
● Ongoing pain with activity + reduced grip strength and difficulty with functional tasks e.g. opening jars, pouring kettle
● Tendon structural changes occur and there is a reduced ability to handle load
● Timeline of recovery: 3 – 12 months with appropriate rehabilitation + load management

Risk Factors:
● Age: Typically between 35 – 55 years
● Smoking, obesity + metabolic conditions are associated with an increased risk of development tendinopathies
● Repetitive upper limb tasks
● Manual handling or manual labour work
● Racket sports with poor technique or sudden spikes in load + inadequate conditioning
● Heavy typing and mouse usage

Physiotherapy Involves:
● Education: Tailored to the individual and their lifestyle factors
● Advice on load modification: Complete rest is not recommended. Tailored loading for specific activities is key
● Progressive and individualised strengthening exercises for the
● Manual therapy for pain relief in the initial stages of recovery

Medical Treatments:
● Pain relief + general analgesics can support staying active through reduced pain in recovery.
● Corticosteroid injection: Corticosteroid injections can provide short-term relief. However, recent evidence has shown worse long-term outcomes + higher recurrence compared to physiotherapy treatment alone
● Surgery: Surgery is a rare treatment for Tennis Elbow
● Imaging: Imaging is not often recommended, however, may be used to rule out other conditions