Tennis Elbow

By Janet Fabbri – Musculoskeletal Physiotherapist


Lateral elbow tendinopathy (also known as ‘tennis elbow’) affects the tendon/s that connect the wrist extensor, or forearm, muscles to the forearm bone. These muscles help control your wrist-joint position and lift your hand upwards.

Most lateral elbow tendinopathies occur due to a) too much load (including repetitive movements such as use of hedge clippers, used of a screwdriver, or increased typing/ mouse use) or b) muscle weakness, placing increased demand on the muscle and tendon.


Other risk factors

  • Age > 40 years
  • High blood pressure
  • Menopausal/Pos-menopausal
  • Higher levels of body fat
  • Type 2 diabetes
  • Other systemic metabolic conditions
  • High cholesterol
  • Recent antibiotics (Fluoroquinolones)


Recovering from a tendinopathy requires consistent management over 3 months and can take approximately 12-18 months to recover completely and return to full function/sport.

Tendons do not like change – therefore they will not like a rapid increase in exercise or activity (e.g. trimming the garden hedge or cleaning the bathroom). They will not like rest. Tendons need a similar amount of activity each day.

This is why your daily exercise program and management of daily load is important!


Common Symptoms

Pain with using your affected forearm, pain that worsens with moving your wrist repetitively or with lifting (e.g. a shopping bag or the kettle). Night pain can occur when the tendon is irritable. Pain is often experienced on the outside of your forearm near your elbow and can extend down towards your wrist. Pain management and control of wrist position and movement is important!


What not to do  ❌

  • Don’t stretch your forearm muscles, because this compresses the tendon onto the bone which reduces the blood flow and reduces healing.
  • Don’t start any new activity you haven’t tried for a while or persist with daily movements/activities or movements that aggravate pain.
  • Do not rest it , keep it gently moving often.
  • Don’t wear a compressive bandage over the tendon because this reduces healing due to reduced blood flow.
  • Do not have a Steroid Injection, as this weakens the tendon and reduces blood flow. Initially there will be less pain , but long term the tendon will not heal and improve.


What to do ✅

  • Load management is key in any tendinopathy. Perform exercises as directed by your Physio or Exercise Physiologist (no more, no less)
  • Heavy slow resistance exercise prescribed by your Physio, which may be moderately painful but this is ok as long as the pain is no more than 4/10 and only lasts a few hours,
  • The use of dry needling versus corticosteroid injection to treat lateral epicondylitis: a prospective, randomized, controlled study DN and CS injection afforded significant improvements during the 6 months of follow-up. However, compared to CS injection, DN was more effective.
  • Observe and note what increases your pain (immediately and up to 72 hours afterward) and what eases your pain
  • Limit mouse use and typing. Pace/break up your work tasks and perform isometrics at work throughout the day.
  • Recommended methods for pain relief include:
    – Ice (however this is controversial so see our insight about “Ice”)
    – Isometric exercise
    – Self-massage of the muscle, not the tendon
    – Use of ibuprofen or naproxen (discuss use of these medications with your GP or pharmacist)

If your pain is getting worse, it means the muscle/tendon is not coping with the load you have placed on it. If it is less stiff and sore, this is a good sign that your tendon is recovering.


How long will it take to recover? ⏰

It can take up to 4 months or longer to fully recover, so be patient and consistent with your exercise program . Your Physio will upgrade the program regularly so that you are gradually increasing the load on the tendon. Our Reformer and Matwork Classes, or specific individually designed gym session on our Pilates equipment, can help  to strengthen and stabilise the elbow and upper body for optimal recovery. Speak to your Physio about which class would suit you best.


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Higher Function Team
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