Advice on how to avoid and treat tennis elbow

Spring is upon us and as the weather warms up we become more active increasing outdoor hobbies, increasing the time spent on these hobbies and undertaking work previously set aside for the better weather.
Muscles and tendons get used to day to day activities and loads that we place through them. However, if they are subjected to a sudden increase in repetitive activity and load for enough time can become painful and weak. One commonly known condition is tennis elbow also known as lateral epicondylitis and more recently extensor tendinosis. Golfers elbow is a similar condition however is associated with the tendons on the inside of the elbow and will be discussed in a separate blog.

What is Tennis Elbow?

Tennis elbow is caused by repetitively overusing forearm muscles that attach through tendons to your elbow and primarily produce the movement to extend the wrist. As its name suggests tennis elbow can be caused by tennis commonly the back hand stroke however can also be caused by other activities that place strain through the elbow for example gardening, racquet sports, painting, decorating and DIY. The condition is common and can effect anyone; however you are most likely to suffer with symptoms around the ages of 40-50 years.

Tennis elbow is characterised by pain on the outside of the elbow when gripping. For example opening a door or jar, lifting the kettle, shaking hands, gripping a power tool, lifting bags, pulling up pants and trousers. Repetitive overload of the tendon compromises blood flow to the tendon triggering a painful degenerative process. The good news is that tennis elbow is a self-limiting condition and can spontaneously improve over one to two years. Recovery timescales can be improved with self management and conservative therapy.

Initial management for tennis elbow which can improve recovery timescales.

  1. The most important point to remember is to rest from the repetitive activity that causes the problem.
  2. Apply a cold compress; for example ice or frozen peas wrapped in a damp cloth to the painful area for 20 minutes every two hours whilst you are awake.
  3. Adopt a Lifting technique with your palm facing up.
  4. Painkillers if required such as Paracetamol and Ibuprofen.
  5. Commence a graded loading programme
    Link –
    Hold for 20 seconds, ten times and twice a day. It will feel uncomfortable, but you will not be causing harm and after 5-7 days the discomfort will ease.

Self-help treatment options if symptoms persist

  1. You may wish to purchase an elbow epi-clasp which correctly fitted will redirect the load/strain away from the effected tendon
  2. Sport tape or Kinesiology tape is useful for reducing inflammation and pain
    How to apply the tape –

How can physiotherapy help?

At Fay Pedler physiotherapy clinic we will first undertake an assessment including full medical history including aggravating and easing factors, any previous tendon, general health and other conditions that may pre-dispose to Tennis elbow. A physical examination will determine any loss of elbow, wrist or finger range of movement, test for signs of nerve involvement and stress the forearm extensor muscles to recreate symptoms and accurately diagnose.
We then make sure that you are undertaking all possible self-help management strategies correctly and progress as appropriate before discussing any further interventions we can offer which may include:

  1. Acupuncture – Although not a standardised treatment for Tennis elbow we have had great responses in reducing pain and enabling patients to undertake the strengthening exercises.
  2. Shockwave therapy – Recent guidelines suggest a benefit to patients with tennis elbow. Follow the link below for further information:
  3. Arrange onward referral for a steroid injection into the affected area of the elbow to reduce painful symptoms allowing full participation with strengthening exercises.

Prevention is better than cure

  • Maintain and/or build up the strength in your forearm musculature so they are strong and conditioned to undertake repetitive activities.
  • Take regular breaks from repetitive activity.
  • Reduce the load / stress through your forearm and modify repetitive activities.
  • Widen your grip.