Tennis Elbow (Lateral Epicondylalgia)

Overview

Tennis elbow is pain on the bony point on the outside of the elbow, where the tendons of the muscles that lift your wrist and fingers attach. Despite the name, fewer than one in ten people with it play tennis. It is really a condition of repetitive gripping and wrist use — computer work, DIY, lifting a kettle or a laptop bag, carrying children, or racket sports.

The medical term has shifted from "epicondylitis" (meaning inflammation) to "epicondylalgia" or "tendinopathy", because research shows the tendon is not simply inflamed. Instead, repeated load without enough recovery leads to changes in the tendon structure, making it painful and less able to cope with gripping.

It is most common between 35 and 55, affects both sexes, and usually affects the dominant arm. Many cases improve over months with the right loading programme, though some can linger for a year or longer if the tendon keeps being irritated.

Causes and risk factors

• Repetitive gripping, lifting or twisting — DIY, cooking, carrying bags, racket sports
• Long hours of keyboard and mouse use with the wrist held up
• A sudden increase in a new activity (gardening, redecorating, a new gym routine)
• Age 35–55
• Poor racket technique or a grip that is too small or too tight
• Smoking, and conditions affecting tendon health such as diabetes

How we may be able to help

Our assessment confirms the diagnosis, checks how much grip strength has been lost, and looks for contributing factors — the neck and shoulder are routinely assessed, because nerve irritation in the neck can mimic or worsen tennis elbow. If the picture is unusual or you have not responded to treatment, we can arrange an online GP consultation for an ultrasound scan or specialist referral.

The main treatment is a progressive loading programme delivered through physiotherapy: starting with isometric holds that reduce pain, moving to slow, heavy resisted wrist work, and finally building grip strength under load. This retrains the tendon's capacity, and evidence suggests it gives better long-term results than rest or passive treatments alone.

Focused shockwave therapy is one of the more widely studied adjuncts for tennis elbow and may help stimulate tendon recovery when pain has been present for several months. We combine this with hands-on treatment — IASTM and dry needling for the tight forearm extensor muscles, and mobilisation of the elbow joint — plus kinesiology taping to offload the tendon during work and sport. Therapeutic ultrasound may be used for pain relief early on. Where the neck or upper back is contributing, our chiropractor can address it.

What you can do at home

• Reduce — not stop — gripping tasks; swap heavy pans and bags for lighter ones for now
• Lift with your palm facing up rather than down, which takes load off the extensors
• Try an isometric hold: press the back of your hand up against a table edge for 30–45 seconds, a few times a day
• Adjust your desk so your wrist rests flat and your mouse is close to your body
• A forearm strap (counterforce brace) may ease pain during tasks for some people
• Avoid aggressive stretching when the elbow is very sore; it can irritate the tendon