Tennis Elbow: Causes, Symptoms, and How We Can Help
- staystrongtherapy
- Jun 30
- 4 min read
All information in this blog is supported by NICE guidance and peer-reviewed research. Reference numbers appear throughout, with the full list at the bottom of the page.
What Is Tennis Elbow?
Tennis elbow, medically known as lateral epicondylitis, is one of the most common causes of elbow pain we see. It describes an overuse injury caused by eccentric overload of the common extensor tendon at its origin on the outer elbow, specifically affecting the extensor carpi radialis brevis tendon, and results primarily from repetitive strain. ¹
Despite the name, it has little to do with tennis for most people. It commonly affects anyone whose work or hobbies involve repetitive gripping, lifting, or wrist movement, from manual trades to keyboard use to racquet sports.
Common Signs and Symptoms
Pain and tenderness over the outer (lateral) side of the elbow
Pain that may radiate down the forearm
Gradual, insidious onset rather than sudden injury
Pain worse with gripping, lifting, or twisting movements, such as shaking hands, lifting a kettle, or turning a door handle
Discomfort that can also be worse at night or after periods of rest
How Is It Diagnosed?
Diagnosis is primarily based on history and examination, and making the correct diagnosis is crucial to ensure efficient, optimum treatment. ² Plain X-rays are not essential for confirming the diagnosis, and specialist imaging such as MRI or CT scans are not needed for treatment in primary care. ² Two specific hands-on tests are commonly used to support diagnosis, Mill's test and Cozen's test, both designed to reproduce pain over the lateral epicondyle through resisted wrist extension. ³
Signs to Look Out For
Tennis elbow is a benign, self-limiting condition. Please seek medical assessment if you experience:
Significant swelling, redness, or warmth around the elbow (possible infection)
Elbow pain following significant trauma, with deformity or inability to move the arm
Numbness or weakness spreading down the arm
Fever or feeling generally unwell alongside elbow pain
How We Can Help
Osteopathic manual techniques and manual therapy: isometric and eccentric strengthening exercise combined with manual therapy has been shown to produce significant reductions in pain, alongside improved functional outcomes. ⁵ Manual therapy techniques such as deep transverse friction massage and joint mobilisation, used alongside conventional exercise therapy, have shown genuine improvement in pain and function in clinical case evidence. ⁶
Deep tissue and sports massage: deep transverse friction massage helps release tension from the muscle and tendon tissue and break up scar tissue that can develop after repeated strain. ⁶
Medical acupuncture and cupping: used alongside exercise-based treatment to support pain management during the rehabilitation process.
Corticosteroid injection: whilst corticosteroid injection can provide promising short-term relief, its recurrence rate is higher than physiotherapy alone or even a simple wait-and-see approach, so we would not recommend this as a first-line treatment. ⁷
Exercise: The Cornerstone of Recovery
Eccentric loading exercise, gradually strengthening the tendon by lengthening it under controlled tension, is well established as a core part of tennis elbow rehabilitation. ¹
Eccentric wrist extension: using the unaffected hand to lift the affected wrist into extension, then slowly lowering it against gravity with the affected arm alone.
Isometric wrist extension holds: useful in the early, more painful stage, holding the wrist in extension against light resistance without movement.
Progressive grip strengthening: gradually building tolerance to gripping activities as symptoms allow.
Your practitioner will guide a structured, progressive loading programme tailored to your stage of recovery, since pushing too hard too soon can aggravate symptoms.
What to Expect at Your First Appointment
We will take a thorough history and carry out a hands-on assessment using Mill's and Cozen's tests, in line with current diagnostic guidance, without the need for imaging in most cases. We will explain clearly what we find and build a progressive treatment plan combining manual therapy with a tailored exercise programme.
Frequently Asked Questions
Do I need a scan? No, NICE guidance confirms imaging is not needed to diagnose or treat tennis elbow in most cases. ²
Should I have a steroid injection? It can help short-term pain, but evidence shows higher recurrence rates compared with physiotherapy, so we'd recommend starting with exercise-based treatment. ⁷
How long will it take to improve? Tennis elbow is generally self-limiting, but recovery with structured exercise typically takes several weeks to a few months, depending on how long symptoms have been present.
Recognise these symptoms? Get in touch using the contact form and we will assess and build the right treatment plan for you.
References
Lateral Epicondylitis (Tennis Elbow). StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK431092/
National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary, Tennis Elbow. Available at: https://cks.nice.org.uk/topics/tennis-elbow/
Effectiveness of Active Release Technique With Conventional Therapy in the Management of Lateral Epicondylitis: A Case Report. Cureus. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10800006/
Karanasios S, Korakakis V, Whiteley R, et al. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small. British Journal of Sports Medicine. 2021;55:477-485.
Advances in the Diagnosis, Management, and Rehabilitation of Lateral Epicondylitis: A Comprehensive Review of Recent Evidence. Journal of Pioneering Medical Sciences. 2025. Available at: https://jpmsonline.com/article/advances-in-the-diagnosis-management-and-rehabilitation-of-lateral-epicondylitis-a-comprehensive-review-of-recent-evidence-803/
Effectiveness of the Cyriax Technique With Conventional Therapy in the Management of Lateral Epicondylitis: A Case Report. Cureus. 2024. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227430/
Management of Lateral Epicondylitis Using Transdermal Nitroglycerin: A Systematic Review. Cureus. 2022. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840472/
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