Tennis Elbow (Lateral Epicondylitis): Causes, Recovery & How Physiotherapy Helps

Tennis elbow — medically known as lateral epicondylitis — is one of the most common causes of outer elbow pain, yet it affects far more than just tennis players. It can impact anyone who performs repetitive gripping, lifting, or wrist-extension tasks, whether at work, in sport, or during daily activities.

This article explains what tennis elbow really is, why it happens, and how a structured physiotherapy approach can help reduce pain, restore function, and prevent recurrence.

What Is Tennis Elbow?

Tennis elbow isn’t actually an inflammation of the elbow joint — it’s a tendinopathy of the tendons that connect the forearm muscles to the outer part of the elbow. Over time, repetitive stress leads to micro-tears and degeneration of tendon fibers, which causes pain and weakness.

Despite the name, tennis players are just one group affected. Other common contributors include:

• Prolonged use of a computer mouse or keyboard

• Repetitive gripping or lifting at work

• Heavy manual labor

• Painting or DIY tasks

Example: A graphic designer who grips a mouse for hours a day may develop tennis elbow symptoms similar to a tennis player’s, even without ever playing a set.

Common Symptoms

Tennis elbow typically presents with:

• Pain or tenderness on the outside of the elbow

• Pain that worsens with gripping or lifting

• Weakness in the forearm or wrist

• Difficulty with basic activities like turning a door handle or shaking hands

Tip: Pain may feel worse during actions like lifting a coffee mug or holding a phone — especially if the wrist is extended.

Why Tennis Elbow Develops

Tennis elbow arises when the forearm muscles (especially the extensor carpi radialis brevis) are overloaded repeatedly, leading to tendinopathy.

Frequently Contributing Factors

• Repetitive work tasks (typing, gripping tools)

• Poor technique in sport or lifting

• Muscle imbalances between forearm flexors and extensors

• Inadequate recovery between heavy tasks

Rather than a single incident, tennis elbow often develops gradually, so early recognition and modification of movement patterns can make a big difference.

How Physiotherapy Helps Tennis Elbow

Physiotherapy targets the root causes and supports both pain reduction and functional recovery. Treatment isn’t one-size-fits-all — it’s tailored to your specific movement patterns, postures, and pain triggers.

1. Movement Assessment and Biomechanical Analysis

A physiotherapist will assess:

• Forearm strength and flexibility

• Elbow and wrist mechanics

• Grip technique

• Daily or sport-specific movements -This helps uncover factors that may have contributed to tendon overload.

2. Progressive Tendon Loading (Eccentric & Isometric Exercises)

Evidence supports tendon-specific exercises for long-term recovery:

• Isometric holds (static tension) can reduce pain

• Eccentric exercises (controlled lengthening) help tendon healing. These are carefully progressed over time to build tolerance.

Example: An isometric hold might involve gripping a light weight with the wrist in slight extension and holding without pain for set durations.

3. Manual Therapy

Hands-on techniques such as soft tissue release or gentle joint mobilizations can:

• Reduce muscle tension

• Improve circulation

• Enhance movement quality around the forearm and elbow

4. Acupuncture Therapy and Electro-acupuncture

Acupuncture and electro-acupuncture may be used to help manage tennis elbow pain, particularly in the early or more persistent stages.

These techniques can help:

• Reduce pain sensitivity

• Improve local blood flow

• Decrease muscle tension in the forearm

Electro-acupuncture applies a mild electrical current through the needles, which may enhance pain-modulating effects and support short-term symptom relief.

Importantly, acupuncture is used as an adjunct to active rehabilitation — helping reduce pain so that strengthening, movement retraining, and load-management exercises can be performed more effectively.

5. Education and Movement Coaching

Learning to modify daily tasks (e.g., adjusting a mouse grip or tool position) reduces repetitive strain and prevents flare-ups.

Practical Exercises for Tennis Elbow

Here are some controlled exercises commonly used in therapy:

Wrist Extensor Stretch

• Hold your arm straight

• Gently pull back the fingers with the other hand

• 30 sec × 3 sets

Isometric Wrist Extension Hold

• Light weight in hand, wrist slightly extended

• Hold without movement for 10–15 sec × 6 reps

Eccentric Wrist Extension

• Slow lowering of a light weight from wrist extension to neutral

• 3 sets × 10 reps (pain-free range only)

Note: Always perform exercises under the guidance of a qualified physiotherapist to ensure proper technique and progression.

Ergonomics & Daily Activity Adjustments

• Consider a neutral wrist posture when typing or lifting

• Adjust keyboard and mouse positions

• Use ergonomic tools and grips

• Break up repetitive tasks with short movement breaks

Small changes in how you handle everyday activity can significantly reduce stress on the tendons.

When to Seek Further Medical Care

Tennis elbow can improve conservatively in most cases, but you should seek professional review if:

• Pain persists beyond 3 weeks

• Pain is severe and interferes with sleep

• You notice significant weakness or numbness

• Symptoms affect both arms

If you’re experiencing persistent pain related to repetitive use, sport, or everyday activities, a tailored physiotherapy assessment can help identify the root causes and build a recovery plan that works for you.

📞 Call +356 9921 2441 to book an appointment and take the first step toward lasting relief.

👉 For more expert articles on movement, pain management, and rehabilitation, visit our main blog page.

References

1. NHS (UK) – Tennis Elbow (Lateral Epicondylitis)https://www.nhs.uk/conditions/tennis-elbow/

2. Mayo Clinic – Tennis Elbow: Symptoms, Causes, and Treatmenthttps://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987

3. American Academy of Orthopaedic Surgeons (AAOS) – Tennis Elbowhttps://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow/

4. British Journal of Sports Medicine – Tendinopathy: Pathophysiology and Treatmenthttps://bjsm.bmj.com/content/49/21/1404

5. Journal of Orthopaedic & Sports Physical Therapy (JOSPT) – Exercise-Based Management of Tendinopathyhttps://www.jospt.org/doi/10.2519/jospt.2016.6272

6. Physio-pedia – Lateral Epicondylitishttps://www.physio-pedia.com/Lateral_Epicondylitis

7. Cochrane Database of Systematic Reviews – Acupuncture for Lateral Elbow Painhttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003527.pub2/full

8. National Center for Complementary and Integrative Health (NCCIH) – Acupuncture: What You Need to Knowhttps://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know

9. Journal of Pain Research – Electro-Acupuncture for Chronic Musculoskeletal Painhttps://www.dovepress.com/electroacupuncture-for-pain-management-peer-reviewed-fulltext-article-JPR

10. World Health Organization (WHO) – Acupuncture: Review of Controlled Clinical Trialshttps://apps.who.int/iris/handle/10665/42414

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