Tennis Elbow: What It Is and What To Do About It

Tennis elbow, also called lateral elbow tendinopathy, causes pain on the outside of the elbow where the forearm extensor tendons attach. Despite the name, you do not have to play tennis to get it. It is commonly linked with gripping, repetitive wrist extension, lifting and manual tasks. NICE describes it as chronic symptomatic tendon degeneration at the outer elbow.

What tennis elbow feels like

Typical symptoms include:

• pain on the outside of the elbow
• pain when gripping, lifting a kettle or turning a handle
• discomfort when shaking hands
• tenderness over the bony outer part of the elbow
• reduced grip strength

NHS advice notes it can last for weeks or months and often needs patience as the tendon gradually settles.

Why it happens

Tennis elbow is usually an overload problem rather than an inflammation problem. It often develops when the tendon has been repeatedly stressed without enough recovery. Common triggers include:

• repetitive manual work
• racquet sports
• gardening or decorating
• carrying heavy bags
• sudden increase in gripping or lifting tasks

NICE and recent elbow guidelines both emphasise that it is a tendon loading issue and often improves with activity modification and structured exercise.

What helps most people

Early management usually includes:

• modifying painful gripping or lifting tasks for a while
• gradually reloading the tendon with specific exercises
• avoiding complete rest for long periods
• considering a strap or brace if it helps short term
• reviewing workstation or tool use if symptoms are work related

NICE CKS points patients towards exercises, self management and occupational advice where needed. NHS and hospital exercise leaflets also stress that improvement can be slow but steady if you build strength consistently.

What kind of exercises are used

Common rehab usually starts with:

• gentle wrist extensor isometrics
• progressive wrist extension strengthening
• grip strengthening
• forearm stretching where appropriate
• loading that increases in a measured way

The 2022 JOSPT clinical practice guideline for lateral elbow tendinopathy supports exercise based rehabilitation and careful load management as core elements of treatment.

Where chiropractic care may fit

For persistent tennis elbow, chiropractic care can support recovery as part of a broader plan. That may include:

• checking the elbow, wrist, shoulder and neck to see how the whole upper limb is functioning
• soft tissue work for overloaded forearm muscles
• joint mobilisation where appropriate
• guidance on graded strengthening
• advice on work, sport and grip modification

As with many tendon problems, the goal is not just to reduce pain but to rebuild capacity in the tendon and surrounding muscles.

When to seek further medical advice

You should get checked if:

• symptoms are not improving after several weeks
• you have significant swelling or locking of the elbow
• pain followed a major injury
• there is numbness, tingling or wider arm weakness
• your symptoms are stopping you working or sleeping

These features may suggest a different diagnosis or the need for a different treatment route.

Local note

At Alpha Chiropractic in Hemel Hempstead, we help patients with elbow and arm pain from St Albans, Watford, Harpenden, Berkhamsted, Tring, Kings Langley and Apsley. Where appropriate, treatment is combined with clear exercise advice and realistic expectations about tendon recovery.

Pain on the outside of the elbow not settling? Book an assessment and let’s work out whether it could be tennis elbow and what is most likely to help.

Sources

• NICE CKS. Tennis elbow overview and management.
• NHS. Tennis elbow symptoms and treatment.
• JOSPT 2022 Clinical Practice Guideline. Lateral elbow pain and muscle function impairments.
• Oxford University Hospitals. Tennis elbow advice and exercises.
• NHS Inform. Exercises for tennis elbow.
• Royal Berkshire NHS Foundation Trust. Tennis elbow leaflet.
• BESS patient care pathway for tennis elbow.