Chiswick-Physio BLOG


A Guide To Tennis Elbow
Muscles & Joints


Clients with non-traumatic elbow disorders are most common to seek help for pain in the outside aspect of the elbow. Tennis elbow, also known as lateral epicondylopathy (LE), is the most common diagnosis.

Approximately 1% to 3% of the population is affected by this condition, which primarily affects middle-aged people without gender predisposition.

“You don’t have to play tennis to be diagnosed with tennis elbow”.

What are the symptoms of Tennis Elbow?

Most people present with pain on the outside of the elbow, usually radiating along the muscle mass on the front of the arm. This is usually exacerbated by making a fist or when gripping.

Tennis Elbow typically presents itself over a period of 6 to 24 months, and 90 percent of affected individuals have symptom resolution within one year.

The onset of symptoms is usually insidious and not directly linked to a specific traumatic event. Tennis elbow is usually related to a sudden increase in activity involving a grip such as cutting the hedge, DIY, lifting or playing a sport which involves gripping a racquet or club. During lifting activities or while holding the forearm in pronation (palm down), pain can also be exacerbated.

What are the causes of Tennis Elbow?

The role of the tendon is to stretch easily in response to gradually increasing forces (think of a tendon as a spring).

Occasionally, a microtear may occur when this stretch exceeds the tendon’s tolerance. Frequent high loads, repetitive use, and only rarely one abrupt force directed towards the tendon can cause this.

The accumulation of multiple microtears can cause degenerative changes in the tendon, also known as tendinopathy.

What is the treatment for Tennis Elbow?

There are usually five therapeutic goals in treating tennis elbow:

  • Managing elbow pain

  • Maintaining the movement of the affected limb

  • Increasing grip strength and endurance

  • Returning the affected limb to normal function

  • The prevention of further deterioration

An important step in early effective management is educating patients concerning the nature of their condition, modifying their lifestyles to reduce aggravating activities, and using the appropriate pain-relief medication, including anti-inflammatories.

Additional supportive measures – such as splinting, eccentric loading exercise, and early referral to a physiotherapist – assist with pain management and decrease the associated psychological stress.

Shockwave Therapy and Tennis Elbow

Shockwave therapy or extracorporeal shockwave therapy (ESWT) is a non-invasive, evidence-based treatment for common musculoskeletal conditions such as tennis elbow. 

Here at Chiswick-Physio we use it in conjunction with a progressive loading programme and it must not be used in isolation or as the only form of treatment.

The main benefits of shockwave is pain relief and restoration of function.


    Activities and movements to avoid with Tennis Elbow

    Excessive or unaccustomed activity is likely to be the most important factor to avoid in patients with tennis elbow. A pain-monitoring model can help patients determine how much activity to do based on the symptoms they experience during and after activities.

    • Refrain from extending your elbow joint all the way to its end range of motion. Similarly, avoid bending your arm inwards to the end range.

    • Avoid repetitive movements with your hands and wrists, for example, when performing domestic chores like washing up or when typing. Make sure you take breaks from such activities when possible.

    • Do not lift heavy objects with your arm fully extended. Work or lift weights partially bent at the elbow instead.

    • When using heavy tools use both hands, and when playing tennis, use the two-handed backhand.

    • Avoid repetitive grasping and gripping motions with your hands.

    • If a movement triggers the pain again, avoid it and notify your clinician.

    Summary of Tennis Elbow

    Tennis Elbow is a common cause of pain and disability affecting patients aged between 35 and 55 years. The typical course of these cases lasts between 12 and 18 months. Symptoms can, however, persist and be refractory, thus requiring interventional measures.

    Tennis elbow is typically treated nonoperatively as the priority and mainstay. Treatment may include exercises, stretches, anti-inflammatory medications, and activity modification.

    In the vast majority of cases, nonoperative treatments can be used to treat the condition, with a success rate as high as 90%.

    We are here for you

    If you’re in pain and would like to talk to us about getting some help, some specialist advice, or if you are looking for a diagnosis, remember we are always here to help you.

    Appointments remain limited and we are experiencing an exceptionally high demand for our physio services, so please contact us immediately to avoid a long wait.

    If you would like to get one of our limited slots, please click book a consultation to email or CALL us on 07900603617.

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