If you’ve been experiencing pain on the outside of your elbow when lifting, gripping, opening jars or even shaking hands, you may be suffering from tennis elbow, also known as lateral elbow tendinopathy.
Despite its name, tennis elbow doesn’t just affect tennis players. In fact, many people who develop this condition have never picked up a tennis racquet.
What causes tennis elbow?
Tendon pain often develops following a change in the amount of load placed on the tendon.
This might occur because you’ve:
- Started a new job or changed work duties.
- Increased your hours of manual work.
- Taken up or increased training in sports such as tennis, golf or gym-based activities.
- Suddenly increased lifting or repetitive gripping activities.
Our tendons are designed to cope with load, but when that load changes faster than the tendon can adapt, pain can develop.
What does tennis elbow feel like?
The pain is most commonly felt over the lateral epicondyle—the bony prominence on the outside of the elbow where the forearm extensor muscles attach.
Symptoms may include:
- Pain when gripping or lifting.
- Difficulty opening jars or turning door handles.
- Pain when shaking hands.
- Tenderness over the outside of the elbow.
- Reduced strength when using the affected arm.
In some cases, other structures can also contribute to symptoms. For example, irritation of the radial nerve may cause pain that extends into the forearm or wrist, making assessment a little more complex.
Because several conditions can cause lateral elbow pain, an accurate diagnosis is important to ensure the most appropriate treatment is prescribed.
Do I need a scan?
Most cases of tennis elbow can be diagnosed through a thorough clinical assessment.
Occasionally, further investigation such as an ultrasound or MRI may be recommended if symptoms are severe, persist despite appropriate treatment, or if another condition is suspected. However, imaging is not routinely required and a conservative approach is often the most appropriate first step.
Why has the treatment advice changed?
Years ago, people with tendon pain were commonly advised to rest completely and stretch the affected muscles.
Research over the past two decades has significantly changed our understanding of tendon pain.
While a short period of relative rest may be appropriate for very irritable or painful tendons, complete rest is rarely the long-term solution. Tendons need carefully prescribed loading to recover.
Current best practice focuses on a graduated strengthening program that helps the tendon adapt and become more resilient over time.
Depending on the stage and severity of the condition, rehabilitation may include:
Isometric exercises
These involve contracting the muscle without changing its length. They are commonly used early in rehabilitation and can help reduce pain while maintaining muscle activity.
Isotonic exercises
These involve moving the muscle through its range while working against resistance. They progressively strengthen the tendon and improve its ability to tolerate everyday activities, work and sport.
The intensity and progression of these exercises should be tailored to each individual, as the appropriate loading will vary depending on the severity and stage of the condition.
How may osteopathy help?
Effective management of tennis elbow extends beyond strengthening exercises alone.
At Lower Plenty Osteopathy, our osteopaths perform a thorough assessment to determine the factors contributing to your pain. Treatment may include:
- Accurate diagnosis and assessment.
- Advice on activity modification and load management.
- Individualised tendon rehabilitation programs.
- Hands-on treatment to improve movement of the neck, shoulder, elbow and wrist where restrictions may be contributing to altered mechanics.
- Soft tissue techniques where appropriate.
- Taping techniques to help reduce symptoms and improve function.
- Guidance on safely returning to work, sport and everyday activities.
Our aim is not only to reduce your pain but also to address the underlying factors contributing to the problem and minimise the risk of recurrence.
You don’t have to manage tennis elbow alone
Tennis elbow can be a frustrating condition. Recovery often takes time, and symptoms can fluctuate throughout the rehabilitation process.
The good news is that with an accurate diagnosis, an appropriate rehabilitation program and the right guidance, most people make excellent progress without the need for surgery.
Our osteopaths are here to help you understand your condition, guide you through every stage of rehabilitation and provide evidence-based treatment tailored to your individual needs.
If you’re experiencing pain on the outside of your elbow or have persistent arm pain that’s affecting your work, sport or everyday activities, we’d be happy to help.