What is Tennis Elbow?

Lateral epicondylalgia or lateral epicondyle tendinopathy, formerly and commonly referred to as tennis elbow, is a condition which causes dysfunction within the origin of the tendons on the outside of the elbow.

This is caused by overuse and repetitive loading of the wrist extensor muscles, usually during manual labour, housework and hobbies (For example: racquet sports, typing and playing an instrument). It can come on acutely as a result of a strenuous activity that you do not normally do.

Repetitive use of the forearm muscles can lead to microscopic tears within the tendon origin,  collagen disruption and an in growth of blood vessels. It also leads to muscle dysfunction and changes in the pain systems.

Risk Factors:

  • Smoking
  • Obesity
  • Repetitive wrist extension which is carried out for more than 2 hours per day
  • Vigorous activity (managing loads of over 20kg at least x10 a day)
  • Handling tools heavier than 1kg.

Common symptoms include:

  • Pain on the outside of your elbow.
  • Pain from your elbow down into the forearm.
  • Difficulty with gripping activities due to pain.
  • Difficulty with twisting movements such as opening jars.

What you can do to help yourself

Avoiding aggravating activities and activity modification

  • Turning palm up while lifting
  • Racquet sports – avoid using a heavy racquet or with a too small grip size
  • Using lighter tools at work
  • Counter force brace – some people get relief from using a counterforce brace to offload the tendon when using their arm.

Address ergonomics

  • Mouse – ensure your mouse is within close reach. It should be positioned at your side with your arm close to your body and a straight line between your hand and your forearm. The mouse should fit your hand, as if it is too small then this can cause your finger, hand and wrist muscles to remain tense.
  • Keyboard – your wrists should be straight and not bent up or down. Do not raise the back of your keyboard as this can increase the strain on your wrists. If your hands are not level with the keyboard you can use a wrist pad.
  • Maintain a 90 degree angle between forearms and upper arm. If your forearms are too high or too low, adjust the height of your chair.
  • Ambidextrous vertical mouse – reduces exaggerated movements at the wrist joint to reduce stress on muscles and tendons. It can be used in the left and right hand to share the workload.
  • Split Keyboard – can help keep your hands in a more neutral position.

Reduce / Quit Smoking

Smoking has been found to reduce circulation. If circulation is poor, tendons may take longer to heal and therefore will increase the risk of injury.  Previous smokers are also at increased risk of tennis elbow due to the previous exposure and effects of tobacco on the vascular system. You can find help to reduce or quit smoking here – here

Weight Loss

Being overweight can increase the inflammatory molecules in the body which can lead to local and systemic inflammation within the body and therefore poorer healing and resolution of pain. You can calculate your BMI here to find out if you are a healthy weight.


The majority of patients (80-95%) with this condition will resolve with conservative treatment.

For lateral epicondylalgia there is no quick fix. There is no substitute for a thorough examination to allow for a specifically tailored treatment approach.

Physiotherapy will include:

  • Specialise strengthening program and load management.
  • Manual therapy – which may include joint mobilisations, soft tissue release and acupuncture to settle pain.


Extracorporeal Shock-Wave Therapy (ESWT) is a treatment method which sends sound waves into the tissue which initiates a pro inflammatory response to the affected tissue. This increases blood circulation and metabolism in the affected area to accelerate the body’s own healing process.

For further information about ESWT – please click here

Ultrasound Guided Dry Needling

If conservative treatment is failing then “dry needling” of the tendon may help stimulate an inflammatory reaction within the tendon to kick start the healing process. We do this using ultrasound guidance to ensure we target the exact tissue.

PRP and Hyaluronic acid Injections

There is research to suggest that using a steroid injection to treat this condition will give temporary relief but at 3 months post injection, things are usually worse. PRP (Platelet Rich Plasma) injections may be a more suitable alternative as it is considered a regenerative medicine and more likely to give better long-term symptomatic relief than a steroid injection. It involves using your own blood constituents and separating the plasma out of the blood to re-inject back into the damaged tissue. This is usually done in combination with the dry needling mentioned above to help stimulate healing. 

Hyaluronic acid can also be injected around the tendon origin to stimulate healing. It also does not have any potential negative effects that cortisone can have in this location. 

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