Tennis Elbow: A Physiotherapist's Perspective



'Tennis elbow' or 'lateral epicondylitis' or 'lateral epicondylalgia', are the various terms used by different clinicians to describe pain around the outer aspect of elbow joint. Pathologically, it involves tendon of the forearm muscles. Lateral epicondylitis is now considered an inappropriate term as it is very clear through research that it is more of a degenerative issue rather than an inflammatory condition. The term tennis elbow can also be confusing to the patient as it does not only occur to people who are engaged in playing tennis. The term is used as back hand stroke of tennis, puts extra strain on tendon in question. Racket sports can also be a predisposing factor to this condition.

Lateral epicondylalgia is an overuse syndrome and activities like back hand stroke in tennis, manual DIY work which involves heavy lifting, poor technique in sports, use of a heavy racket or bat in cricket etc can trigger it. All these leads to over-loading of the forearm muscles which in turn pulls on its tendon (muscles attach to bone through tendon) attachment. If the aggravating factor is continued the condition can worsen and in extreme situation it can also lead to a rupture of the tendon.


Management of tennis elbow:


Rest is crucial in tennis elbow as it is for any musculoskeletal and sports injury, to allow the tendon to heal. It is very important to assess the causative factor and thus refrain from it.


Application of ice or a bag of frozen peas wrapped in a towel for about ten minutes may help to reduce pain. It is important to be careful not to leave it too long as one may end up having cold burns.


Full recovery will more often require modifying the causative factors such as changes to either activities or technique of sport. Anti-inflammatory medications or gel may also have a role to play. Please discuss with your GP prior to use.


Recommendation from research literature is that any sport or exercise should be avoided if that leads to a greater than moderate discomfort or 4/10 pain.


As healing occurs, it is important to regularly stretch the muscles around the elbow and in particular the muscles of the tendon involved. Regular strengthening exercises are important to allow the injured tendon to heal prior to return to sport (Trained professionals at The Sherwood Clinic can guide you towards specific exercises).


For non-respondent cases or for early recovery, manual therapy may be required. At The Sherwood Clinic we have chartered physiotherapists who use evidence based manual techniques for all conditions.


Acupuncture, deep tissue manipulation, ultra-sound therapy may also be useful. Wearing an elbow support during the aggravating activities to support the muscles in the forearm can also be used.


Prevention of Tennis Elbow:


Warm-up before any sporting activity is very important to prepare the muscles for sport. Rest is equally important for your muscles as exercise is, never play a sport or engage in any activities for prolonged period if they lead to greater than moderate discomfort.

For racket sport people make sure the racket is not too heavy. Assess your technique and make sure it is good with all your shots, always strike the ball in front of you with the elbow straight but supple to dissipate force.


Do regular exercises aimed at stretching and strengthening of your forearm muscles.


Huzaifa Dahodwala MSc (Sports), COMT (Australia). MCSP

Senior Physiotherapist, The Sherwood Clinic