If the outside of your elbow aches after a long day, hurts when you shake hands, or fires up when you grip a kettle, this is for you. Tennis elbow is the most common cause of lateral elbow pain in adults aged 30 to 60, and for most of the people we see, it has very little to do with playing tennis.
01 . What it is
What tennis elbow actually is
Tennis elbow, known clinically as lateral epicondyle tendinopathy or lateral epicondylalgia, is a tendon-load problem. The forearm extensor tendons that attach to the bony bump on the outside of your elbow stop coping with the demands placed on them, and the tissue becomes painful and tender. In some cases there is microscopic tearing within the tendon, but most current research describes the problem as a failed healing response rather than ongoing inflammation.
This matters because the old name “tennis elbow” makes the condition sound like a sports injury. In a large population study, around 1.3% of working-age adults had definite tennis elbow, with the highest rates in the 45 to 54 age group and a clear link between repetitive arm movement and forceful activity done together. Office workers, tradespeople, musicians and parents of small children all show up in clinic with it.
The tendon can become overloaded two ways. It can be underused: a desk-based job with low background load, then a sudden ramp in typing, painting, or weekend gardening. Or it can be overused: high repetition without enough recovery, week after week.
02 . Causes
What sets tennis elbow off
The pattern is almost always the same: an activity that loads the wrist extensors, repeated more often than the tendon is used to. The common triggers we see at Optimum Health Solutions include:
- Gripping and wringing activities such as using a screwdriver, pulling weeds, wringing out cloths, or carrying heavy bags by the handle.
- Painting, hammering, and tool use: the classic “unaccustomed hand use” pattern, where a person takes on a one-off job that loads the forearm in a way their tendons have not adapted to.
- Typing and keyboard work, especially with the wrist bent or held in extension for long stretches.
- Racquet sports, particularly with a poor backhand technique, a too-tight grip, or a string tension that does not suit the player.
- A sudden ramp in volume, like going from an hour of typing a day to a five-hour drafting session, or from no gym to a heavy grip-based session, without a build-up.
Awkward wrist postures, like working with the wrist bent and turned to one side, change how the forearm muscles share the load and have been studied as a risk factor. Weak forearm muscles or tight wrist extensors make all of the above more likely, and so does a previous episode on the same side. The dominant arm is most often affected, but both arms can be involved if both hands are doing the loading.
03 . Signs and symptoms
The signs and symptoms to look for
Tennis elbow symptoms come on gradually. Most people cannot point to a single moment of injury. The pain starts as a mild ache on the outside of the elbow and builds over weeks or months. The classic signs and symptoms include:
- Pain or burning on the outside of the elbow, often centred on the bony bump (the lateral epicondyle).
- A weak or painful grip, especially when the elbow is straight. Opening jars, turning a key, or holding a coffee cup can become sore.
- Pain that worsens with forearm activity such as typing, holding a racquet, shaking hands, lifting a kettle, or turning a wrench.
- Pain at night in some cases, particularly after a busy day.
- Stiffness in the morning that eases as the arm warms up.
A Physiotherapist can confirm the diagnosis with a brief examination. Common in-clinic tests include resisted wrist extension (pressing the back of the hand up against light resistance), Cozen’s test (resisted wrist extension with the elbow straight and the fist clenched), and Mill’s test (gently stretching the wrist into flexion with the elbow straight). Pain at the bony bump during any of these points toward tennis elbow. We also track pain levels and pain-free grip strength over time, so progress is measured, not guessed at.
04 . What helps
What physiotherapy actually does for tennis elbow
In the first two to six weeks, the highest-value steps are relative rest (not full rest), load management, and changing the activity that set the pain off. That might mean easing your grip on tools, frequent micro-breaks, a softer technique on the court, or a kinder desk setup. Short bouts of ice for 10 to 15 minutes after a flare can help with comfort, and simple over-the-counter pain relief used short-term is reasonable. Taping the forearm can give a useful pain-relief and grip bump while you build the program underneath it.
Beyond six weeks, the evidence consistently points to loaded exercise as the foundation of recovery. A systematic review of eccentric exercise (lengthening the muscle under load) found it should be part of a multimodal physiotherapy program for tennis elbow, rather than used on its own. A randomised controlled trial in Brisbane found that physiotherapy combining manual therapy and exercise was better than wait-and-see in the first six weeks, and better than a corticosteroid injection after six weeks, with far lower recurrence than injection at one year. A later trial found that a corticosteroid injection gave short-term relief but worse recovery and much higher recurrence at one year than a dummy injection.
Practically, your Physiotherapy program will likely include:
- Isometric holds in the early painful phase to settle symptoms while keeping the tendon loaded.
- Eccentric and heavy slow resistance work for the wrist extensors as pain settles, building tendon capacity week by week.
- Manual therapy techniques such as graded joint mobilisations alongside loaded exercise when stiffness or guarding is limiting your range.
- Forearm and shoulder strength work to take some of the load off the elbow.
- A return-to-activity plan that gradually rebuilds typing volume, gripping work, or sport-specific load.
This takes time. Tendon tissue adapts over weeks to months, and the people who recover well are the ones who keep loading it under guidance rather than waiting for it to disappear.
Tendon tissue adapts over weeks to months. Waiting for tennis elbow to disappear is the slowest path through it.
05 . Day-to-day
Self-care, work setup, and getting back to activity
Most of the recovery happens between physiotherapy visits, so the day-to-day choices matter.
If desk work is part of the picture, the keyboard and workstation setup is worth getting right, and our companion guide to tennis elbow from typing covers that in detail. Whatever set your elbow off, a few practical anchors help:
- Take a 30-second wrist break from repetitive tasks like typing or tool use every 20 to 30 minutes. Drop the hands, shake them out, and stretch the forearm gently.
- Ease your grip on tools, racquets, pens, and the steering wheel. A light grip is plenty for most tasks.
- Carry weight closer to the body when shopping, gardening, or lifting. Long-lever loads hit the outside of the elbow hard.
- Heat for stiffness, ice for a flare. Both are short-term comfort tools, not the treatment.
- If you wake up sore, try not to sleep with the elbow fully bent under a pillow.
Returning to sport, gym, or trade work follows the same principle as the rest of recovery: increase the load gradually. A useful rule of thumb is no more than a 10% increase in volume or intensity per week, with a check-in if pain stays above a mild ache the next day. Your Physiotherapist can build the specific progression for the activity you want back.
References
- Shiri and colleagues, 2006. Prevalence and determinants of lateral and medial epicondylitis: a population study. American Journal of Epidemiology, 164(11), 1065-74. DOI: 10.1093/aje/kwj325.
- Cullinane and colleagues, 2014. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clinical Rehabilitation, 28(1), 3-19. DOI: 10.1177/0269215513491974.
- Bisset and colleagues, 2006. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ, 333(7575), 939. DOI: 10.1136/bmj.38961.584653.AE.
- Coombes and colleagues, 2013. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA, 309(5), 461-9. DOI: 10.1001/jama.2013.129.
- Australian Physiotherapy Association. Choosing a physiotherapist. National peak body for the Physiotherapy profession in Australia.
- Healthdirect Australia. Tennis elbow. Australian Government health information service.
