What Is Tennis Elbow and How Does It Develop?

Tennis elbow is a common condition that causes pain around the outside of the elbow. Despite its name, it is not limited to tennis players. Repetitive gripping, lifting, twisting, typing, manual work and sports can all place repeated stress on the tendons connecting the forearm muscles to the elbow.

Medically known as lateral elbow tendinopathy, tennis elbow usually develops gradually when these tendons are repeatedly overloaded and do not have enough time to recover.

Tennis elbow affects the tendons attached to the lateral epicondyle, the bony prominence on the outside of the elbow. These tendons help extend the wrist and fingers and are heavily involved in gripping and lifting.

Despite the commonly used term "lateral epicondylitis," persistent cases are not solely due to inflammation. Repeated tendon loading can lead to microscopic tissue changes and a reduction in tendon capacity over time.

The main trigger is repetitive or excessive loading of the forearm muscles and tendons. This can happen during sports, work or everyday activities.

Common causes include:

• Repeated gripping, squeezing or lifting

• Tennis, badminton and other racquet sports

• Gardening, carpentry and plumbing

• Frequent use of hand tools

• Repetitive wrist movements

• Sudden increases in exercise intensity

• Poor technique or unsuitable sports equipment

A sudden change in activity, such as starting a new sport or significantly increasing training volume, can also increase tendon stress.

The most characteristic symptom is pain and tenderness on the outside of the elbow, which may extend into the forearm. Pain often begins during specific movements and may become more persistent if the tendon continues to be overloaded.

Other symptoms can include:

• Pain while gripping or squeezing objects

• Difficulty lifting a cup, bag or other objects

• Pain when turning a doorknob or opening a jar

• Weakness in the hand or forearm

• Stiffness around the elbow

• Pain during wrist or forearm movements

Tennis elbow can affect anyone, but it is particularly common in adults between 35 and 54 years of age. Risk can increase when work or recreational activities involve repetitive wrist and forearm movements.

People involved in manual occupations, racquet sports and activities requiring frequent gripping may be more exposed to repetitive tendon loading.

A healthcare professional will usually diagnose tennis elbow through a medical history and physical examination. The examination may include checking tenderness, grip strength and pain during specific wrist and forearm movements.

Imaging is not always necessary. X-rays, ultrasound or MRI may be recommended when symptoms are persistent, severe or atypical, or when another condition needs to be ruled out.

Treatment aims to reduce excessive tendon stress, manage pain and gradually restore strength and function.

Temporarily reducing activities that aggravate the pain can allow the tendon to recover. However, complete immobilisation is generally unnecessary.

Changing the way an activity is performed, reducing repetitive movements and taking regular breaks can help decrease tendon loading.

Progressive strengthening is one of the most important components of rehabilitation. A physiotherapist may recommend exercises targeting the wrist extensors, forearm and surrounding muscles.

The amount of resistance should generally increase gradually as the tendon becomes better able to tolerate load.

The goal is not simply to reduce pain but to improve the tendon’s ability to handle everyday and sporting demands.

A forearm strap or wrist support may temporarily reduce stress on the affected tendon and make certain activities more comfortable. These supports are generally used alongside rehabilitation rather than as a replacement for strengthening.

Pain-relieving medicines and topical oils or gels may help manage tennis elbow symptoms and provide local relief when needed.

Topical cannabinoid-based oils are also used for localised musculoskeletal pain and may offer supportive relief alongside activity modification and rehabilitation.

Corticosteroid injections may provide short-term relief but may have less favourable long-term outcomes. Surgery is rarely needed and is generally considered when symptoms persist despite non-surgical treatment.

Alongside appropriate medical care, several lifestyle and rehabilitation strategies can support recovery:

• Gradually increase activity: Avoid sudden increases in training, workload or repetitive movements.

• Strengthen the forearm: Progressive exercises can improve tendon capacity.

• Take regular breaks: Particularly during repetitive occupational or computer-based activities.

• Use proper technique: Correct sporting or workplace technique can reduce unnecessary tendon stress.

• Apply heat or cold: These may provide temporary symptom relief for some people.

• Prioritise recovery: Adequate rest between repetitive or strenuous activities can help manage tendon load.

Prevention focuses on managing repetitive load before it becomes excessive. Increasing exercise intensity gradually, maintaining forearm strength, using appropriate equipment and technique and taking breaks during repetitive tasks can all help. It is also important to address pain early rather than repeatedly working through significant symptoms.

Medical evaluation is recommended when pain is severe, persistent or interfering with daily activities, or when symptoms follow a significant injury. Evaluation is also important if there is considerable swelling, redness, weakness or loss of movement.

Persistent elbow pain should not automatically be assumed to be tennis elbow, as several other conditions can cause similar symptoms.