• Aug 07, 2025
• By TJICLondon

Tennis Elbow: Causes, Symptoms, and Effective Treatment Options

Tennis Elbow: Causes, Symptoms, and Effective Treatment Options

Have you been experiencing a nagging pain on the outer side of your elbow, especially when lifting or gripping objects? You might be dealing with tennis elbow, a common condition that isn’t limited to tennis players at all. In fact, despite the name, many people who develop tennis elbow do not play tennis - any repetitive strain on the elbow tendons can lead to this painful issue. The good news is that tennis elbow (known medically as lateral epicondylitis) is treatable, and most people recover well with the right approach.

What is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow is essentially an overuse injury of the tendons that attach to the bony bump on the outside of your elbow (the lateral epicondyle). Repeated motions of the wrist and arm can strain these forearm tendons, causing tiny tears and inflammation over time. This results in pain and tenderness on the outer elbow. In other words, the muscles you use to straighten your wrist and grip objects become overloaded, and their tendon attachment at the elbow becomes irritated and painful. Although it’s called “tennis” elbow, any activity that overworks these tendons can cause the condition. For example, painters, plumbers, carpenters, or anyone doing frequent DIY projects and gardening can develop tennis elbow, even if they’ve never swung a racket. Sometimes it arises after a sudden increase in activity intensity (like a long weekend of home repairs), and in some cases, there’s no single obvious cause.

Causes and Risk Factors

Repetitive strain is the number one cause of tennis elbow. The condition often develops from repeated movements of the forearm and wrist, which put stress on the extensor tendons in the elbow. Activities that can trigger tennis elbow include: using tools (screwdrivers, hammers or plumbing tools), painting walls, typing or using a computer mouse extensively, playing musical instruments, and of course, racket sports like tennis (especially with poor backhand technique) . Over time, these motions can cause degeneration in the tendon fibers and pain at the elbow.

Several risk factors make tennis elbow more likely:

• Age: It can affect adults of any age, but it’s most frequently seen in those around 30 to 50 years old, as tendons naturally become a bit less tolerant to stress with age.

• Occupations with repetitive use: People whose jobs involve repeated arm and wrist motions have a higher risk. This includes carpenters, plumbers, painters, butchers, cooks, assembly line workers, and even hairdressers - anyone who uses their forearm muscles in a repetitive way day after day.

• Sports and activities: Playing racket sports (tennis, badminton, squash) can lead to tennis elbow, especially if you use improper form or equipment. Weightlifting and other sports that put strain on the forearm can also contribute. Even hobbies like gardening or knitting, if done excessively, might provoke symptoms in some individuals.

• Other factors: In some cases, age-related changes in the tendons (tendons become less flexible over time) can predispose you to injury. Certain underlying conditions (like arthritis or diabetes) might slightly increase risk by affecting tendon health. It’s worth noting that sometimes tennis elbow occurs with no clear single cause - it can just gradually come on if your tendon becomes overloaded over time.

Symptoms and Diagnosis

Pain on the outside of the elbow is the hallmark symptom of tennis elbow. This pain can range from a mild ache to a sharp discomfort that makes everyday tasks difficult. Often, the pain is worse when using the affected arm – for instance, when lifting or bending your arm, gripping objects, or twisting your wrist (like turning a doorknob or pouring from a kettle). The pain may also radiate down the forearm toward the wrist. You might notice weakness in your grip; even shaking hands or holding a coffee cup can become challenging if the tendon is very irritated. Other common symptoms include tenderness to touch on the outer bony part of the elbow and difficulty fully straightening the arm due to pain. In some cases ,there may be slight swelling or stiffness in the elbow joint, though significant swelling is uncommon in tennis elbow.

Diagnosing tennis elbow usually starts with a medical history and physical exam. A doctor will ask about your arm usage, any recent increase in activity, and where exactly it hurts. They will examine your elbow, checking for points of tenderness on the lateral epicondyle (outer elbow) and testing your forearm and wrist strength. Often, simply reproducing the pain by pressing on the tendon or asking you to lift or extend your wrist against resistance can confirm the diagnosis. Usually, no elaborate tests are needed to identify tennis elbow. However, if the diagnosis is unclear or if another injury is suspected, the doctor might order imaging tests. An ultrasound or MRI scan can visualize the tendon to see if there are any tiny tears or degeneration. (On an ultrasound, the clinician may notice structural changes in the common extensor tendon or increased blood flow in the area - a hallmark of tendon overuse inflammation .) X-rays generally won’t show tennis elbow but might be done to rule out arthritis or other bone issues if needed.

If you’ve had elbow pain for a while, it’s important to get a proper evaluation. Tennis elbow is one of the most common causes of persistent elbow pain, so doctors are quite familiar with diagnosing it. The sooner you know what’s going on, the sooner you can start the right treatment plan.

Treatment Options for Tennis Elbow

Most cases of tennis elbow can be treated without surgery. The primary goals are to relieve pain, allow the tendon to heal, and then gradually strengthen the forearm so you can return to your normal activities. Treatment typically progresses from simple self-care to more structured therapies. Here are the key treatment options:

• Rest and activity modification: Giving your elbow a break is crucial, especially in the early stages. This means avoiding or reducing the activities that trigger your pain. You don’t have to stop all use of your arm, but listen to your pain - if an activity hurts, pause or find a different way to do it. Often, a couple of weeks of relative rest (and avoiding heavy lifting or repetitive motions) will start to calm the tendon irritation.

• Ice (cold therapy): Applying ice or a cold pack to the outer elbow for 10–15 minutes at a time can help reduce pain and inflammation. In the first few weeks of injury or after any activity that aggravates your elbow, icing a few times a day (for example, every 2–3 hours) may provide relief. Always wrap the ice pack in a cloth to protect your skin. Some people also find relief by alternating cold and heat (warm compress) after the initial acute phase, but ice is generally most helpful for reducing inflammation in tendon injuries.

• Pain relief medication: Over-the-counter painkillers can be used to manage tennis elbow pain, especially if it’s affecting your daily function. Paracetamol is a safe option to ease pain. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can also help with pain and reduce inflammation in the short term. These can be taken as tablets, or you can use anti-inflammatory gels/creams applied to the elbow area. (Always follow the dosage guidelines, and check with a pharmacist or doctor if you have any health conditions that might make NSAIDs unsafe for you.)

• Physiotherapy and exercises: Physiotherapy is often extremely helpful for tennis elbow. A physiotherapist can show you targeted stretches and strengthening exercises for the forearm muscles, helping the injured tendon gradually regain strength and flexibility. They may use techniques like massage to improve blood flow, ultrasound therapy or shockwave therapy to stimulate healing, and guided exercise programs to rehab the elbow. You’ll learn exercises to gently stretch the tendon (such as wrist flexor and extensor stretches) and later, strengthening moves (like using light dumbbells or resistance bands to build up the forearm muscles). Doing these exercises consistently is key to a full recovery and to preventing future flare-ups.

• Bracing or splints: Using a support can offload the strained tendon. An elbow brace or a forearm strap (counterforce brace) worn just below the elbow can distribute pressure away from the affected area and give the tendon a chance to heal. Some people also find relief with a wrist splint, which rests the forearm muscles. Bracing is typically used during activities that would normally provoke pain - for example, wearing the forearm strap while typing or playing a sport. It’s a temporary aid, not a permanent solution, but it can be very useful in the healing phase.

• Steroid or hydrosaline injections: If the pain is persistent and not improving with the above measures, injection therapy may be recommended as a next step. A corticosteroid injection can deliver powerful anti-inflammatory medicine directly to the painful tendon area. This is often done under ultrasound guidance for precision. Steroid injections tend to provide significant short-to-medium term relief - many patients experience noticeable pain reduction within a week or two after the injection. This can be especially useful if pain is preventing you from doing the rehabilitation exercises, as it calms the inflammation and allows you to participate in physio more comfortably. Another injection approach uses a hydrosaline solution (a sterile saline fluid, sometimes combined with a small amount of steroid or local anesthetic) introduced around the tendon under ultrasound. This so-called “hydrosaline injection” helps by mechanically flushing the area and disrupting painful tissue adhesions, which can promote healing. Injection therapies are quick, outpatient procedures – the area is numbed with local anaesthetic, and the solution is injected at the tender point under imaging guidance. You may feel a brief pressure, and afterwards the elbow might be a bit sore for a day or two as the solution does its work. These injections are a highly effective non-surgical option for many people, often allowing you to avoid or delay surgery altogether. (Note: Platelet-Rich Plasma (PRP) injections are another injection treatment sometimes used for tennis elbow, using your own blood growth factors to aid healing, but corticosteroids remain more common for quick pain relief.)

• Surgery (last resort): Fortunately, surgery is rarely needed for tennis elbow. Most people recover well with conservative treatments. However, if you have tried rest, therapy, injections, and other options for 6–12 months with no improvement, an orthopaedic surgeon might suggest a minor operation. The surgical procedure for tennis elbow is often done arthroscopically (through tiny keyhole incisions) and involves releasing or repairing the damaged tendon fibers at the elbow. Essentially, the surgeon will trim away the unhealthy part of the tendon and reattach normal tendon tissue to relieve tension on the lateral epicondyle. This is typically a day-case surgery and has a high success rate for chronic severe cases. However, it comes with the usual post-surgical recovery time and effort, so it’s truly considered only when all else fails.

As you can see, there are many steps before surgery to manage tennis elbow, and the vast majority of patients get better with those non-surgical treatments. Your healthcare provider will tailor a plan that might combine several of the above approaches. For example, you may start with rest and NSAIDs, then do physiotherapy, and if needed, get an injection to settle a stubborn case. The goal is to get you pain-free and back to the activities you enjoy, without having to resort to an operation if possible.

When to Seek Help from a Specialist

Minor elbow aches and pains can often be managed at home initially. But how do you know when it’s time to see a doctor or specialist for tennis elbow? A general rule is: if you still have significant elbow pain after about two weeks of rest and self-care, get it checked out by a medical professional. Also, if the pain is worsening despite your efforts, or if it’s immediately impacting your ability to work or do daily tasks, don’t wait that long - seek help sooner.

A specialist (such as a sports medicine doctor or orthopaedic specialist) can confirm whether it’s tennis elbow or another issue, and make sure you get the most appropriate treatment. They may recommend advanced therapies like the injections mentioned above, especially if basic measures haven’t given relief. Remember that early intervention can speed up recovery – for instance, getting physiotherapy guidance early on might prevent the tendon from getting more irritated.

It’s particularly advisable to see a doctor if you experience symptoms like significant weakness (dropping objects because of pain), numbness or tingling (which could indicate a nerve involvement rather than classic tennis elbow), or if you have elbow pain alongside fever or significant swelling (which might hint at an infection or a different problem). Those scenarios are less common, but they merit prompt medical attention.

For most people, tennis elbow starts as a mild pain and gradually builds. It’s best not to ignore it until it becomes severe. Listening to your body is key - if your elbow pain is not improving or is interfering with your life, reach out for help. In many cases, seeing a physiotherapist or doctor sooner rather than later can shorten the overall recovery time.

And if you’re in the London area and dealing with persistent elbow pain, be aware that expert help is available nearby. Specialized clinics offer targeted elbow pain treatment in London that can provide personalized care - from expert diagnosis to ultrasound-guided injections and rehab programs – to get you on the mend quickly. Don’t hesitate to explore these options if your pain isn’t getting better; you deserve to get back to pain-free living.

Outlook and Encouragement

Tennis elbow can certainly be frustrating – it might limit your ability to play sports, do your job, or even enjoy simple things like lifting a cup of tea. However, the outlook for tennis elbow is generally very positive. With the right care, most people recover fully and can return to their normal activities without pain. Keep in mind that tendons heal a bit more slowly than muscles due to less blood supply, so patience is important during the recovery process.

The key is to take action and not ignore the pain. Start with rest and home remedies, and if those aren’t enough, consult a professional who can guide you through treatments like physiotherapy or injections. Relief is very much within reach. By addressing the issue, you’re not only treating the pain but also preventing potential worsening or recurrences.

In summary, tennis elbow is a common elbow strain that can affect anyone – not just athletes – and it doesn’t have to become a chronic hindrance. With a combination of self-care, guided therapies, and possibly medical treatments, you can overcome tennis elbow and get back to the activities you love. If you’re struggling with persistent elbow pain, take the first step: seek out advice and treatment. Don’t let elbow pain hold you back from your work or hobbies. With proper care and a bit of time, you’ll be able to focus on your daily life and passions, not the pain in your elbow.

Finally, remember that help is available. You don’t have to “just live with it.” Whether it’s getting a thorough evaluation, starting a physiotherapy program, or exploring an injection for quick relief, there are solutions for tennis elbow. Reach out to a healthcare provider or specialist clinic if your elbow pain isn’t improving - a personalised treatment plan can make all the difference. With the right approach, you’ll likely be back to feeling like yourself and using your arm normally in no time. Here’s to a future of healthy, pain-free elbows and a return to your normal routine!