Tennis Elbow (Lateral Epicondylalgia)

Typical symptoms

• Pain on the outer elbow, sometimes radiating into the forearm.
• Pain and weakness when gripping — lifting a kettle, turning a key, shaking hands or carrying a bag.
• Tenderness over a specific point on the outer elbow.
• Pain when lifting with the palm facing down, which usually eases with the palm facing up.
• Stiffness and soreness in the morning that eases with light movement.
• Symptoms that developed gradually rather than from a single injury.

Why rest alone does not work

Complete rest often reduces pain in the short term, and the pain usually returns as soon as normal activity resumes. That happens because rest does nothing to improve the tendon’s capacity — if anything, an unloaded tendon becomes less tolerant, so the same activity that provoked it before provokes it again.

The treatment that has the strongest evidence is progressive loading: exercising the tendon at a level it can handle and increasing that level systematically as it adapts. This is not fast — tendons remodel over months rather than weeks — but it addresses the actual problem rather than deferring it.

How treatment is structured

Assessment confirms the diagnosis and rules out the alternatives — referred pain from the neck, radial nerve irritation and elbow joint problems can all mimic tennis elbow, and each needs different treatment. Grip strength is usually measured, since it provides an objective way to track progress.

Early treatment settles symptoms enough to allow loading: manual therapy to the elbow and wrist, soft-tissue work through the forearm, and temporary modification of the specific activities provoking it. Where the neck or shoulder is contributing, that is treated too.

The core of the programme is graded strengthening of the wrist extensors, progressing through isometric holds into slow, controlled loading and eventually into the grip and lifting demands of your work or sport. Some discomfort during exercise is acceptable and expected; pain still raised the next day means the load was too high.

Managing daily activities

• Lift with the palm facing up where you can — this shifts the load away from the painful tendons.
• Carry bags on the forearm or shoulder instead of gripping with the fingers.
• Use larger grips on tools, pens and utensils to reduce grip force.
• Break up sustained gripping tasks rather than working through them continuously.
• A counterforce brace can help some people during aggravating tasks, as a short-term aid alongside exercise.
• Review your workstation — mouse position and unsupported forearms are common contributors.