Tennis Elbow and Why It's Not Just for Tennis Players

Lateral epicondylalgia, known more colloquially as tennis elbow, is a condition involving the tendons on the outer side of the elbow where the forearm extensor muscles attach. Despite the name, only a small proportion of people who develop it actually play tennis. It's an overuse condition, meaning it tends to arise not from a single dramatic injury but from accumulated load that the tendon isn't quite keeping up with.

The muscles that extend and stabilise the wrist attach via tendons to a bony prominence on the outer side of the elbow called the lateral epicondyle. When these muscles and tendons are repeatedly loaded without enough recovery, the tendon tissue can become irritated and, over time, undergo degenerative changes that make it less able to handle load. This process is sometimes called tendinopathy rather than tendinitis, because it may involve more than simple inflammation.

Who tends to develop it

Anyone who uses their forearm and wrist repetitively can develop tennis elbow. Trades workers such as painters, plumbers, and carpenters are commonly affected, as are chefs who spend long hours chopping and stirring, people who do a lot of typing or mouse work, and those who take up racket sports or start a new physical activity that involves gripping. It tends to appear in people aged 35 to 54 and may affect the dominant arm more often, though not exclusively.

A sudden increase in the amount of gripping or forearm activity, changes in equipment (a new racket, different tools, a new workstation), or returning to an activity after a break are all situations where the tendon may struggle to adapt quickly enough.

Tennis elbow can be remarkably persistent. Many people find that ignoring it and pushing through makes it worse, while complete rest alone rarely resolves it either.

What it feels like

The pain is typically felt on the outer side of the elbow and may radiate into the forearm. It's often provoked by gripping, lifting, or twisting movements, such as turning a door handle, lifting a kettle, shaking hands, or using a screwdriver. Some people notice it most when extending the wrist against resistance. In the early stages, the pain may ease after a warm-up and return afterwards. Over time, it can become more constant and harder to settle.

One of the features that makes tennis elbow frustrating is the time it takes to resolve. Research suggests that many cases do improve over time, often between 12 and 18 months, though a significant proportion of people find it persists or recurs without appropriate management.

What tends to help

The most consistently supported approach involves progressive tendon loading exercises, particularly those that work the extensor muscles eccentrically (lengthening under load). These exercises, which may begin with something as simple as slowly lowering a light weight with the forearm extended, have been associated with meaningful improvement in pain and function for many people. The key is gradual progression and consistency over weeks rather than days.

Activity modification during recovery, rather than complete rest, is generally recommended. The tendon needs some load to adapt and recover, but load needs to be appropriate. Identifying and temporarily reducing the activities most likely to provoke the pain could create the right environment for the tendon to respond to rehabilitation.

Some people find that forearm bracing (a counterforce strap worn below the elbow) provides short-term comfort and allows them to continue modified activities, though this manages the symptom rather than the underlying issue. Corticosteroid injections may offer short-term relief but evidence suggests their long-term effect may be less favourable than progressive loading in many cases, so they're often considered as part of a broader plan rather than a standalone solution.

When to seek assessment

If the pain has been present for more than a few weeks, is significantly affecting daily activities or work, or doesn't seem to be responding to self-management, working with a physiotherapist or sports medicine practitioner might be a worthwhile step. They could confirm the diagnosis, rule out other causes of elbow pain such as referred pain from the neck or nerve involvement, and guide a structured loading programme appropriate to your situation.

Tennis elbow has a reputation for being stubborn, and sometimes it is. But with the right approach to loading and recovery, many people find that the elbow gradually becomes less reactive and more resilient over time. Patience and consistency tend to matter more than any single intervention.