Despite the name, most of the tennis elbow I see in clinic has nothing to do with tennis.
Elbow pain that spreads up into the arm can have another source, covered in PhysioHub's guide to upper arm aching pain.
Tradespeople with repetitive gripping and lifting, and office workers with keyboard-heavy days, make up more of my tennis elbow caseload than racket-sport players. Here's what's actually going on, and what a course of physiotherapy for it involves.
Tennis elbow, or lateral epicondylalgia, is pain and tenderness on the outside of the elbow, caused by overload of the tendons controlling wrist and finger extension. Any repeated gripping or wrist-extension load, sustained over weeks or months, is enough to bring it on: manual trades, keyboard-heavy office work, DIY projects, and yes, racket sports.
The first job is confirming the diagnosis and ruling out referred pain from the neck, which can mimic tennis elbow but needs a different treatment approach. We'll also look at grip strength, tendon irritability, and the specific tasks or movements that provoke your pain, so the plan is built around your actual triggers.
Progressive loading exercise is the evidence-based core of treatment: a structured programme of tendon-loading exercises that starts gently and builds resistance over weeks. You'll get a home-exercise programme between sessions, since consistent loading between visits matters more than the time spent in clinic. A realistic course runs several weeks; tendons adapt slowly, and rushing the loading progression tends to set recovery back rather than speed it up.
For some people, tightness through the forearm and upper arm is part of what's keeping the tendon irritated. Where that's the case, we may add clinical massage alongside the loading programme rather than treating the elbow in isolation. For longer-standing cases that haven't responded to loading alone, shockwave therapy is sometimes discussed as a further option, always alongside the exercise programme rather than instead of it.
The goal is activity modification rather than complete rest. Reducing the grip-heavy tasks that provoke your pain while keeping the rest of your arm moving normally, and avoiding a sudden return to full activity once pain settles, both help keep progress on track between sessions.
The question in nearly every tennis elbow appointment is why it has not settled, given how long the person has rested it. At PhysioHub in Uckfield the answer is usually that the resting is what keeps it there.
Tennis elbow is a tendon problem, and tendons lose capacity when they are unloaded. Rest reduces the pain because it removes the demand, then the first heavy day back exceeds what the tendon can now tolerate and the cycle restarts, which is why a brace and six weeks off so often ends where it began. Tendons respond to graded load instead. Measuring grip strength at the outset gives a number to work from, and re-measuring through the course shows whether capacity is genuinely climbing, which beats guessing from how the elbow feels on a given morning.
To have your elbow's capacity measured rather than estimated, book an assessment.
Tennis elbow responds well to a structured, progressive loading programme in the large majority of cases; it just takes consistency and a few weeks of patience. If it's not settling on its own, an assessment is the best place to start. If you're specifically trying to get back onto the court rather than just pain-free day-to-day, see returning to sport after injury for how that last stage is judged.
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