Tennis Elbow (Lateral Epicondylitis): Causes, Symptoms & Treatment
Tennis elbow, clinically known as lateral elbow tendinopathy or lateral epicondylitis, is a common cause of pain on the outside of the elbow.
Despite its name, you don’t need to play tennis to develop tennis elbow. It can occur in anyone who repeatedly grips, lifts, twists or uses their wrist and forearm — including tradespeople, gym-goers, office workers, gardeners, musicians and recreational athletes.
At Vitality Chiropractic Australia, we take a rehabilitation-focused approach to tennis elbow. Rather than simply treating the painful area, we assess the elbow, wrist, forearm, shoulder and relevant nerves to identify the factors contributing to your symptoms.
Our goal is to help you reduce pain, restore strength and function, and progressively return you to the activities you enjoy.
What Is Tennis Elbow?
Tennis elbow is a condition involving the tendons of the muscles that attach to the outside of the elbow. These tendons help control movements of the wrist and fingers and are particularly important when gripping, lifting and extending the wrist.
The tendon most commonly involved is the extensor carpi radialis brevis (ECRB), although several of the wrist extensor tendons can contribute to lateral elbow pain. The term “lateral epicondylitis” is commonly used, but it can be misleading. The condition is not necessarily caused by ongoing inflammation. In many persistent cases, the tendon is better described as having a tendinopathy, involving changes in tendon structure, load tolerance and pain sensitivity. This distinction is important because recovery is generally not about simply “getting rid of inflammation.”
Instead, rehabilitation focuses on gradually restoring the tendon and surrounding muscles’ ability to tolerate load.
Where Does Tennis Elbow Hurt?
Tennis elbow typically causes pain around the outer or lateral aspect of the elbow, near the bony prominence known as the lateral epicondyle. Pain may also extend down the outer forearm.
You may notice symptoms when:
- Gripping a heavy object
- Opening a jar
- Turning a door handle
- Shaking hands
- Lifting a kettle or coffee cup
- Using a screwdriver
- Carrying bags
- Typing or using a mouse for prolonged periods
- Playing tennis, squash or other racquet sports
- Performing pulling exercises at the gym
- Performing wrist extension exercises
- Using tools repeatedly at work
Some people experience relatively mild discomfort at rest but significant pain whenever the elbow and forearm are loaded.
Common Symptoms Of Tennis Elbow
Symptoms vary from person to person, but common features include:
Pain on the outside of the elbow
The most characteristic symptom is tenderness or aching around the lateral elbow.
Pain with gripping
Activities requiring sustained or forceful gripping can reproduce symptoms.
Pain with wrist extension
Lifting the wrist against resistance can aggravate the involved tendon.
Reduced grip strength
Pain can inhibit your ability to generate force through the hand and forearm.
Forearm discomfort
Pain may extend several centimetres down the outer forearm.
Pain with lifting
Even relatively light objects can become uncomfortable when the wrist and elbow are positioned in certain ways.
Stiffness or aching
Some people experience stiffness after periods of inactivity or following repetitive activity.
What Causes Tennis Elbow?
Tennis elbow is usually associated with repeated loading of the forearm and elbow that exceeds the current capacity of the tissues to tolerate that load. This does not necessarily mean that one particular movement caused an injury. Instead, symptoms can develop when the overall workload gradually exceeds the body’s ability to recover and adapt.
Common contributing factors include:
Repetitive gripping
Trades, gardening, manual work and repetitive household activities can place substantial demands on the wrist extensor muscles.
Racquet sports
Tennis, squash and badminton can increase loading through the forearm, particularly when training volume, technique or equipment changes.
Gym training
Exercises involving gripping and pulling can aggravate the elbow when the tendon is not currently tolerating the required workload.
Examples include:
- Rows
- Pull-ups
- Deadlifts
- Dumbbell exercises
- Barbell exercises
- Heavy carries
- Wrist extension exercises
Occupational loading
Tennis elbow is relatively common in occupations involving repetitive gripping, lifting, twisting or tool use.
Sudden changes in activity
You may develop symptoms after suddenly increasing:
- Training volume
- Workload
- Gardening
- DIY projects
- Racquet sports
- Weight training
Reduced tissue capacity
A tendon that has become less tolerant to load may react to activities that previously caused no problems. This is why simply resting until the pain disappears does not always provide a lasting solution.
Is Tennis Elbow Caused By Inflammation?
Not necessarily. Although the condition is traditionally called lateral epicondylitis, persistent tennis elbow is generally considered a tendinopathy rather than simply an inflammatory condition. This is one reason why treatment should not focus exclusively on reducing inflammation.
The more important question is:
How much load can the tendon currently tolerate, and how can we progressively increase that capacity?
This is where structured rehabilitation becomes particularly important.
Risk Factors For Tennis Elbow
Your risk of developing lateral elbow tendinopathy may increase with:
- Repetitive manual work
- Frequent gripping
- Racquet sports
- Weight training
- Sudden increases in exercise volume
- Repetitive computer or mouse use
- Poorly tolerated work tasks
- Previous elbow problems
- Reduced forearm strength
- Sudden changes in sporting technique or equipment
- Repeated exposure to high tendon loads without adequate recovery
Importantly, having one of these risk factors does not mean you will develop tennis elbow. It is usually the interaction between load, capacity, recovery and individual factors that matters.
Conditions That Can Mimic Tennis Elbow
Not every case of outer elbow pain is tennis elbow. Part of a good assessment is determining whether another condition could better explain your symptoms.
Differential considerations can include:
- Radial tunnel syndrome
- Radial nerve irritation
- Cervical radiculopathy
- Referred pain from the neck
- Elbow joint disorders
- Ligament injuries
- Osteoarthritis
- Acute tendon injury
- Other forearm tendon problems
This is particularly important if symptoms include significant neurological changes, widespread arm symptoms, unusual weakness or symptoms that do not behave like typical lateral elbow tendinopathy.
How Is Tennis Elbow Diagnosed?
Tennis elbow is usually diagnosed clinically. At your appointment, we will begin by discussing:
- When your symptoms started
- Whether there was a specific injury
- Your work and sporting activities
- Recent changes in workload
- Activities that aggravate your symptoms
- Activities that relieve them
- Previous elbow or upper-limb injuries
- Your current level of strength and function
We then assess the relevant areas of the upper limb.
This may include:
Elbow assessment
We assess elbow movement, tenderness, loading tolerance and function.
Wrist and forearm assessment
The wrist and forearm muscles play an important role in controlling load through the elbow.
Grip strength
Comparing grip strength and pain between sides can provide useful information about functional capacity.
Resisted testing
Specific resisted movements of the wrist and fingers can help reproduce and assess your symptoms.
Shoulder and upper-limb assessment
The elbow does not operate independently. Shoulder and upper-limb function can influence how forces are distributed through the arm.
Neurological assessment
Where appropriate, we assess the nerves supplying the arm to help determine whether symptoms may be coming from the neck or another part of the nervous system.
Do I Need an X-Ray, Ultrasound or MRI?
Usually, imaging is not required to diagnose uncomplicated tennis elbow. A clinical assessment is often sufficient.
Imaging may be considered when:
- Symptoms are severe or unusual
- The diagnosis is uncertain
- There has been significant trauma
- Symptoms are not improving as expected
- Significant weakness is present
- Another condition needs to be excluded
- There is concern about a substantial tendon injury
Depending on the clinical situation, this may involve ultrasound, X-ray or MRI, or referral to another appropriate healthcare professional.
Tennis Elbow Treatment
There is no single treatment that works for everyone with tennis elbow. The most appropriate management depends on:
- How long you have had symptoms
- Your current pain levels
- Your work requirements
- Sporting demands
- Your strength and functional capacity
- The irritability of your symptoms
- Previous injuries
- How much load the elbow currently tolerates
At Vitality Chiropractic Australia, treatment may combine several strategies.
1. Education & Load Management
One of the most important parts of recovery is understanding what is currently irritating the tendon. This does not necessarily mean completely stopping activity.
Instead, we can help you identify:
- Which activities are aggravating your elbow
- How much activity you can currently tolerate
- How to modify painful movements
- When to increase or reduce workload
- How to return progressively to sport or work
The objective is to find the appropriate balance between protecting the tendon from excessive aggravation while still providing enough stimulus for adaptation.
2. Progressive Strengthening
Exercise rehabilitation is a major component of managing persistent tennis elbow. Rather than relying on rest alone, rehabilitation progressively exposes the forearm muscles and tendon to increasing levels of resistance.
Depending on your presentation, exercises may include:
- Isometric wrist extension
- Controlled wrist extension
- Eccentric wrist extension
- Concentric and eccentric strengthening
- Forearm pronation and supination
- Grip strengthening
- Finger extension strengthening
- Functional loading exercises
- Progressive return-to-sport exercises
The exact exercises should be matched to your current capacity rather than simply following a generic list from the internet.
3. Manual Therapy & Joint Mobilisation
Manual therapy may be used as part of a broader treatment plan to help reduce symptoms and improve movement. Depending on your assessment, this may include:
- Elbow mobilisation
- Wrist mobilisation
- Forearm mobilisation
- Soft tissue therapy
- Myofascial techniques
- Trigger point therapy
Manual therapy is generally best viewed as a tool to assist movement and symptom management, rather than the entire rehabilitation strategy.
4. Soft Tissue Treatment
The muscles of the forearm can become sensitive and overloaded when the elbow is repeatedly exposed to demanding activities. Soft tissue techniques may be used around the:
- Wrist extensors
- Forearm
- Triceps
- Biceps
- Upper arm
- Shoulder
The goal is to help manage symptoms and improve your ability to perform the rehabilitation exercises required for recovery.
5. Taping & Bracing
Some people find temporary support useful during work, exercise or other aggravating activities. A tennis elbow strap may help redistribute some of the load away from the painful area during activity. Taping can also be considered in some cases. Importantly, a brace should generally be viewed as an adjunct, not a replacement for rehabilitation.
6. Return-to-Sport & Work Rehabilitation
If your tennis elbow is related to your occupation or sport, treatment should ultimately prepare you for the activities you actually need to perform.
For an athlete, this may involve progressively returning to:
- Racquet hitting
- Serving
- Backhands
- Gym training
- Pulling exercises
- Grip-intensive activities
For a tradesperson, rehabilitation may involve gradually restoring tolerance to:
- Tool use
- Carrying
- Lifting
- Repetitive gripping
- Twisting
- Manual work
The aim is not simply to make your elbow feel better in the clinic. The aim is to make it strong and capable enough to tolerate real-world demands.
How Long Does Tennis Elbow Take To Recover?
Recovery time varies considerably. Some people improve within several weeks, while persistent cases can take considerably longer.
Factors influencing recovery include:
- Duration of symptoms
- Severity of symptoms
- Current tendon capacity
- Occupational demands
- Sporting demands
- Sleep and recovery
- Previous injuries
- Ability to modify aggravating activities
- Consistency with rehabilitation
One of the biggest mistakes is expecting the tendon to recover simply because pain has temporarily decreased. The tendon also needs to regain load capacity. That is why rehabilitation should progressively transition from symptom management to strengthening and functional loading.
Can You Prevent Tennis Elbow?
You cannot eliminate the risk completely, but you can improve the capacity of the elbow and forearm to tolerate demanding activities.
Helpful strategies include:
Increase training gradually
Avoid sudden increases in gym, work or sporting volume.
Strengthen the forearms
Regular strengthening can improve your ability to tolerate gripping and wrist loading.
Manage repetitive workloads
If your work involves repetitive gripping, incorporate appropriate breaks and vary tasks where possible.
Check sporting technique
If symptoms repeatedly occur during tennis or another racquet sport, technique and equipment may need to be assessed.
Don’t ignore persistent symptoms
Continuing to repeatedly overload a painful tendon without modifying the underlying workload can make recovery more difficult.
The Vitality Tennis Elbow Recovery Program
We’ve developed a dedicated Tennis Elbow Rehabilitation Program designed to provide a structured progression from symptom management through to strength and return to activity.
The program focuses on:
- Reducing sensitivity
- Restoring wrist and forearm strength
- Improving grip capacity
- Progressively loading the tendon
- Building elbow resilience
- Returning to gym and sporting activities
- Preventing repeated flare-ups
This program complements, rather than replaces, an individual clinical assessment where required.
Recommended Products for Tennis Elbow
The right rehabilitation equipment can make it easier to progressively load the forearm and manage symptoms between appointments.
Mueller 4-Way Stretch Elbow Support
A supportive elbow sleeve can provide compression and support during everyday activities or exercise.
Best suited for: General elbow support and activity modification.
Ortholife Padded Tennis Elbow Brace
A counterforce-style tennis elbow brace can be useful for some people during activities that aggravate the lateral elbow. It may help reduce discomfort while performing tasks involving gripping and repetitive forearm loading.
Best suited for: Activity-related tennis elbow symptoms.
Fortress FlexBar
A FlexBar is particularly useful for progressive forearm rehabilitation. It can be incorporated into controlled wrist and forearm strengthening exercises and is a useful tool once the elbow is ready for progressively greater loading.
Best suited for: Progressive tendon and forearm strengthening.
Fortress Premium Massage Gun
A massage gun may be useful as an adjunct for managing muscle tightness and sensitivity around the forearm. It should not be used aggressively directly over a painful tendon or bony prominence.
Best suited for: Forearm muscle recovery and general soft-tissue management.
Explore the Fortress Premium Massage Gun and the full range of Massage products here.
Tennis Elbow vs Golfer’s Elbow
Although they are often confused, the location of pain is different.
| Condition | Typical location | Common loading pattern |
|---|---|---|
| Tennis elbow | Outside of elbow | Wrist extension and gripping |
| Golfer’s elbow | Inside of elbow | Wrist flexion and gripping |
Tennis elbow involves the structures around the lateral epicondyle, while golfer’s elbow involves the structures around the medial epicondyle. If you’re unsure which condition you have, an assessment can help distinguish between them.
When Should You See A Sports Chiropractor For Tennis Elbow?
Consider having your elbow assessed if:
- Pain has persisted for several weeks
- Your grip strength has reduced
- Work is becoming difficult
- Exercise is limited
- You are unable to play your sport normally
- Symptoms continue despite reducing activity
- You repeatedly experience flare-ups
- You are unsure whether the problem is actually tennis elbow
Early assessment can help identify the factors contributing to your symptoms and provide a structured plan for progressing your activity.
When Should You See Another Healthcare Professional?
Not every elbow problem is appropriate for chiropractic management alone.
You should seek appropriate medical assessment if you experience:
- Significant trauma
- Obvious deformity
- Severe swelling
- Sudden substantial loss of strength
- Inability to move the elbow
- Progressive neurological symptoms
- Significant numbness or loss of sensation
- Unexplained systemic symptoms
- Symptoms that are unusual or rapidly worsening
Where appropriate, we can recommend referral or co-management with your GP, physiotherapist, sports physician or other healthcare professional.
Why Choose Vitality Chiropractic Australia For Tennis Elbow?
At Vitality Chiropractic Australia, we don’t view tennis elbow as simply an elbow that needs to be “adjusted.” We take a broader rehabilitation-focused approach.
Your assessment may consider:
- The elbow
- Wrist
- Forearm
- Shoulder
- Neck
- Nerve function
- Grip strength
- Work demands
- Sporting demands
- Training load
- Previous injuries
Treatment can then be tailored to your presentation and goals. Our approach combines hands-on care with education, exercise rehabilitation and progressive loading rather than relying on passive treatment alone. Vitality Chiropractic Australia has been providing musculoskeletal and sports injury care in Melbourne’s northern suburbs for more than 10 years. The clinic is located in Mill Park and provides care to patients from surrounding areas including South Morang, Epping, Bundoora, Lalor, Mernda, Doreen, Thomastown and Wollert.
Book A Tennis Elbow Assessment In Mill Park
If pain on the outside of your elbow is interfering with work, exercise, sport or everyday activities, we’d be happy to assess your condition and determine whether it is consistent with lateral elbow tendinopathy.
We’ll explain what we find, discuss your treatment options and help you establish a practical path toward recovery.
Vitality Chiropractic Australia
9/7 Development Boulevard
Mill Park VIC 3082
Phone: 1300 003 777
Frequently Asked Questions About Tennis Elbow
Should I completely rest my arm?
Usually, complete rest is not necessary. Reducing or modifying activities that significantly aggravate symptoms may be useful initially, followed by a gradual return to loading.
Are eccentric exercises good for tennis elbow?
Eccentric exercises can be useful, but rehabilitation does not need to consist exclusively of eccentric exercises. Progressive strengthening through appropriate ranges and loading strategies can be tailored to your individual capacity.
Can chiropractic treatment help tennis elbow?
Chiropractic care may form part of a broader conservative management plan involving assessment, manual therapy, symptom modification and exercise rehabilitation. The emphasis should be on restoring function and progressively increasing the capacity of the elbow and forearm rather than relying solely on passive treatment.
