Elbow pain can be frustrating, especially when it starts interfering with everyday activities like lifting, gripping, or using tools at work. If you’re experiencing persistent pain on the outside of your elbow, particularly during repetitive tasks, you’re not alone. One of the most common causes of elbow discomfort in adults is Lateral Elbow Tendinopathy (LET) – commonly known as tennis elbow.
Despite the name, you don’t have to be a tennis player to suffer from this condition. In fact, it’s more prevalent in non-athletes and even occurs more frequently in golfers than the so-called “golfer’s elbow.” If you’re dealing with elbow pain, this comprehensive guide will help you understand what’s going on, what you can do about it, and how physiotherapy can support your recovery.
What Is Lateral Elbow Tendinopathy (Tennis Elbow)?
Lateral Elbow Tendinopathy (LET) is a condition that affects the tendons attached to the outer part of your elbow. These tendons are responsible for extending your wrist and fingers. Overuse or repetitive strain can lead to irritation, microtears, and even degeneration of the tendon, causing pain and functional limitations.
Who Is Most at Risk?
LET is particularly common among individuals aged 40 to 55, and women are slightly more likely to be affected. In the general population, the prevalence ranges between 1-4%, but among workers performing repetitive manual tasks, the rates can soar to 15-30%.
Common occupational risk factors include:
- Frequent lifting or gripping, especially with the palm facing down
- Repetitive wrist or forearm movements
- Working with hand tools or machinery
- Poor ergonomics and awkward hand or arm postures
Common Symptoms of Tennis Elbow
If you’re wondering whether your elbow pain might be LET, here are the typical signs:
- Pain or tenderness on the outside of the elbow
- Discomfort that radiates down the forearm
- Pain during gripping, lifting, or twisting movements
- Increased pain when performing wrist or finger extension
- Difficulty performing daily tasks like lifting a kettle, opening jars, or typing
Do You Need a Scan for Elbow Pain?
It’s natural to think you might need an MRI or X-ray if you’re experiencing persistent elbow pain. However, imaging is not typically the first step in diagnosing tennis elbow – especially if there’s no history of trauma like a fall.
Here’s why:
- 20–50% of pain-free individuals show tendon changes on ultrasound or MRI. This means imaging doesn’t always correlate with pain.
- Diagnosis is best made based on a thorough clinical assessment by a qualified physiotherapist or healthcare provider.
When Is Imaging Appropriate?
A scan might be warranted if:
- There’s a history of trauma (e.g., a fall or direct blow)
- Symptoms persist beyond 6–8 weeks despite physiotherapy
- The pain pattern is unusual or suggests another issue
In such cases:
- Ultrasound is generally the preferred imaging method for LET.
- X-rays may be used to rule out bone conditions or fractures.
- MRI is rarely required unless there’s suspicion of other joint involvement.
What Causes Tennis Elbow?
Tennis elbow is usually caused by a mismatch between the load placed on the tendon and its ability to cope with that load. This could happen due to:
- Sudden increase in repetitive activities (e.g., painting, gardening, typing)
- Overtraining in sports or the gym
- Poor technique or ergonomics
- Aging-related changes in tendon structure
When the tendon is overloaded, it can lead to irritation and, over time, tissue disrepair if the load isn’t managed properly.
Effective Self-Management for Tennis Elbow
1. Modify Aggravating Activities
The first and most crucial step is to identify and reduce activities that worsen your symptoms. This doesn’t mean stopping all movement. Instead:
- Avoid lifting objects with your palm facing down
- Take regular breaks during repetitive tasks
- Use your non-affected arm for tasks like holding shopping bags or dog leashes
- Continue non-painful activities like walking, running, or playing non-impact sports
2. Avoid Corticosteroid Injections
While corticosteroid injections might provide short-term relief, research shows they have poorer long-term outcomes, including:
- Higher rates of symptom recurrence
- Delayed recovery at 6- and 12-month follow-ups
In most cases, outcomes with corticosteroid injection are worse than doing nothing at all. Your best bet is early intervention with evidence-based physiotherapy.
3. Consider a Counterforce Brace
Some patients find relief using a counterforce elbow strap to offload the tendon. These are available at most chemists, but for quality and comfort, we recommend the Mueller Hg80 Tennis Elbow Support, available at our clinic.
How Physiotherapy Can Help
Physiotherapy is the gold standard treatment for lateral elbow tendinopathy. Early intervention offers the best chance for full recovery and long-term relief.
What to Expect at Your Physio Appointment:
- Comprehensive Assessment
- Your physiotherapist will conduct a thorough examination of your elbow, wrist, and surrounding muscles to identify the root causes of your pain. They may also assess your posture, strength, and ergonomics at work or during sport.
- Education and Load Management
- Understanding your condition is essential. Your physio will explain what’s going on in plain terms, so you can take control of your recovery. They’ll help you adjust your activity levels and avoid unnecessary interventions like injections or surgery.
- Manual Therapy
- Techniques like soft tissue release, joint mobilisations, and dry needling may be used to reduce pain and improve mobility in the early stages.
- Targeted Exercise Program
- Your rehab will include progressive loading exercises to rebuild tendon strength and resilience. This may start with isometric holds, progressing to eccentric and concentric loading, and eventually functional movements that mimic your daily tasks or sport.
- Long-Term Prevention
- As you recover, your physiotherapist will guide you on gradual return to activity, ergonomic modifications, and strategies to prevent recurrence.
When to See a Physio
If you notice any of the following, it’s time to book an appointment:
- Elbow pain that lasts more than a few days
- Difficulty lifting, gripping, or performing daily activities
- Pain that worsens with repetitive use
- You’re tempted to rest completely or seek injections as your first step
The sooner you act, the quicker your recovery.
Final Thoughts
Tennis elbow (lateral elbow tendinopathy) can be a painful and limiting condition, but with early intervention, appropriate management, and targeted physiotherapy, you can make a full recovery. The key is to understand your pain, manage your load, and commit to a rehab plan that strengthens the tendon over time.
Avoid the temptation of quick fixes like injections, and don’t let pain stop you from staying active. With the right guidance, most people recover well and return to doing what they love – pain-free.
Need help managing your elbow pain?
Book a consultation with our experienced physiotherapy team today. Early treatment leads to better outcomes, and we’re here to guide you every step of the way.
