Tennis Elbow: Symptoms, Treatment, and How Physiotherapy Can Help

Surprisingly, you do not have to play tennis to develop tennis elbow. Despite its name, this common elbow condition can affect anyone who regularly performs activities that place repetitive stress on the muscles and tendons of the forearm.

Tennis elbow causes pain and tenderness around the outside of the elbow and can make everyday activities such as gripping, lifting, typing, turning a doorknob, or carrying a bag uncomfortable. For athletes, it can interfere with racquet sports, weightlifting, golf, and other activities that require repeated wrist and forearm movement.

The good news is that most cases of tennis elbow can be managed without surgery. At our Etobicoke physiotherapy clinic, we treat tennis elbow by reducing aggravating activities, gradually rebuilding the strength and capacity of the affected tendon, and addressing any contributing movement or training factors.

If you are experiencing persistent pain on the outside of your elbow, understanding what may be causing it and how it can be treated is an important first step.

What Is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylitis or lateral elbow tendinopathy, affects the tendons that connect the muscles of the forearm to the outside of the elbow. These muscles help extend the wrist and fingers and stabilize the wrist during gripping and other activities. One of the tendons commonly involved is the extensor carpi radialis brevis (ECRB), which attaches near the lateral epicondyle, the bony prominence on the outside of the elbow.

When these tissues are repeatedly exposed to more load than they can tolerate, the tendon can become painful and develop structural changes. This is why persistent tennis elbow is better understood as a tendinopathy rather than simply an episode of inflammation. You may initially notice mild discomfort after a particular activity, followed by pain that becomes more noticeable during everyday movements or exercise.

What Causes Tennis Elbow?

Tennis elbow is usually associated with repeated loading of the muscles and tendons on the outside of the elbow. This can happen when the demands placed on the forearm exceed the tissue’s ability to adapt.

Common contributing activities include:

• Playing tennis, pickleball, badminton, or other racquet sports
• Repeated gripping or squeezing
• Using hand tools for prolonged periods
• Painting, carpentry, plumbing, or other manual work
• Gardening
• Repetitive computer or mouse use
• Weightlifting exercises that heavily involve gripping and wrist extension
• Repeated lifting or carrying
• A sudden increase in the amount or intensity of an activity

The problem is not necessarily the activity itself. Changes in workload can also matter. Increasing the frequency, duration, weight, or intensity of an activity without giving your body enough time to adapt can increase stress on the forearm tendons. Equipment and technique can also play a role. Racquet size, grip size, string tension, tool design, and the way you perform a repetitive movement may influence how much load reaches the elbow.

However, there is rarely one single cause of tennis elbow. A combination of activity levels, biomechanics, strength, recovery, and previous injury may contribute to the development or persistence of symptoms.

What Does Tennis Elbow Feel Like?

The most recognizable symptom of tennis elbow is pain on the outside of the elbow. The area may also feel tender when touched, particularly around the bony prominence on the outside of the joint. Pain may become more noticeable when the wrist and forearm are working against resistance. 

Common aggravating activities include:

• Gripping or squeezing objects
• Lifting a cup, bag, or other object
• Shaking hands
• Turning a doorknob or key
• Using a screwdriver or other hand tool
• Extending the wrist
• Playing racquet sports
• Performing certain strength-training exercises

Tennis elbow does not typically cause numbness or tingling. If you are experiencing significant pins and needles, numbness, or symptoms that extend into the hand, another condition involving a nerve may need to be considered. An assessment can help determine the likely source of your symptoms.

How Is Tennis Elbow Diagnosed?

Tennis elbow can often be diagnosed through a physical assessment, rather than extensive testing. During an assessment, a healthcare professional may ask about when your symptoms began, what activities aggravate them, your occupation and exercise habits, and whether you have experienced any previous elbow or upper-limb injuries.

They may also assess:

• Location and severity of your pain
• Elbow and wrist range of motion
• Grip strength
• Forearm strength and endurance
• Pain during resisted wrist or finger movements
• Tenderness around the outer elbow
• Movement patterns that may be contributing to excessive tendon loading

In some cases, additional testing may be recommended if your symptoms are unusual, severe, or not responding to treatment. Imaging can also help rule out other potential causes of elbow pain when necessary. Because several conditions can cause elbow pain, an accurate assessment is important before beginning a treatment program.

How Is Tennis Elbow Treated?

There is no single treatment that works for every person with tennis elbow. Treatment depends on the severity and duration of your symptoms, the activities you need to return to, and how your elbow responds to rehabilitation.

For most people, conservative treatment is the first approach. This may include activity modification, physiotherapy, therapeutic exercise, and other strategies to manage symptoms and gradually improve the tendon’s capacity.

Activity Modification

When treating tennis elbow, stopping all activity is not always necessary. Instead, treatment often involves identifying the movements that are placing excessive stress on the elbow and temporarily modifying them. This might mean reducing the weight you lift, changing your grip, shortening the duration of a repetitive task, taking more frequent breaks, or temporarily reducing the frequency of a sport. The goal is to find a level of activity that allows the tendon to recover while maintaining as much normal movement and function as possible.

Physiotherapy and Therapeutic Exercise

Exercise is an important component of rehabilitation for tennis elbow. A physiotherapist can develop a progressive program that addresses the strength and endurance of the muscles and tendons around the elbow and wrist. The emphasis is generally on progressively increasing the amount of load the tendon can tolerate. Rather than avoiding movement indefinitely, a structured rehabilitation program can help you gradually return to the activities that caused your symptoms. A physiotherapist can also adjust your exercise program as your symptoms and strength improve, helping you progress from basic movements to the demands of your job, sport, or other activities.

Bracing and Taping

A counterforce elbow brace or wrist support may be recommended in some cases to reduce discomfort during activities that aggravate your symptoms. A counterforce brace is typically worn around the forearm just below the elbow. It may help redistribute some of the forces generated by the forearm muscles during gripping and other movements. Bracing should generally be viewed as one component of treatment rather than a replacement for rehabilitation. Your physiotherapist can help determine whether a brace is appropriate and how it should be used.

Manual Therapy

Depending on your assessment, physiotherapy may also include hands-on techniques directed at the elbow, wrist, forearm, or surrounding joints and soft tissues. Manual therapy may help improve mobility and reduce discomfort, making it easier to participate in your exercise program and daily activities. It is typically used alongside active rehabilitation rather than as the sole treatment.

Shockwave Therapy

Shockwave therapy may be considered for some people with persistent tendon-related pain. It uses acoustic waves to deliver mechanical energy to the affected area and is offered by HealthMax for several chronic musculoskeletal conditions, including tennis elbow. Whether shockwave therapy is appropriate depends on your symptoms, diagnosis, and response to other treatment approaches. A physiotherapy assessment can help determine whether it may be a suitable component of your rehabilitation plan.

Medication and Other Medical Treatments

Over-the-counter pain medications may help manage discomfort for some people, although you should speak with your physician or pharmacist about whether a particular medication is appropriate for you. Injections may also be discussed when symptoms persist. However, treatment decisions should take into account both short-term symptom relief and longer-term recovery. Some evidence suggests that corticosteroid injections may provide short-term relief but may not offer the same long-term benefits as other approaches. Persistent symptoms should therefore be assessed rather than repeatedly treated with short-term pain relief alone.

Surgery

Surgery is rarely the first treatment for tennis elbow. However, if significant symptoms continue despite an appropriate course of nonsurgical treatment and substantially interfere with your work, sport, or daily activities, a physician may discuss whether surgical treatment is appropriate.

How Long Does Tennis Elbow Take to Heal?

Healing tennis elbow is similar to many other recovery periods: it takes time. Some people experience significant improvement within several weeks, while others have symptoms that persist for several months. Longer-lasting cases can take considerably more time to settle, particularly when the activities contributing to the condition cannot easily be avoided.

This does not necessarily mean that your elbow is continuously being damaged. Tendons often require a gradual return to loading rather than complete rest.

Your recovery timeline may depend on various factors, such as:

• How long you have had symptoms
• The severity of your pain
• Your current strength and physical capacity
• How much you can modify aggravating activities
• Whether you follow a progressive rehabilitation program
• Your work or sport demands
• Whether you have experienced previous elbow problems

Consistency is important. Completing your exercises regularly and gradually increasing your activity as your symptoms improve can help build the capacity needed to return to normal activities.

How HealthMax Can Help With Tennis Elbow

At our Etobicoke physiotherapy clinic, our team takes an individualized approach to treating tennis elbow. Rather than simply treating the painful area, our physiotherapists assess your symptoms, strength, mobility, activity demands, and movement patterns to determine what may be contributing to your condition.

Your treatment plan may include therapeutic exercises, manual therapy, activity modification, bracing, shockwave therapy, and other appropriate physiotherapy techniques. HealthMax offers personalized treatment plans and a range of physiotherapy services across seven GTA locations.

Whether elbow pain is interfering with your tennis game, limiting your workouts, or making everyday tasks uncomfortable, the right rehabilitation plan can help you gradually restore strength and function.

If you are experiencing persistent elbow pain, book an assessment at a HealthMax Physiotherapy Clinic near you or call (416) 431-4000. Our experienced healthcare professionals will develop an individualized treatment plan based on your symptoms, goals, and needs, helping you manage pain, improve mobility, and get back to the activities you enjoy.