Tennis Elbow (Lateral Epicondylalgia).
What is tennis elbow?
Tennis elbow — more accurately called lateral epicondylalgia or lateral elbow tendinopathy — is one of the most common upper limb conditions presenting to physiotherapy, affecting approximately one to three percent of adults. Despite its name, the majority of people who develop it have never played tennis. It is primarily an overuse condition of the wrist extensor tendons at their attachment to the lateral epicondyle — the bony prominence on the outer elbow — rather than an acute inflammatory process, which is why the older term "lateral epicondylitis" has been largely replaced in clinical practice.
The most common cause is unaccustomed repetitive activity involving the forearm extensors or repeated gripping. This can include a new job involving hand tools, or activities you have done before but greatly increased in duration. It can also result from a single forceful lift or action involving the forearm and hand.
The condition affects men and women equally and is most common between the ages of 35 and 54. It is strongly associated with occupational exposure — keyboard workers, tradespeople, healthcare workers and manual labourers are all at elevated risk — and is classified as an occupational disease under WorkCover provisions in many presentations.
What are the symptoms?
People with lateral epicondylalgia typically experience pain and decreased function, including pain that lingers following activity, potentially into the following day. The pain is localised to the outer elbow and lateral forearm, and is typically provoked by gripping, lifting with the palm facing down, using a computer mouse, and wringing or twisting actions. In severe presentations, pain occurs at rest and at night.
It is important to note that several other conditions present similarly to lateral epicondylitis — a physiotherapy diagnosis is important to rule out causes relating to local inflammation, joint dysfunction, neural irritation, or referred pain from the neck or shoulder. Posterior interosseous nerve entrapment, radial tunnel syndrome and referred pain from the C6 cervical nerve root can all produce lateral elbow and forearm pain that mimics tennis elbow and requires quite different management.
How is it diagnosed?
Clinical assessment involves specific provocation tests — resisted wrist extension, Cozen's test and Mill's test — alongside palpation of the common extensor origin at the lateral epicondyle. Assessment of cervical spine and radial nerve neural tension distinguishes neural contributors from pure tendon pathology. A physiotherapy diagnosis is important to direct the right treatment at the right structure — treating a cervical nerve root irritation with tendon loading exercises will not produce improvement.
Ultrasound identifies tendon degeneration, partial tearing and associated changes at the lateral epicondyle, and can guide diagnostic or therapeutic injections.
How can physiotherapy help?
An appropriate rehabilitation program is important for recovering and regaining function as early as possible. Physiotherapy aims to accurately diagnose and differentiate from other elbow injuries, devise a pain reduction plan including activity modification and taping or bracing if necessary, facilitate tissue repair through load management, and restore movement, strength and function through a tailored rehabilitation program.
The cornerstone of tennis elbow rehabilitation is progressive tendon loading — specifically eccentric and heavy slow resistance (HSR) exercise of the wrist extensors. This approach directly targets the tendon degeneration that underlies the condition, stimulating collagen remodelling and progressive restoration of tendon load capacity. The loading program begins at a level that is comfortable — typically isometric contractions — and progresses through isotonic and then eccentric loading over weeks to months. The pace of progression is guided by pain response: a small amount of discomfort during exercise is acceptable and expected, but pain that takes more than 24 hours to settle indicates the load was too high.
Activity modification is the essential parallel intervention — continuing the aggravating activity at the same level while starting a loading program undermines the tissue's ability to adapt. Physiotherapy advice on grip modification, ergonomic adjustment, and activity substitution during rehabilitation is as important as the exercise program itself.
A lateral epicondyle brace (counterforce strap) reduces pain during activity by redistributing the forces transmitted to the tendon's attachment point. It is a useful symptomatic tool during rehabilitation but is not a substitute for the loading program.
Manual therapy — joint mobilisation of the lateral elbow using Mulligan's mobilisation with movement (MWM) technique — produces immediate and clinically meaningful pain reduction during gripping and is one of the most effective short-term interventions for tennis elbow. Dry needling of the common extensor origin and surrounding musculature assists with pain management and trigger point release.
As a general guideline, you should be able to return to all typical daily activities in 2 to 6 weeks, and all work-related activities in 3 to 12 weeks depending on how strenuous they are. While you should feel restored to full function, you may find mild pain present for 3 to 6 months following the original injury.
For patients whose tennis elbow developed in a workplace context — which is common given the occupational risk factors — WorkCover funded physiotherapy and capacity assessment is available.
Our physiotherapists Bethany Kippen and Yulia Khasyanova both have experience in upper limb tendinopathies and are members of the Australian Physiotherapy Association. Please note — the phone number on the existing page shows 3406 and needs correcting to 07 3706 3407.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Tennis elbow — more accurately called lateral epicondylalgia or lateral elbow tendinopathy — is one of the most common upper limb conditions presenting to physiotherapy, affecting approximately one to three percent of adults. Despite its name, the majority of people who develop it have never played tennis. It is primarily an overuse condition of the wrist extensor tendons at their attachment to the lateral epicondyle — the bony prominence on the outer elbow — rather than an acute inflammatory process, which is why the older term "lateral epicondylitis" has been largely replaced in clinical practice.
The most common cause is unaccustomed repetitive activity involving the forearm extensors or repeated gripping. This can include a new job involving hand tools, or activities you have done before but greatly increased in duration. It can also result from a single forceful lift or action involving the forearm and hand.
The condition affects men and women equally and is most common between the ages of 35 and 54. It is strongly associated with occupational exposure — keyboard workers, tradespeople, healthcare workers and manual labourers are all at elevated risk — and is classified as an occupational disease under WorkCover provisions in many presentations.
What are the symptoms?
People with lateral epicondylalgia typically experience pain and decreased function, including pain that lingers following activity, potentially into the following day. The pain is localised to the outer elbow and lateral forearm, and is typically provoked by gripping, lifting with the palm facing down, using a computer mouse, and wringing or twisting actions. In severe presentations, pain occurs at rest and at night.
It is important to note that several other conditions present similarly to lateral epicondylitis — a physiotherapy diagnosis is important to rule out causes relating to local inflammation, joint dysfunction, neural irritation, or referred pain from the neck or shoulder. Posterior interosseous nerve entrapment, radial tunnel syndrome and referred pain from the C6 cervical nerve root can all produce lateral elbow and forearm pain that mimics tennis elbow and requires quite different management.
How is it diagnosed?
Clinical assessment involves specific provocation tests — resisted wrist extension, Cozen's test and Mill's test — alongside palpation of the common extensor origin at the lateral epicondyle. Assessment of cervical spine and radial nerve neural tension distinguishes neural contributors from pure tendon pathology. A physiotherapy diagnosis is important to direct the right treatment at the right structure — treating a cervical nerve root irritation with tendon loading exercises will not produce improvement.
Ultrasound identifies tendon degeneration, partial tearing and associated changes at the lateral epicondyle, and can guide diagnostic or therapeutic injections.
How can physiotherapy help?
An appropriate rehabilitation program is important for recovering and regaining function as early as possible. Physiotherapy aims to accurately diagnose and differentiate from other elbow injuries, devise a pain reduction plan including activity modification and taping or bracing if necessary, facilitate tissue repair through load management, and restore movement, strength and function through a tailored rehabilitation program.
The cornerstone of tennis elbow rehabilitation is progressive tendon loading — specifically eccentric and heavy slow resistance (HSR) exercise of the wrist extensors. This approach directly targets the tendon degeneration that underlies the condition, stimulating collagen remodelling and progressive restoration of tendon load capacity. The loading program begins at a level that is comfortable — typically isometric contractions — and progresses through isotonic and then eccentric loading over weeks to months. The pace of progression is guided by pain response: a small amount of discomfort during exercise is acceptable and expected, but pain that takes more than 24 hours to settle indicates the load was too high.
Activity modification is the essential parallel intervention — continuing the aggravating activity at the same level while starting a loading program undermines the tissue's ability to adapt. Physiotherapy advice on grip modification, ergonomic adjustment, and activity substitution during rehabilitation is as important as the exercise program itself.
A lateral epicondyle brace (counterforce strap) reduces pain during activity by redistributing the forces transmitted to the tendon's attachment point. It is a useful symptomatic tool during rehabilitation but is not a substitute for the loading program.
Manual therapy — joint mobilisation of the lateral elbow using Mulligan's mobilisation with movement (MWM) technique — produces immediate and clinically meaningful pain reduction during gripping and is one of the most effective short-term interventions for tennis elbow. Dry needling of the common extensor origin and surrounding musculature assists with pain management and trigger point release.
As a general guideline, you should be able to return to all typical daily activities in 2 to 6 weeks, and all work-related activities in 3 to 12 weeks depending on how strenuous they are. While you should feel restored to full function, you may find mild pain present for 3 to 6 months following the original injury.
For patients whose tennis elbow developed in a workplace context — which is common given the occupational risk factors — WorkCover funded physiotherapy and capacity assessment is available.
Our physiotherapists Bethany Kippen and Yulia Khasyanova both have experience in upper limb tendinopathies and are members of the Australian Physiotherapy Association. Please note — the phone number on the existing page shows 3406 and needs correcting to 07 3706 3407.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
