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Thomas Nemeth

Tennis Elbow

What better time than the Australian Open to talk about one of the most common tennis injuries: Tennis elbow. 

What is Tennis Elbow?

Tennis elbow refers to irritation of the elbow due to an overuse or overloading of the tendons in the outside part of the elbow (1). The bony part of the elbow that these tendons attach to is called the “lateral epicondyle,” therefore you might also hear this injury described as “lateral epicondylitis” or “lateral elbow tendinopathy.” The tendon itself is the connection point for the muscles in the forearm responsible for extending the wrist, therefore this injury is also commonly called “common extensor tendinopathy.” Pain is normally felt on the lateral epicondyle on the outside of the elbow with carrying, lifting, or manipulating heavy objects. It is also not uncommon to have pain referred into the muscles of the forearm (2).

What Causes It?

You don’t have to be a professional tennis player to develop tennis elbow. In fact, any activity that involves a lot of repetitive wrist movement, particularly extension, can lead to the development of tennis elbow. This does include racket sports like badminton or tennis, but it also includes things like pruning in the garden, cleaning the house, or constructing a fence or deck. Importantly, it is not typically the activity itself that causes tennis elbow, but an increase in the frequency or volume of the activity, which greatly exceeds or is different to a person’s normal frequency or volume of activity. The ability of the tendon to withstand this increased load and repair itself is ultimately overwhelmed, and this leads to injury and pain (1).

How Do You Fix It?

Treatment for tennis elbow needs to take into account both the injury-specific physical factors (i.e. Current level of pain/irritation/inflammation, underlying strength and capacity of the tendons), and also the more contextual factors that may have contributed to overloading the tendons in the first place (i.e. Activity or training frequency/volume, poor technique or biomechanics, strength and capacity of other muscles in the arm) (2).

The significance of each of these factors will differ for every individual’s circumstance, however here are some general Do’s and Don’ts that can apply to most cases of tennis elbow.


Keep Active! – Deloading doesn’t always mean stop everything completely. Keeping a baseline level of tolerable activity can make it easier to gradually increase your activity and avoid reaggravating the injury as you progress through your rehab (4).

Use bracing/support (1, 4) – A tennis elbow brace/strap won’t fix your injury, but it can often help to support your tendon enough to allow you to continue working or staying active without irritating the tendon further

Get stronger! – The best way to increase the capacity of a tendon or muscle is to gradually load it up (1, 3). For tennis elbow, this pertains mostly to the muscles of the forearm and shoulder. We can guide you on the best way to do this safely without aggravating the tendon further.

Self-massage muscles– Increasing mobility of the forearm muscles can reduce tension on the tendon itself, and provide short-term pain relief (2).


Floppy Wrists – Examples of this might be flexing your wrist when doing a bicep curl at the gym, using your wrist rather than your arm/shoulder to stir something on the stove, or using your wrist to generate movement of the tennis racket during a backhand stroke rather than generating momentum through the trunk and shoulder. The more work the wrist has to do during a task, the more load on the elbow, therefore treating the hand/wrist/arm as one unit during day-to-day tasks, or altering swing mechanics to limit excessive wrist movement can help to reduce this load (2, 4) 

Rub the tendon – Self-massage to the muscles is okay, but rubbing the elbow and tendon itself will only serve to irritate it further (2).

Corticosteroid injections – We know from research that compared to exercise-based physiotherapy interventions, corticosteroids do provide short-term pain relief, but lead to worse long term outcomes with higher recurrence rates (3)

While these Do’s and Don’ts can be applied safely to most cases of tennis elbow, it is important to have your injury assessed and managed properly by a physiotherapist. If you have been experiencing any of the signs or symptoms of tennis elbow, our physiotherapist’s can help implement an appropriate rehab plan that can address the factors most significant to your situation. Please click on the link below to book an appointment or call 9455 1177.


1. Bhabra, G., Wang, A., Ebert, J. R., Edwards, P., Zheng, M., & Zheng, M. H. (2016). Lateral Elbow Tendinopathy. Orthopaedic Journal of Sports Medicine, 4(11), 2325967116670635–2325967116670635.

2. Scott, A., Bell, S., & Vincenzino, B. (2012). Elbow and arm pain. In P. Brukner & K. Khan (Eds.), Clinical sports medicine (pp 390-400). McGraw Hill Education.

3. Coombes, B., Bisset, L., Vincenzino, B. (2015). J Orthop Sports Phys Ther 2015;45(11):938–949. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5841

4. Renstrom, P. & Ackermann, P. W. (2018). Pathophysiology of Tendinopathy: Implications for Tennis Elbow. In G. Di Giacomo, B. Kibler, & T. S. Ellenbecker (Eds.), Tennis medicine: A complete guide to evaluation, treatment, and rehabilitation (pp 263-277). Springer International Publishing.