How to treat tennis elbow

how to treat tennis elbow

Lateral epicondylitis / tennis elbow or RSI — or when it hurts to pick up your cup of tea!!

What is it lateral epicondylitis / epicondylalgia

This very common, painful condition (properly termed lateral epicondylalgia but which everyone calls tennis elbow for ease of pronunciation!) manifests as elbow pain. This is usually on the top of the forearm or around the edge of your elbow where the muscles that stabilise your wrist when you grip are located.

Who gets it?

Tennis elbow is commonest in manual workers but also affects people who regularly grip their hand, for example to lift weights at the gym or play tennis (hence the term tennis elbow). Repetitive strain injury affects the same exact muscle group but is triggered by repeated use of parts of the muscle, not to stabilise the hand, but to lift the fingers, to type and use the mouse by office workers with heavy typing loads or piano players.

Is it badly damaged?

Historically, clinicians have used ultrasound to identify changes in the muscles and tendons that they associated with amounts of damage. More recently however, research has demonstrated that 50% of people who have no pain or symptom salso have these changes in their muscles and have never needed treatment for RSI /tennis elbow/lateral epicondylitis.

What do these typical ultrasound findings mean for people with ongoing elbow pain then? It means that the changes in the muscles used to be wrongly attributed to ‘damage’ that needed to be repaired. They should have just been identified as normal ageing like crow’s feet wrinkles round your eyes due to lots of smiling!

Why does tennis elbow pain last so long?

The pain should be considered a strain (like a sprained ankle) that, given sufficient time to rest and recover, plus exercise, will heal. Not unlike a sprained ankle, which you tend to keep straining (following the first sprain the ligaments are a little more lax) as you have to just keep using them, tennis elbow sufferers tend to experience ongoing pain because it is so very hard to rest the muscles; even though they are strained you have to keep using them (try getting through the day without gripping anything!)

What else can you do?

Avoid aggravating exercises and movements. If you’ve had the pain for less than 6-8 weeks, rest your arm as much as you can. Carrying things facing up, and close to your body. Work to get your grip pain free by doing the exercise below but avoid manual labour.

So how do you reduce the pain?

Isometric loading of tendons has been shown by researchers to reduce pain and help repair the tendon. Isometric means keeping the length of tendon the same.

In tennis elbow and lateral epicondylalgia, you can do this by looping a theraband under your foot while the affected hand grips the top of loop (fingers facing the floor) as heavy a load as you can manage for a minute without feeling any pain.

When you can do two minutes with a minute’s break in the middle, straighten your elbow until you begin to feel the pain, and then bend very slightly into the painfree zone.

Perform two more 1 minute holds with a minute’s rest between, until this is easy.

Pronate your hand (turn your fist so your thumb rotates toward the floor) the next time you perform the exercise staying just inside your pain threshold.

Keep extending your arm, until you can do the exercise with a straight arm, and with your fist pronated. Then increase the tension on the theraband by shortening the loop gradually for each days’ exercise. This is the exercise version of Paracetamol!

Will therapy help?

Some therapies will help some people. NHS Nice guidelines recommend mobilisation and massage as well as ultrasound.

Sometimes traditional Chinese acupuncture or electroacupuncture can be effective at pain control.

As osteopaths and physiotherapists not only are we experienced at manual therapy such as mobilisation and massage, but we also add dry needling to reduce trigger points and improve tissue health to the aforementioned treatments — see our blogs on Dry needling and 5 things you didn’t know about Acupuncture and Dry needling for more information.

An epicondyle strap will help to rest the strained part of the muscle during the day while you continue to manage your pain and strengthen it with exercise.


If you’re not sure whether we can help, please give us a call on 02077356813 or email