- Tennis elbow is a tendon problem on the outside of the elbow, usually from gripping
- It is most common between about 35 and 55
- Progressive strengthening and changing how you grip are the core treatments
- Many people improve within a year, often much sooner with good rehab
- Steroid injections can ease pain short term but may raise the risk of it returning
What tennis elbow is
Tennis elbow, or lateral elbow tendinopathy, affects the common extensor tendon, where the muscles that extend your wrist and fingers attach to the bony bump on the outside of the elbow. When that tendon is loaded more than it can currently tolerate, it becomes sensitive and gradually less able to cope with gripping and lifting.
Despite the older name lateral epicondylitis, it is not mainly an inflammatory problem. Under a microscope, the tendon shows changes in its structure and repair process rather than classic inflammation, which is why rest and anti-inflammatories on their own rarely fix it.
Common causes and who gets it
It is most common between about 35 and 55 and affects men and women roughly equally. Only a small minority of cases come from tennis. The usual cause is repetitive gripping and wrist extension, especially when it increases suddenly.
- Manual jobs involving tools, such as plumbing, joinery or plastering
- A long weekend of gardening, painting or DIY
- Lots of mouse and keyboard work without breaks
- A sudden rise in gripping work in the gym: heavy deadlifts, rows, pull-ups, farmers carries or sled pulls
- Racket sports, especially with a new racket or a technique change
HYROX training is a common trigger, because sled pulls, farmers carries, rowing and SkiErg all load grip heavily in the same week. Smoking and some health conditions are also linked with slower tendon recovery, and poor sleep lowers pain tolerance generally.
Typical symptoms
Pain is felt on the outside of the elbow and may spread down the forearm. It usually comes on gradually. Classic aggravating tasks include lifting a full kettle, shaking hands firmly, turning a stiff door handle, pouring from a jug, and lifting a bag with the palm facing down.
The elbow may feel stiff first thing, and grip can feel weak because pain inhibits it. Pins and needles or numbness in the hand is not typical of tennis elbow and should be assessed, as it can suggest a nerve problem or pain coming from the neck.
What a physio assessment looks at
Your physio will ask about your work, training and hobbies, because the plan depends on where the load is coming from. They will check the elbow for tenderness, test grip strength and resisted wrist and finger extension, and look at the neck and shoulder to rule out referred pain. Imaging is rarely needed unless the picture is unusual or it is not improving.
They will also look at your grip habits. Small changes, such as lifting with the palm facing up, using a thicker handle, or using lifting straps for high-volume pulling work for a while, can make a big difference.
What usually helps
The strongest approach combines education, load management and a progressive strengthening programme for the wrist extensors and grip. Programmes usually begin with isometric holds, then slow lifting and lowering with a dumbbell, then heavier and more functional grip work. Tendons take time to adapt, so steady progress over months is normal.
A counterforce brace, a strap worn just below the elbow, helps some people get through work or training days more comfortably. Manual therapy can ease pain in the short term. Steroid injections can reduce pain for a few weeks, but research shows they are linked with poorer outcomes and more recurrences over the following year, so many clinicians now use them sparingly. Shockwave therapy and other injections have mixed evidence.
What you can start with at home
- Isometric wrist extension: rest your forearm on a table, palm down, and push the back of your hand up into your other hand at a moderate effort for 30 to 45 seconds, 4 to 5 times.
- Slow wrist extension with a light dumbbell or water bottle, lifting and lowering over 3 seconds each way, 3 sets of 15.
- Grip squeezes with a soft ball or towel, 3 sets of 10 to 15.
- Change how you lift: palm up where possible, keep objects close, and take breaks from repetitive tasks.
- Keep training the rest of your body, swapping or strapping the most aggravating grip-heavy lifts for now.
Mild discomfort during these exercises is acceptable, up to about 3 or 4 out of 10, if it settles by the next day. Add weight to the slow wrist extensions when 3 sets of 15 feel easy, typically every week or two.
As the elbow improves, rebuild the gym lifts that load grip. Start with lighter pulling at moderate reps, then gradually reduce your reliance on straps and add heavier carries and holds over several weeks. The aim is a forearm that is stronger than it was before the problem started, not just a pain-free one.
Recovery time and when to get help
Tennis elbow can be stubborn. Many people improve within a few months with a good plan, and most improve within a year, but some cases drag on longer. Ongoing symptoms are not a sign of damage, just a tendon that needs more time and graded load. The on-site physio at Lycan Strength can help, with 20% off for members; book a physio appointment if it is not settling.
- Go to A&E after a fall or injury if the elbow is deformed, very swollen or you cannot move it.
- Call NHS 111 or see a GP urgently if the elbow is hot, red and swollen, or you have a fever.
- See your GP if you have numbness, pins and needles or weakness in the hand, or pain that is getting steadily worse despite rest.
Questions
How long does tennis elbow take to heal?
Many people improve over a few months with good rehab, and most within a year. Some cases last longer, especially if the aggravating load continues unchanged.
Should I rest tennis elbow completely?
Complete rest often leaves the tendon weaker. Reducing the aggravating tasks while doing a progressive strengthening programme usually works better.
Does a tennis elbow strap work?
A counterforce strap helps some people reduce pain during work or training. It is a support tool alongside exercise rather than a fix on its own.
Can I lift weights with tennis elbow?
Usually yes, with changes. Use straps or different grips for heavy pulling, reduce grip-heavy volume, and add in specific wrist extensor strengthening.
This page is general information, not a diagnosis. If you are worried about a symptom, speak to a physiotherapist, your GP or NHS 111.
