Tennis Elbow

Despite its name, tennis elbow is not primarily a condition of tennis players. The majority of people who walk into a physiotherapy clinic with lateral elbow pain are office workers, manual workers, and tradespeople whose common activity is not a backhand groundstroke but a computer mouse, a screwdriver, or a paintbrush. The name refers to the mechanism, not the population — the same forearm muscles loaded during a tennis backhand are the ones affected, but the load doesn’t have to be tennis-specific. Tennis elbow, or lateral epicondylalgia, is a tendinopathy of the extensor carpi radialis brevis — a failed healing response to chronic overload that produces degeneration rather than the normal repair expected from acute injury.

The condition is famously persistent, with symptoms often lasting months to years despite rest and self-management. Tendons respond to load with a cycle of micro-damage and repair; when load consistently exceeds the tendon’s capacity to repair, the degenerative process outpaces repair and tendinopathy develops. The degenerated tissue isn’t inflamed in the traditional sense, which is why anti-inflammatory medication produces only modest benefit — and it becomes pain-sensitised, so stimuli that wouldn’t normally hurt now do, a sensitisation that can persist even after the tendon pathology has improved.

This is exactly why rest alone doesn’t work: a rested tendon hasn’t become stronger, so the same inadequate capacity is still there when load resumes, and the condition returns. Corticosteroid injections give rapid short-term relief but multiple studies show worse outcomes at three to six months compared with physiotherapy, because the relief comes at the cost of temporarily worsening the tendon pathology. The evidence-based fix is progressive tendon loading — starting with isometric holds, then eccentric, concentric, and heavy slow resistance work as the tendon adapts.