Quick Summary
Tennis elbow (lateral epicondylitis) is a common overuse condition of the tendons on the outside of your elbow, causing pain when you grip, lift or twist. It affects around 1–3% of adults, most often between the ages of 35 and 54 — and despite the name, only a small minority of cases come from playing tennis. At J&J Therapy we combine shockwave therapy, hands-on manual therapy and a progressive exercise programme, and most patients improve within 3–6 shockwave sessions alongside targeted loading exercises.
What Is Tennis Elbow?
Tennis elbow — known medically as lateral epicondylitis — is a problem with the tendons that attach your forearm muscles to the bony bump on the outside of your elbow (the lateral epicondyle). The tendon most often affected is the extensor carpi radialis brevis, which helps you extend your wrist and stabilise your grip.
Although the name ends in "-itis", research shows tennis elbow is not primarily an inflammatory condition. Studies of affected tendons reveal a degenerative process: disorganised, immature collagen and abnormal blood-vessel growth rather than inflammatory cells (Wolf, New England Journal of Medicine, 2023). Repetitive gripping and wrist movements load the tendon beyond its capacity, creating small tears that accumulate faster than the tendon can repair itself.
Tennis elbow usually affects your dominant arm and is essentially an overuse condition — most cases arise from work, DIY or everyday repetitive strain rather than sport. The good news is that it generally settles within 6–12 months even without treatment; evidence shows that physiotherapy combining manual therapy and exercise speeds recovery and reduces the risk of recurrence (Bisset et al., BMJ, 2006; Coombes et al., JOSPT, 2015).
Do You Experience These Symptoms?
✓ Pain and tenderness on the outside of your elbow, sometimes spreading down the forearm
✓ Pain that worsens when gripping, lifting, twisting or shaking hands
✓ A weakened, painful grip — for example when holding a mug or turning a key
✓ Tenderness just below the bony point on the outside of your elbow
✓ Pain when straightening your wrist or fingers against resistance
✓ Stiffness or aching that is often worse in the morning or after activity
✓ Symptoms usually affecting your dominant arm
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Tennis Elbow?
• Repetitive gripping and wrist movements
The most common cause is repeated loading of the wrist extensor tendons beyond their capacity. Sustained or forceful gripping — manual work, DIY or racquet sports — gradually builds up micro-damage in the tendon at its attachment.
• Occupational strain
Jobs involving repetitive hand, wrist and forearm movements — such as plumbing, carpentry, cleaning, hairdressing and prolonged keyboard or mouse work — are strongly associated with tennis elbow. This is why the condition most often affects the dominant arm.
• A sudden increase in activity
A rapid jump from relative rest to heavy use — a weekend of gardening, decorating or a new gym routine — can overload an unaccustomed tendon. Tendons adapt slowly, so sudden spikes in load often trigger symptoms.
• Age-related tendon changes
Tendon quality naturally declines with age, which is why people between 35 and 54 are most susceptible. Older tendons tolerate less repetitive load before micro-damage begins to accumulate.
• Lifestyle and health factors
Research suggests smoking and obesity are associated with a higher risk of developing tennis elbow and with slower recovery. Addressing these factors may support your rehabilitation.
How We Treat Tennis Elbow at J&J Therapy
Hands-On Manual Therapy
Our physiotherapists use specialised hands-on techniques, including mobilisation with movement — a sustained glide of the elbow joint performed while you actively grip. Research shows this approach can produce immediate improvements in pain-free grip strength, and a landmark trial found physiotherapy combining elbow mobilisation with exercise was superior to a wait-and-see approach at six weeks. We use manual therapy to reduce pain so you can load the tendon and exercise effectively.
Shockwave Therapy*
We deliver radial shockwave therapy using the Swiss-engineered Storz Medical MASTERPULS system. For tennis elbow, acoustic pulses are applied to the affected tendon to stimulate collagen repair, promote new blood-vessel growth and modulate pain signals — helping to restart a stalled healing response. Non-invasive, evidence-based. Typically 3–6 sessions.
Targeted Exercise Programme
A progressive tendon-loading programme is the cornerstone of lasting recovery. Our physiotherapists prescribe individualised exercises — often starting with isometric holds for pain relief, then progressing to eccentric wrist extensor strengthening, which research shows significantly improves pain and grip strength. We also address technique, forearm and shoulder strength, and give practical advice on modifying aggravating activities while your tendon heals.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Tingling, numbness or weakness spreading into your hand, or neck pain radiating down your arm — this may indicate a nerve problem rather than a tendon issue
Elbow pain after a fall or direct injury, inability to move your arm, or a sense of the joint locking or giving way
A hot, red, swollen elbow, or elbow pain with fever or feeling generally unwell
Severe night pain that does not ease with rest or position changes
FAQs About Tennis Elbow
How long does tennis elbow take to get better?
Tennis elbow usually settles within 6–12 months, and around 9 in 10 people recover within a year even without treatment. The value of physiotherapy is speeding up that recovery — easing pain sooner, restoring grip strength and reducing the chance of it coming back.
Does shockwave therapy work for tennis elbow?
Research suggests shockwave therapy may help, particularly for stubborn tennis elbow that has not settled with exercise alone. Reviews of clinical trials have found it can reduce pain more than ultrasound or steroid injection, though results vary between studies. It works best combined with a loading programme, and we will discuss honestly whether it is likely to help you.
Should I have a steroid (cortisone) injection?
Generally we do not recommend it as a first choice. Steroid injections can ease pain for a few weeks, but high-quality trials show worse outcomes at one year, with a much higher chance of the pain returning compared with physiotherapy or even doing nothing. We can talk through the trade-offs if you are considering one.
Will I need surgery?
Almost certainly not. Surgery is reserved for the small minority of cases that fail 6–12 months of well-structured conservative care. The vast majority of people improve with exercise, manual therapy, shockwave therapy and activity modification.
Can I keep using my arm?
Yes — complete rest is not advised. Modifying aggravating activities, such as lifting with your palm facing up and using tools with a larger grip, while continuing to load the tendon in a controlled way gives the best results.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
Last reviewed:
2026년 8월 20일