Tennis Elbow: Symptoms, Causes and 6 Exercises That May Help

⏱ Read time: 7 min  ·  J&J Therapy, New Malden

TL;DROnly about 5% of people with tennis elbow actually play tennis (Newcastle Hospitals NHS Foundation Trust) — most cases come from everyday gripping, typing and DIY.Evidence suggests early physiotherapy helps: in a randomised trial, manual therapy plus exercise outperformed a "wait and see" approach by 6 weeks (Bisset et al., BMJ 2006).You don't need a GP referral — same-week assessments are available at J&J Therapy in New Malden, 7 days a week.

That twinge on the outside of your elbow when the kettle goes up? It could be tennis elbow — an overuse problem in the tendons that anchor your forearm muscles to the bony point on the outer elbow. Despite the name, only about 5% of sufferers actually play tennis, according to Newcastle Hospitals NHS Foundation Trust. Most cases come from gripping, lifting, mouse work and DIY. The good news: research supports simple, structured care — hands-on physiotherapy and progressive loading exercises — as the evidence-based first-line treatment, and most people improve without injections or surgery.

What Is Tennis Elbow?

Tennis elbow (lateral epicondylitis) is an overuse condition of the tendons that attach your wrist-extending muscles to the lateral epicondyle — the bony bump on the outer side of the elbow. Repeated gripping and wrist movements create tiny amounts of damage faster than the tendon can repair, a bit like a rope fraying strand by strand from being pulled the same way every day.

It's common: tennis elbow affects around 1–3% of UK adults every year (BMJ Clinical Evidence), and it's most frequent between ages 35 and 54. The largest UK general-population study found an incidence of 2.45 per 1,000 person-years, peaking at 7.35 per 1,000 in the 45–50 age group (Titchener et al., Shoulder & Elbow, 2012). Office workers, cleaners, tradespeople, hairdressers and parents lifting children are all typical patients — racquet players are the minority.

Do I Have Tennis Elbow? A 30-Second Self-Check

Run through this quick checklist. If 3 or more apply to you, it's time to pay attention:

☑️ Pain when lifting a mug or kettle

☑️ It hurts to wring out a towel

☑️ Sharp pain turning a door handle

☑️ Your grip feels weak or unreliable

☑️ Your elbow aches after mouse or keyboard use

In clinic, a physiotherapist confirms the diagnosis with simple provocation tests such as Cozen's test and Mill's test, which reproduce the pain at the lateral epicondyle, alongside a grip-strength comparison between arms. Imaging is rarely needed.

What Happens If You Just Leave It?

Tennis elbow is usually self-limiting — but slowly. The average course runs 6 months to 2 years, and up to 20% of people still have symptoms after a year (BMJ Clinical Evidence; NHS Fife). That's a long time to struggle with mugs, door handles and a mouse.

There's a wider cost, too. Absence from work due to lateral elbow tendinopathy is estimated to cost the UK economy around £27 million per year (Evans et al., UK systematic review). And waiting for NHS care can be slow: 372,560 people were on community MSK physiotherapy waiting lists in England as of August 2025 (Chartered Society of Physiotherapy).

Early treatment appears worthwhile. In a randomised trial of 198 patients, physiotherapy (manual therapy plus exercise) produced better pain and function than "wait and see" by 6 weeks, with less need for further treatment (Bisset et al., BMJ 2006). If you've had no improvement after around 6 weeks of sensible self-management, an assessment is a reasonable next step.

Are Steroid Injections a Shortcut?

They can look like one — but the long-term data tells a different story. In the Bisset trial, injections had the best results at 6 weeks (78% success), yet 47 of those 65 early successes later relapsed. In a landmark follow-up study, 1-year recovery was 83% with corticosteroid injection versus 96% with placebo, and relapse rates were 54% versus 12% (Coombes et al., JAMA 2013). In other words, the injection group did worse at one year than people who had no injection at all.

The evidence therefore supports an exercise- and manual-therapy-led approach first, keeping injections for carefully selected cases after a proper discussion of the trade-offs.

How Physiotherapy Can Help

At J&J Therapy in New Malden, treatment for tennis elbow combines three evidence-based elements:

1. Hands-on manual therapy. Joint mobilisation techniques such as Mill's manipulation and Mulligan mobilisation-with-movement, plus soft-tissue release of the forearm extensors, may help reduce pain and restore comfortable movement — research supports adding manual therapy to exercise for better short-term results.

2. A personalised loading programme. Progressive exercise — from isometric holds to eccentric and heavier resistance work — is the first-line treatment recommended in UK practice (81% of clinicians surveyed named exercise their first choice; Bateman et al., 2019). Loading rebuilds the tendon's capacity rather than just calming symptoms.

3. Shockwave therapy for stubborn cases. For chronic tennis elbow that hasn't improved after 3+ months of conservative care, extracorporeal shockwave therapy is an option, typically once a week for 3–6 sessions. NICE (IPG313) notes there are no major safety concerns but that evidence of benefit is inconsistent — so we present it honestly as something that may help selected chronic cases, delivered by our Storz Medical certified practitioner.

Unlike NHS MSK pathways, where hundreds of thousands are waiting, you can self-refer to private physiotherapy — no GP letter needed — and same-week appointments are usually available at our New Malden clinic, open 7 days a week.

6 Exercises You Can Try at Home

These exercises are drawn from NHS patient resources and published rehabilitation research. Work within mild discomfort only (no more than 3 out of 10 pain), and if pain lasts more than an hour after exercising, do less next time.

1. Wrist Extensor Stretch

Straighten your elbow with the palm facing down and fingers pointing to the floor. With the other hand, gently press the back of the hand towards your body until you feel a stretch along the top of the forearm. Avoid bouncing.

Hold 15–30 seconds × 3–5 reps, 2–3 times a day.

2. Isometric Wrist Extension

Rest your forearm on a table, palm down, elbow bent to about 90 degrees. Press the back of your hand up against the underside of the table (or your other hand) at about 70% effort, without letting the wrist actually move. This can settle pain in the early, irritable stage.

Hold 10–45 seconds × 5 reps, 1–2 times a day.

3. Eccentric Wrist Lower (bottle version)

Forearm on the table, wrist just past the edge, holding a small water bottle or light dumbbell palm-down. Use your other hand to lift the wrist up, then lower it slowly over 3–4 seconds using the affected arm only. Slow lowering under load is the part that stimulates tendon repair — adding eccentric exercise improved pain by 81% and strength by 72% in one randomised trial (Tyler et al., 2010).

15 reps × 3 sets, once a day. Increase the weight gradually only if pain-free.

4. Forearm Rotation (Supination/Pronation)

Elbow bent to 90 degrees and tucked against your side, holding a light weight or a hammer. Slowly turn your palm up, then down, keeping the elbow still. This rebuilds tolerance for everyday twisting — jars, keys, screwdrivers.

10–15 reps × 2–3 sets, once a day.

5. Grip / Ball Squeeze

Squeeze a soft ball or therapy putty gently for 5 seconds, then slowly release. Start well below maximum effort and build up as comfort allows.

5-second squeeze × 10–15 reps, 2–3 times a day.

6. Radial Nerve Glide

Stand with the arm by your side, palm turned to face behind you, wrist gently bent. Take the arm slightly out to the side until you feel a light pull, then ease back. Keep it gentle and oscillating — stop immediately if you get tingling or sharp nerve pain.

5–10 gentle reps × 1–2 sets, 1–2 times a day.

⚠️ A note on going it alone: home exercises help, but poor technique or overloading can flare symptoms, and if the underlying cause — desk setup, neck and shoulder contribution, workload spikes — isn't addressed, recurrence is common. Evidence suggests combining a tailored programme with hands-on treatment may speed recovery compared with home exercise alone.

When to Seek Help Right Away

Don't wait if you notice any of these:

🚩 Pain that started after a fall or injury, or a visibly deformed elbow 🚩 Numbness or tingling in the fingers 🚩 Clearly restricted elbow movement 🚩 Fever, redness or heat around the joint 🚩 No improvement after 6–12 months of conservative care

If any of these apply, see a doctor or physiotherapist promptly — they can rule out fracture, nerve involvement, joint problems or infection.

Frequently Asked Questions

Do I need a GP referral to see a physiotherapist?

No. You can self-refer directly to private physiotherapy — same-week appointments are usually available at J&J Therapy. If you plan to claim on health insurance, check your policy first, as some insurers ask for a GP referral.

How many sessions will I need?

It varies with how long you've had symptoms and what your job or sport demands. In the key research, physiotherapy programmes ran around 8 sessions (Bisset et al., BMJ 2006), and shockwave courses are typically 3–6 weekly sessions. Your physiotherapist will agree a plan with you at the first assessment.

Does treatment hurt?

Some techniques, including deep soft-tissue work and shockwave, can feel briefly uncomfortable — patients often describe shockwave as a tapping sensation, sometimes with short-lived redness (NICE IPG313). Treatment is always adjusted to what you can comfortably tolerate.

Can I keep working and using my arm?

Usually yes — complete rest isn't recommended. The aim is to modify aggravating tasks (lift palm-up with a bent elbow, adjust your mouse grip, use a wrist rest) while the tendon is progressively reloaded. Most people stay at work throughout treatment.

Will my tennis elbow come back?

It can, especially if the tendon never regains full load capacity or work habits don't change. That's why a graded strengthening programme and simple ergonomic changes matter as much as short-term pain relief. Research supports loading-based rehabilitation for lowering recurrence compared with rest or injection alone.

Book a Same-Week Tennis Elbow Assessment in New Malden

If gripping, lifting or typing has become a wince, don't wait months for it to settle on its own.📍 J&J Therapy, CI Tower, New Malden, KT3 4TE — 2 min from New Malden station · Free parkingOpen 7 days · 9am–7pm · Same-week appointments · No GP referral neededCare in English · Korean · Cantonese · Mandarin — also serving Kingston upon Thames, Raynes Park, Wimbledon and Worcester Park 📞 +44 07935 869938 — Reception · 9am–7pm · call or text 📞 +44 07882 943540 — 24-hour AI bookings · call/text/WhatsApp anytime 🌐 www.jjtherapy365.com [ Book Now ]

About the author Valton Lam, MSK Physiotherapist — MSci Physiotherapy (Keele University), HCPC-registered (PH148704), member of the Chartered Society of Physiotherapy. Valton specialises in musculoskeletal assessment, progressive loading rehabilitation and manual therapy, and is a Storz Medical certified shockwave practitioner at J&J Therapy, New Malden.

This article is for general information only and is not a substitute for an individual assessment, diagnosis or treatment by a qualified health professional. Every patient is different — results and recovery times may vary. If you are worried about your symptoms, please seek professional advice.

Sources· NICE. Extracorporeal shockwave therapy for refractory tennis elbow (IPG313)· NHS Fife / NHS inform / Newcastle Hospitals NHS Foundation Trust — Tennis elbow patient resources· Bisset L, et al. BMJ 2006;333:939 — physiotherapy vs corticosteroid injection vs wait-and-see· Coombes BK, et al. JAMA 2013;309(5):461–469 — corticosteroid injection 1-year outcomes· Tyler TF, et al. J Shoulder Elbow Surg 2010;19:917–922 — eccentric wrist extensor exercise· Titchener AG, et al. Shoulder & Elbow 2012;4:209–213 — UK incidence (THIN database)· Evans J, et al. — UK lateral elbow tendinopathy absenteeism cost (systematic review)· Bateman M, et al. Shoulder & Elbow 2019 — UK clinical practice survey· Chartered Society of Physiotherapy (CSP), Aug 2025 — community MSK waiting list data· BMJ Clinical Evidence — tennis elbow prevalence and natural history