Tennis elbow (lateral epicondylitis) is pain on the outside of the elbow, where the tendons of the forearm muscles attach to the bone. Despite the name, most people with tennis elbow don’t play tennis. It comes from repeated gripping and twisting of the wrist: working with a mouse or tools, carrying bags. It is most common between the ages of 35 and 55.
Symptoms
- Pain on the outside of the elbow, sometimes reaching down the forearm.
- Pain when you squeeze, for example when shaking hands or holding a cup.
- Pain when you lift things with your palm facing down.
- Pain when you turn a key or a door handle.
- A weaker grip: it is hard to unscrew a lid or wring out a cloth.
- A tender spot on the bone on the outside of the elbow.
The pain usually starts gradually, and at first it appears only after effort. Later it hurts with light movements too, such as lifting a cup of coffee or a kettle. The elbow may feel a little stiff in the morning. The pain is rarely severe at rest: if your elbow hurts badly at night too, the cause may be something else.
Why it happens
- Repeated movements of the wrist and fingers: working with a computer mouse, a keyboard, a screwdriver, a brush.
- Carrying heavy bags.
- Racket sports, especially with poor technique or an unsuitable racket.
- A sudden increase in load: home renovation, gardening, a new sport.
- Weak shoulder and forearm muscles, so the elbow takes more of the strain.
The tendon isn’t inflamed in the classic sense: it is overloaded and irritated. That is why rest alone rarely works. The tendon needs gradually increasing load to become strong again.
How we treat it
Kaloyan checks which movements cause the pain, how strong your grip is, and whether the pain is coming from your neck. Then he explains which activities to cut back on for a while and which you can carry on with. At the start he usually uses ultrasound therapy to calm the irritated tendon. If the forearm muscles are tight and have sore spots, he adds dry needling. Kinesio taping takes some of the load off the tendon while you work.
The core of treatment is exercises that gradually load the forearm muscles, which Kaloyan shows you and makes harder over time. If the pain has lasted for months, the sessions matter less than the exercises, and the course is longer. In the first weeks the exercises may hurt a little. That is normal, as long as the pain doesn’t get worse the next day. Usually your grip strength returns first, and then the pain when lifting goes away. You will usually need 2–5 sessions over 2–4 weeks, and the home exercises continue for a few weeks more. If you work at a computer or with tools, you and Kaloyan will also talk about how to organise your work so that it puts less strain on your elbow.
What you can do yourself
- Lift things with your palm facing up, not down.
- Take breaks if you work with a mouse or tools for long periods.
- Spread bags between both hands.
- If you play tennis, have your racket and technique checked by a coach.
- When you use tools, choose thicker handles: they are easier to grip.
- Don’t stop using your arm completely. Light everyday movements are good for it.
When to see a doctor first
Tennis elbow isn’t dangerous, but elbow pain can have other causes. See a doctor first if:
- the pain started after a fall or a blow to the elbow;
- your elbow is swollen, red and warm;
- you can’t fully bend or straighten your arm;
- you have numbness in your fingers or weakness in the whole arm.
