Tennis Elbow

September 14, 2026

Understanding the Condition and the Role of Physiotherapy in Recovery

If you have ever felt pain on the outer side of your elbow while lifting a cup of tea, shaking someone’s hand, opening a jar, carrying shopping bags, or even typing on a computer, you may be dealing with a condition known as Tennis Elbow.

Many people get worried when they hear the name and immediately tell me:

“Doctor, but I don’t even play tennis.”

I hear this quite often in my clinic. The truth is that most patients with tennis elbow have never picked up a tennis racket in their lives. Office workers, gym-goers, tailors, mechanics, painters, teachers, and even homemakers can develop this condition. The name simply comes from the fact that tennis players commonly experience it.

The good news is that with the right physiotherapy program, most patients recover well and return to their normal daily activities without surgery.

Understanding the Anatomy

Before we discuss the condition, let me explain the area involved.

Your elbow joint is formed by three bones:

• Humerus (upper arm bone)
• Radius
• Ulna

On the outer side of the elbow there is a bony area called the Lateral Epicondyle.

Several forearm muscles attach here through a common tendon. These muscles help you:

• Lift your wrist
• Grip objects
• Hold tools
• Use a computer mouse
• Carry bags
• Shake hands
• Lift objects with your hand

One of the most commonly affected muscles is the Extensor Carpi Radialis Brevis (ECRB). When this tendon becomes irritated from repeated use, pain develops around the outer elbow.

I usually explain it to patients like this:

“Think of the tendon as a rope connecting your muscles to the bone. When that rope is pulled repeatedly day after day, tiny damage starts to develop, and eventually pain appears.”

What is Tennis Elbow?

Tennis Elbow, medically called Lateral Epicondylitis, is an overuse injury affecting the tendons attached to the outer side of the elbow. It develops because of repeated gripping, twisting, lifting, or wrist movements over time.

Many patients tell me:

“The pain started slowly and I ignored it at first.”

That is actually very common.

Unlike a fracture or sudden injury, tennis elbow often develops gradually. At first, there may only be mild discomfort. Then activities that were previously easy become painful.

What Causes Tennis Elbow?

There are many possible causes:

• Repetitive gripping activities
• Frequent computer mouse use
• Weight training with poor technique
• Tennis and racquet sports
• Using screwdrivers and hand tools
• Painting work
• Tailoring and sewing
• Repetitive lifting
• Poor wrist mechanics
• Sudden increase in workload

In my clinic, I often see patients who recently started gym training or changed jobs that involve repeated hand and wrist movements.

Sometimes patients are surprised because they cannot remember a specific injury. Instead, the tendon has simply been overloaded over time.

Common Symptoms

The symptoms can vary, but some complaints are extremely common.

Patients frequently tell me:

“Doctor, I can lift my arm, but gripping things hurts.”

“Even opening a water bottle is painful.”

“My elbow hurts when I shake hands.”

Common symptoms include:

• Pain on the outer side of the elbow
• Tenderness when touching the affected area
• Pain during gripping activities
• Weak grip strength
• Pain when lifting objects
• Pain while twisting door handles
• Discomfort while typing
• Pain that travels into the forearm
• Mild stiffness around the elbow

One thing I have noticed in many patients is that they continue working through the pain for months before seeking treatment. By that stage, the tendon becomes more sensitive and recovery may take longer.

How is Tennis Elbow Diagnosed?

Diagnosis usually starts with a detailed history and physical examination.

As physiotherapists, we assess:

• Pain location
• Grip strength
• Wrist strength
• Elbow range of motion
• Functional activities
• Work and sports history

Special tests may include:

• Cozen’s Test
• Mill’s Test
• Maudsley’s Test

In some cases, doctors may request:

• Ultrasound
• MRI
• X-ray

These investigations help rule out other causes of elbow pain.

For more information about tennis elbow, see the American Academy of Orthopaedic Surgeons (AAOS).

Why Physiotherapy is Important

Many patients ask me:

“Should I completely stop using my arm?”

Not necessarily.

The goal is not to stop moving forever. The goal is to allow the tendon to recover while gradually rebuilding its strength.

Physiotherapy helps:

• Reduce pain
• Improve tendon healing
• Restore grip strength
• Improve forearm flexibility
• Improve arm function
• Correct faulty movement patterns
• Prevent recurrence

Research has shown that exercise-based rehabilitation, particularly strengthening programs, plays an important role in recovery.

Physiotherapy Goals

When treating tennis elbow, our goals are:

• Reduce pain
• Protect the tendon
• Improve flexibility
• Restore grip strength
• Improve forearm muscle endurance
• Improve functional activities
• Return the patient to work and sports
• Prevent future episodes

Physiotherapy Treatment Protocol

Phase 1: Pain Reduction and Protection Phase

Goals

• Reduce pain
• Calm irritated tissues
• Prevent further tendon stress

Treatment

Activity Modification

I usually advise patients to temporarily reduce activities that increase pain.

Examples include:

• Heavy gripping
• Repetitive lifting
• Repeated twisting movements
• Painful gym exercises

Ice Therapy

Cold packs can help reduce pain after activity.

Brace or Counterforce Strap

Some patients benefit from a Tennis Elbow Strap during activities.

Gentle Mobility Exercises

• Elbow Flexion and Extension
• Wrist Circles
• Forearm Pronation and Supination

These exercises help maintain movement without overloading the tendon.

Phase 2: Flexibility and Mobility Phase

Goals

• Restore normal movement
• Reduce stiffness
• Improve tissue flexibility

Stretching Exercises

Wrist Extensor Stretch

One of the most commonly prescribed stretches for tennis elbow.

Wrist Flexor Stretch

Helps maintain balance around the forearm muscles.

Forearm Rotation Stretch

Useful for patients who perform repetitive twisting movements.

Finger Extensor Stretch

Helps reduce tension through the forearm muscles.

Stretches should create a gentle pulling sensation, not sharp pain.

Phase 3: Strengthening Phase

Goals

• Improve tendon strength
• Restore grip power
• Improve endurance

This is usually where patients start feeling more confident again.

Strengthening Exercises

Isometric Wrist Extension

One of my favorite early-stage exercises because it can reduce pain while beginning the strengthening process.

Ball Squeeze Exercise

A simple grip-strengthening exercise.

Wrist Extension with Dumbbell

Strengthens the wrist extensor muscles.

Eccentric Wrist Extension

This exercise is particularly important for tendon rehabilitation and is commonly used in physiotherapy programs.

Theraband Wrist Extension

Progressive strengthening exercise.

Forearm Supination and Pronation with Weight

Improves forearm control and endurance.

Rubber Band Finger Extensions

Strengthens the finger extensor muscles.

I have personally seen many patients improve once we begin progressive strengthening instead of relying only on rest and medication.

Phase 4: Functional and Return-to-Activity Phase

Goals

• Restore full arm function
• Improve endurance
• Return to work and sports

Exercises may include:

• Functional gripping drills
• Carrying exercises
• Sport-specific drills
• Work-specific movement training
• Resistance band training

At this stage, we gradually expose the tendon to normal activities again so it can tolerate everyday demands.

Manual Therapy Techniques

Depending on the patient’s condition, physiotherapy may also include:

• Soft Tissue Mobilization
• Deep Friction Massage
• Myofascial Release
• Joint Mobilization
• Trigger Point Release

These techniques are often used alongside exercise rather than as a replacement for exercise.

Home Exercise Program

I always remind my patients that recovery does not happen only during clinic visits.

A simple home program may include:

• Wrist Extensor Stretch
• Wrist Flexor Stretch
• Ball Squeeze Exercise
• Isometric Wrist Extension
• Theraband Wrist Extension
• Forearm Supination and Pronation
• Rubber Band Finger Extensions

Consistency is usually more important than doing too much too soon.

Recovery Time and Prognosis

One of the most common questions I hear is:

“Doctor, how long will it take to heal?”

Recovery depends on:

• Severity of the condition
• Duration of symptoms
• Work demands
• Exercise compliance

In most cases:

• Mild cases improve within a few weeks.
• Moderate cases may require several weeks of rehabilitation.
• Long-standing cases can take several months.

The overall outlook is generally very good, and most people recover successfully with non-surgical treatment.

Final Thoughts

Tennis Elbow is a common condition that can make even simple daily tasks frustrating. Activities such as lifting a cup, carrying groceries, typing, or shaking hands may become uncomfortable. Fortunately, it is also one of the conditions that responds very well to a structured physiotherapy program.

As a physiotherapist, I have seen many patients arrive worried that they might need injections or surgery. In reality, many of them improve through education, activity modification, stretching, progressive strengthening, and patience.

If you have pain on the outer side of your elbow that has been bothering you for weeks, do not ignore it. Early treatment often leads to faster recovery and a quicker return to the activities you enjoy.

With the right guidance, a proper exercise program, and a little patience, most people can regain strength, reduce pain, and return to normal life with confidence.

This article is for educational purposes and should not replace professional medical advice.

Written by Dr Areej Nadeem PT
College of Physiotherapy
JPMC Karachi