Tennis Elbow
Example Case
A 45-year-old carpenter visits the clinic with recurring pain around the outside of the right elbow.
Initially, the discomfort appeared only after long working days. However, it has gradually become more noticeable during simple tasks, such as carrying groceries or lifting a coffee mug.
“I don’t even play tennis, but every time I lift something or twist a jar lid, I feel a sharp pain on the outside of my elbow. I rested it for a few days, and it felt better. However, as soon as I went back to work, the pain returned. What am I doing wrong?”
There was no accident or sudden injury.
So, why does something as simple as gripping an object cause so much discomfort?
That is the first piece of the puzzle.
Subjective Symptoms
The client reports:
- Pain around the outside of the elbow
- Discomfort when gripping or lifting objects
- Pain when twisting tools or opening jars
- Reduced grip strength because of pain
- Temporary improvement after rest
- Recurring symptoms after returning to work
Interestingly, the pain is not always present. Instead, it becomes more noticeable when the wrist and forearm muscles are placed under repeated or heavier loads.
What It May Feel Like
People with tennis elbow may notice:
- Sharp or aching pain on the outer elbow
- Tenderness around the bony prominence
- Pain extending into the forearm
- Difficulty gripping or squeezing objects
- Discomfort when lifting with the palm facing down
- Stiffness or soreness after repeated activity
- Occasionally, pain that disturbs sleep
Importantly, pain may occur even when the elbow itself moves normally. Therefore, the next clue may come from examining what the wrist and forearm muscles are doing.
Objective Findings
During assessment, the therapist may identify:
- Local tenderness over the lateral epicondyle
- Pain during resisted wrist extension
- Discomfort during gripping tests
- Reduced pain-free grip strength
- Symptoms reproduced by repetitive wrist loading
- Relatively normal elbow range of motion
However, elbow pain does not always originate from the tendon. For this reason, the assessment may also consider the cervical spine, radial nerve and surrounding structures.
The interesting finding is that wrist movements can reproduce pain at the elbow. But why?
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What Could It Be Related To?
Tennis elbow, also known as lateral elbow tendinopathy or lateral epicondylalgia, commonly involves the tendons that connect the forearm extensor muscles to the outside of the elbow. One frequently involved tendon belongs to the extensor carpi radialis brevis (ECRB) muscle.
This muscle helps extend and stabilise the wrist during gripping and lifting. When repeated loading exceeds the tendon’s current tolerance, pain and changes in tendon function may develop.
However, tennis elbow is not simply an inflammatory condition. Persistent cases may involve tendon-related changes and increased pain sensitivity. In other words, the painful area may not be weak because it hurts. Instead, it may currently struggle to tolerate the demands placed on it.
Possible factors include:
- Repetitive gripping or squeezing
- Frequent wrist extension
- Heavy lifting and tool handling
- Sudden increases in workload
- Repeated twisting movements
- Inadequate recovery between demanding activities
- A previous episode of elbow pain
Although tennis players can develop this condition, it is also common among people who perform repetitive or forceful manual tasks. For example, carpenters, painters, gardeners and other manual workers may experience similar symptoms.
Therefore, the problem is often related to repeated tendon loading rather than playing a particular sport.
The assessment aims to determine:
- Which activities reproduce the pain
- Whether the forearm extensor tendons appear involved
- How much gripping load the client can tolerate
- Whether other structures may be contributing
- How symptoms affect work and daily activities
- Whether tendon-loading capacity can be improved
Most importantly, the therapist wants to understand: “Why does the pain return whenever the client resumes normal activity?” Because reducing pain is only part of the solution. Restoring the ability to tolerate everyday demands is equally important.
Management may include:
- Temporarily modifying painful gripping and lifting tasks
- Maintaining comfortable elbow and wrist movement
- Progressive forearm strengthening
- Gradually increasing tendon-loading exercises
- Adjusting tools or work techniques when appropriate
- Manual or soft-tissue therapy for short-term symptom relief
- Monitoring pain and function between sessions
Initially, reducing aggravating loads may help settle symptoms.
Next, progressive resistance exercises can gradually rebuild the forearm muscles’ and tendons’ ability to tolerate loading.
Meanwhile, manual therapy may help relieve discomfort. However, it should support rehabilitation rather than replace strengthening and activity modification.
The next assessment is simple: Can the client grip, lift and work with less pain and better tolerance?
How Does It Usually Recover?
Most people with tennis elbow improve without surgery. Nevertheless, recovery can take several months, and some persistent cases may take a year or longer.
At first, reducing painful activities can provide temporary relief. However, rest alone may not restore the tendon’s ability to tolerate repeated loading.
As symptoms improve, progressive strengthening and a gradual return to demanding activities become increasingly important. For example, the carpenter may begin with lighter gripping tasks before progressively returning to heavier tools and longer working periods. Over time, successful recovery means being able to:
- Lift everyday objects comfortably
- Grip tools with confidence
- Return to normal working hours
- Perform repetitive tasks with fewer symptoms
- Maintain strength and normal arm function
Importantly, some discomfort during rehabilitation does not necessarily indicate further damage. However, loading should remain manageable and be adjusted if symptoms worsen significantly or remain aggravated afterward.
Persistent pain, progressive weakness, numbness, significant swelling or symptoms following an injury warrant further medical assessment.
Your Body Talks. Learn to Listen.
Sometimes the pain disappears when you stop. But returns the moment you begin again. That does not always mean the tendon is failing to heal.
Sometimes, it simply has not rebuilt the capacity to handle what you are asking it to do. Rest may calm the pain. Strength builds the confidence to return.
Ask it. Even if you think it’s a ridiculous question.
Someone else has probably wondered exactly the same thing.
