Written and reviewed by the BPR clinical team. Last reviewed: 30 July 2026. This article is for education and is not a substitute for individual assessment, diagnosis or treatment by a qualified healthcare professional.
It starts as a soreness on the outside of the elbow that flares every time you grip — lifting a kettle, turning a doorknob, shaking hands. Most people who get it have never picked up a tennis racket. “Tennis elbow” is common, often stubborn, and surrounded by well-meaning advice that can actually slow recovery. Understanding what the evidence really says is the key to getting it right.
What is it?
Tennis elbow — lateral elbow tendinopathy — is an overload problem of the tendon on the outside of the elbow, where the muscles that extend your wrist and fingers attach. Despite the name, it's usually driven by repetitive gripping and wrist use, not tennis. It's often self-limiting, settling over 6 to 12 months, but it can linger and become frustrating without the right approach.
Why does it happen?
The usual cause is repetitive or sustained gripping, lifting and wrist extension — manual work, DIY, desk and mouse use, or a sudden increase in a gripping activity. As with tendons elsewhere, it's typically a case of loading the tendon more than it was ready for.
What does it feel like?
Pain and tenderness sit over the bony point on the outside of the elbow, and are provoked by gripping, lifting and extending the wrist. It can radiate down the forearm, and many people notice their grip feels weaker or that holding things becomes uncomfortable.
How it's assessed
We'll palpate the outer elbow and load the tendon with resisted wrist and finger extension to reproduce your pain, and check your grip strength. We'll also screen the neck, since neck problems can occasionally refer pain to the elbow and forearm.
What the evidence says
- Corticosteroid injections make things worse in the long run. A landmark randomised trial found that although an injection helped in the short term, at one year it produced significantly worse recovery and higher recurrence than physiotherapy or a wait-and-see approach (Coombes et al., 2013; Bisset et al., 2006).
- Exercise-based care helps — but must be individualised. The clinical guideline supports tailored exercise and loading with manual therapy, emphasising that “one size does not fit all” (Coombes et al., 2015).
- It often improves with time. Because many cases settle over 6–12 months, avoiding treatments that cause long-term harm is as important as choosing ones that help.
How it's treated
The mainstay is education and load management plus progressive strengthening of the wrist extensor muscles — often starting with gentle isometric holds and building up. Alongside that, we address the aggravating activities: how you grip, your tools, and your workstation. A counterforce brace can ease symptoms in the short term. The evidence is clear that repeated corticosteroid injections should be avoided, given the poorer long-term outcomes.
Patience genuinely pays off here. Consistent loading and sensible activity modification, given time, resolve the great majority of cases.
What you can do yourself
Modify the gripping and lifting that flare it — for example, lifting with the palm up rather than down — and work through a progressive strengthening programme for the forearm. Adjust your workstation and tools to reduce sustained gripping, and give it time. A brace can help during provoking tasks.
When to seek help
When to seek help. See a clinician if the pain is persistent, limiting your daily activities, or not improving with self-care. Seek review sooner if it followed a significant injury, if the elbow locks, or if you have marked weakness or numbness — these point away from a simple tendinopathy.
Frequently asked questions
Should I get a cortisone injection?
Generally no. The evidence shows injections help briefly but lead to worse recovery and more recurrences at one year than exercise or wait-and-see (Coombes et al., 2013).
Do I need to rest it completely?
No. Complete rest doesn't build the tendon's capacity. Modifying aggravating activities while loading the tendon progressively works better.
How long does tennis elbow last?
Many cases settle over 6 to 12 months. The right approach shortens the road and prevents flare-ups; the wrong treatments can prolong it.
Do braces work?
A counterforce brace can reduce symptoms during provoking activities in the short term. It's a helpful support, not a cure on its own.
Is it really caused by tennis?
Rarely. Most cases come from everyday gripping and wrist use — work, DIY and repetitive tasks — not racket sports.
How BPR can help
At BPR we'll confirm the diagnosis, steer you away from treatments that backfire, and build a progressive loading and activity-modification plan that settles the elbow for good. You can book an assessment at bpr.rehab.
References
- Coombes, B.K., Bisset, L., Brooks, P., Khan, A. and Vicenzino, B. (2013) 'Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial', JAMA, 309(5), pp. 461–469. doi:10.1001/jama.2013.129.
- Bisset, L., Beller, E., Jull, G., Brooks, P., Darnell, R. and Vicenzino, B. (2006) 'Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial', BMJ, 333(7575), 939. doi:10.1136/bmj.38961.584653.AE.
- Coombes, B.K., Bisset, L. and Vicenzino, B. (2015) 'Management of lateral elbow tendinopathy: one size does not fit all', Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp. 938–949. doi:10.2519/jospt.2015.5841.