Tennis Elbow – Symptoms, Causes, and Treatment Options

Overview of Tennis Elbow

Tennis elbow (lateral epicondylitis) is a painful condition that develops when the tendons around the outside of your elbow become overused or strained. Despite the name, it doesn’t only affect tennis players—anyone who performs repetitive wrist and arm movements can develop it. This includes office workers, carpenters, mechanics, musicians, and people who spend long hours typing.

Studies estimate that 1–3% of the general population will experience tennis elbow at some point, and it is especially common in adults aged 35 to 55 (Walker-Bone et al., 2012, Best Practice & Research Clinical Rheumatology, https://doi.org/10.1016/j.berh.2012.03.007).

How tennis elbow affects your daily life

• Work impact: Simple tasks like typing, writing, or turning a doorknob may become difficult.
• Sports limitations: Activities such as tennis, golf, or weightlifting may cause sharp pain and reduce performance.
• Household challenges: Carrying groceries, lifting pans, or gardening may trigger discomfort.
• Sleep and rest: Nighttime pain or discomfort when resting on the affected arm may disturb sleep.
• Mental health: Chronic pain can lead to frustration, stress, and reduced quality of life.

How tennis elbow compares to other elbow pain

Unlike golfer’s elbow (medial epicondylitis), which causes pain on the inside of the elbow, tennis elbow is felt on the outside of the joint. This distinction is key for diagnosis and treatment planning.

Symptoms of Tennis Elbow

The main symptom of tennis elbow is pain on the outside of your elbow that may spread down your forearm. This pain often gets worse when you use your hand or wrist for gripping, lifting, or twisting.

What are the main symptoms of tennis elbow?

• Elbow pain: A sharp or burning pain on the outside of the elbow.
• Weak grip: Difficulty holding objects such as coffee cups, tools, or sports equipment.
• Stiffness: Trouble extending or bending the elbow after periods of rest.
• Tenderness: Soreness when pressing on the outer elbow bone (lateral epicondyle).
• Radiating pain: Discomfort may travel into the forearm or wrist.

How severe can symptoms get?

Tennis elbow symptoms range from mild discomfort to constant, debilitating pain. Some people notice discomfort only during activity, while others feel pain even at rest.

1. Mild cases: Occasional pain during activity.
2. Moderate cases: Pain interferes with daily tasks like typing or cooking.
3. Severe cases: Persistent pain, weakness, and disturbed sleep.

Red flag signs – when to see a doctor

If you notice any of these signs, seek medical evaluation promptly:

• Sudden severe elbow pain after trauma.
• Numbness, tingling, or weakness in the hand (which could indicate nerve involvement).
• Swelling, redness, or warmth that may suggest infection or another condition.

Functional and emotional impact

Living with tennis elbow can limit not only physical activity but also social and emotional well-being. For example:

• Work challenges: Manual workers may need time off or task modification.
• Sports and hobbies: Pain may reduce participation in favorite activities.
• Mental health: Persistent pain can cause anxiety, irritability, or reduced motivation.

Reference: Coombes BK, Bisset L, Vicenzino B. (2015). Management of lateral elbow tendinopathy: One size does not fit all. Journal of Orthopaedic & Sports Physical Therapy, 45(11):938–949. https://doi.org/10.2519/jospt.2015.5841

Causes and Risk Factors for Tennis Elbow

Tennis elbow is caused by small tears and irritation in the tendons that attach your forearm muscles to your elbow. These micro-injuries build up over time, especially with repetitive use.

What causes tennis elbow?

• Repetitive strain: Repeated wrist and arm motions, especially gripping and twisting.
• Overuse: Playing sports like tennis, squash, or weightlifting with poor technique.
• Occupational strain: Jobs requiring frequent lifting, hammering, typing, or tool use.
• Sudden overload: Lifting heavy objects without preparation or warm-up.

Who is most at risk?

• Age: Most common in people between 35 and 55 years old.
• Sports participants: Especially tennis, squash, badminton, and throwing sports.
• Manual laborers: Carpenters, plumbers, painters, and mechanics.
• Repetitive-use workers: Typists, computer users, musicians, and hairdressers.
• Posture and biomechanics: Poor shoulder, wrist, or posture mechanics increase strain.

Lifestyle and health factors

Certain lifestyle and health factors can make you more vulnerable:

• Obesity and inactivity: Weaker tendons may be less resilient.
• Smoking: Slows down tendon healing.
• Stress and fatigue: Reduce the body’s ability to recover from overuse.

Why tennis elbow develops in some people and not others

Not everyone with repetitive elbow strain develops tennis elbow. Genetics, tendon resilience, and personal biomechanics may influence susceptibility.

Reference: Sanders TL, Kremers HM, Bryan AJ, Ransom JE, Morrey BF. (2015). The epidemiology and health care burden of tennis elbow: a population-based study. American Journal of Sports Medicine, 43(5):1066–1071. https://doi.org/10.1177/0363546514568087

Diagnosis, Recovery, and Management of Tennis Elbow

Tennis elbow can often be diagnosed through a clinical evaluation and managed with a combination of rest, targeted exercises, and lifestyle changes. Recovery times vary depending on severity, and long-term prevention relies on strengthening, posture, and ergonomic strategies.

This section walks you through how tennis elbow is diagnosed, what to expect during recovery, and evidence-based strategies for managing symptoms and preventing recurrence.

Diagnosis of Tennis Elbow

Tennis elbow is usually diagnosed through a physical exam and a discussion of your symptoms, activity history, and lifestyle. Most cases can be confirmed without advanced imaging, but additional tests may be used if your provider suspects another condition.

How do doctors test for tennis elbow?

Healthcare providers usually follow a structured approach:

• Medical history: They ask about your work, hobbies, or sports that involve repetitive wrist and arm movements.
• Physical exam: Your elbow and forearm are checked for tenderness, swelling, and pain when pressed.
• Functional tests: You may be asked to grip, lift, or extend your wrist against resistance to see if this recreates the pain.
• Comparison tests: The affected arm is compared with the unaffected arm to assess strength and movement.

If symptoms don’t improve or another diagnosis is suspected, imaging may be recommended.

What imaging tests can show tennis elbow?

• Ultrasound: Can reveal tendon thickening or small tears.
• MRI (Magnetic Resonance Imaging): Used if other elbow conditions, like ligament injuries or arthritis, are suspected.
• X-rays: Generally normal in tennis elbow but help rule out fractures or arthritis.

These tests are not always necessary but may help in complex or severe cases.

How do practitioners find the root cause of symptoms?

Since elbow pain can come from multiple sources, doctors look at the whole arm and shoulder chain:

• Neck and shoulder issues can sometimes mimic elbow pain.
• Nerve conditions such as radial tunnel syndrome may cause similar symptoms.
• Golfer’s elbow (pain on the inside of the elbow) must be ruled out.

By combining history, physical testing, and selective imaging, practitioners identify whether the problem truly comes from the tendon attachments at the lateral elbow.

Recovery & Prognosis for Tennis Elbow

Tennis elbow recovery usually takes several weeks to several months depending on the severity of tendon injury and how well you follow management strategies.

How long does tennis elbow usually take to heal?

1. Mild cases: May improve in 6–8 weeks with rest, stretching, and activity changes.
2. Moderate cases: Often require 3–6 months of consistent management, including strengthening and physiotherapy.
3. Severe or chronic cases: Can last 6–12 months or longer, especially if tendon healing is slow or repetitive strain continues.

Decision pathway for recovery

1. If symptoms are mild: Rest, modify activities, and begin gentle stretches.
2. If symptoms are moderate: Add structured physiotherapy, bracing, and progressive strengthening.
3. If symptoms are severe or persistent: Consider advanced imaging, guided injections, or surgical consultation.

This “if/then” logic helps guide both clients and providers in planning next steps.

What affects your long-term outlook?

• Early treatment: Addressing pain early prevents chronic damage.
• Activity modification: Avoiding repetitive overuse supports recovery.
• Strength and flexibility: Building resilient muscles lowers recurrence risk.
• Lifestyle factors: Smoking, obesity, and poor posture can slow tendon healing.

Can tennis elbow come back?

Yes, recurrence is possible, especially if you return too quickly to high-strain activities. Using proper technique, taking breaks, and maintaining strength are key for prevention.

Returning to work, sport, and daily life

• Work: Many people can return to office jobs with modifications (ergonomic keyboards, posture adjustments) within weeks. Manual labor may require a longer recovery window.
• Sport: Most return to recreational play within 3–6 months, depending on symptom severity and training adherence.
• Lifestyle: With proper care, long-term outcomes are excellent, but ongoing maintenance exercises are often recommended.

Reference: Bisset L, Paungmali A, Vicenzino B, Beller E. (2005). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine, 39(7):411–422. https://doi.org/10.1136/bjsm.2004.016170

Management of Tennis Elbow

Managing tennis elbow involves reducing pain, improving tendon healing, and preventing future strain. A mix of activity modification, ergonomic strategies, and targeted exercises is typically most effective.

What’s the best way to manage tennis elbow at home?

A practical step-by-step strategy includes:

1. Rest and modify activities
2. Avoid heavy gripping, twisting, or repetitive strain.
3. Switch to lighter tools or adaptive equipment.
4. Apply ice or cold therapy
5. 10–15 minutes after activity to reduce pain and inflammation.
6. Gentle stretching
7. Extend your arm with palm down, gently pull back on your hand to stretch the forearm.

Strengthening exercises (once pain allows)

• Wrist curls and reverse wrist curls with light weights.
• Resistance band exercises to improve tendon load tolerance.
• Ergonomic adjustments
• Use cushioned grips on tools.
• Ensure workstation height reduces wrist strain.
• Supportive bracing
• Forearm straps can reduce strain during activity.

Can lifestyle changes help tennis elbow?

Yes. Beyond exercises, daily habits play a major role:

• Posture: Keeping shoulders relaxed and wrists neutral reduces tendon strain.
• Core and shoulder strength: Provides better control of arm movements.
• Breaks and pacing: Taking micro-breaks during repetitive tasks prevents overload.
• Healthy living: Balanced diet, regular sleep, and avoiding smoking improve healing capacity.

Therapy and social support options

• Physical therapy: Tailored exercise programs accelerate recovery.
• Occupational therapy: Helps modify work tasks and tools.
• Coaching and habit formation: Encourages sustainable lifestyle changes.
• Community or group exercise: Can provide accountability and reduce isolation.

Multidisciplinary Coordinated Care for Tennis Elbow at CARESPACE

Tennis elbow is best managed with a team-based, whole-person approach. At CARESPACE, your care doesn’t happen in isolation. Instead, multiple disciplines—such as physiotherapy, chiropractic, massage therapy, kinesiology, psychotherapy, nutrition, and more—work together to help you recover faster, manage stress, and reduce the risk of recurrence.

This coordinated model means that your physical pain, emotional well-being, lifestyle, and long-term prevention strategies are all addressed in a personalized, evidence-based plan.

How does CARESPACE treat tennis elbow differently?

Most clinics treat tennis elbow using a single method—such as physiotherapy or massage therapy. At CARESPACE, you benefit from a multidisciplinary model where different professionals collaborate to support every aspect of your recovery.

• Physiotherapy for tennis elbow helps restore mobility and strengthen forearm and shoulder muscles.
• Chiropractic care focuses on joint mobility and posture, ensuring your body mechanics reduce strain on your elbow.
• Massage therapy for tennis elbow reduces muscle tension in the forearm and upper arm, easing pain and promoting circulation.
• Kinesiology and fitness training provide exercise programs to safely rebuild strength, endurance, and coordination.
• Psychotherapy and mental performance coaching help you manage the stress, frustration, or insomnia that can accompany chronic pain.
• Nutrition and naturopathic medicine address inflammation, energy balance, and lifestyle factors that influence healing.
• Acupuncture may be included to relieve pain and stimulate natural healing responses.

This approach recognizes that tennis elbow is not just a tendon problem—it’s a condition that can affect your work, sleep, mental health, and overall quality of life.

👉 Learn more about our physiotherapy for tennis elbow and massage therapy for elbow pain.

Why does a team approach help tennis elbow recover faster?

A team approach works because tennis elbow involves more than just local tendon irritation. Recovery depends on your movement patterns, daily habits, stress levels, and physical conditioning.

At CARESPACE, your care team creates a personalized plan that adapts as you progress:

1. Acute phase (first few weeks): Focus on pain relief and protecting the tendon. You may start with physiotherapy, massage therapy, and acupuncture to reduce irritation.
2. Subacute phase (weeks to months): Begin strengthening, posture correction, and gradual return to activity. Kinesiologists and chiropractors may guide this stage.
3. Maintenance and prevention phase: Focus on long-term resilience with fitness training, nutrition coaching, and mental performance strategies to lower the chance of recurrence.

Example scenario:

Imagine you’re a recreational tennis player with persistent elbow pain. At CARESPACE, your journey might look like this:

• A physiotherapist assesses the tendon and prescribes initial exercises.
• A massage therapist works on reducing tightness in your forearm muscles.
• A chiropractor addresses shoulder or spine posture contributing to extra strain.
• A psychotherapist helps you cope with frustration and sleeplessness due to pain.
• A kinesiologist guides you back to sport with a tailored strengthening program.

By integrating these services, recovery is faster, more complete, and less likely to relapse compared to isolated treatment.

👉 Explore our chiropractic care for sports injuries and kinesiology for injury recovery.

How does CARESPACE support the mental health side of tennis elbow?

Chronic pain is not just physical—it can affect your mood, sleep, and relationships. At CARESPACE, mental health is a core part of the care plan.

• Psychotherapy helps you manage stress, frustration, or anxiety linked to ongoing pain.
• Mental performance coaching builds coping strategies and resilience, especially for athletes returning to sport.
• Nutrition counseling supports energy levels and may reduce inflammation through evidence-based diet strategies.
• Exercise and fitness training improve mood and confidence, helping you stay active safely during recovery.

By addressing both the physical and emotional dimensions, CARESPACE helps you break the cycle where pain leads to stress, and stress worsens pain.

👉 Learn more about our psychotherapy services and nutrition for injury recovery.

The CARESPACE advantage for tennis elbow

Standard single-discipline care often focuses only on symptoms. CARESPACE’s multidisciplinary, coordinated approach provides broader benefits:

1. Faster results – combining physical therapy, manual therapy, and lifestyle support speeds recovery.
2. Personalized care – every plan is unique to your body, your goals, and your lifestyle.
3. Lower recurrence risk – coordinated strengthening, posture, and lifestyle adjustments make future injuries less likely.
4. Whole-person support – physical pain, emotional well-being, and lifestyle are all addressed.

In short, CARESPACE helps you not only heal from tennis elbow but also return to work, sport, and life with confidence and resilience.

Related Conditions for Tennis Elbow

Tennis elbow shares symptoms with several other conditions, which can make diagnosis challenging. Pain on the outside of the elbow is not always caused by tendon irritation—it may come from nearby joints, nerves, or muscles.

Common related or mimicking conditions include:

• Golfer’s elbow (medial epicondylitis): Pain occurs on the inside of the elbow rather than the outside.
• Radial tunnel syndrome: Caused by compression of a nerve near the elbow, often presenting with weakness, numbness, or tingling.
• Arthritis of the elbow joint: Can cause stiffness, swelling, and joint pain that may feel similar to tendon irritation.
• Cervical radiculopathy: Nerve compression in the neck can create pain that radiates down the arm, sometimes mistaken for tennis elbow.
• Shoulder or rotator cuff injuries: Dysfunction in the shoulder can alter movement patterns and overload the elbow.

Because these conditions can overlap, a full evaluation is essential to confirm whether your symptoms are truly due to tennis elbow or another diagnosis.

Looking for information on a different condition? Visit our full Conditions List.