Tennis Elbow

Lateral Epicondylalgia

What is Tennis Elbow?

Tennis elbow is a painful condition affecting the outer side of the elbow. Despite the name, most people who develop it have never picked up a racket. It is caused by repetitive overuse of the forearm and wrist, leading to damage of the tendon that attaches to the bony prominence on the outside of the elbow, known as the lateral epicondyle.

The condition is more accurately described as lateral epicondylalgia or tendinopathy. Research has consistently shown that the underlying problem is degenerative in nature — a breakdown of the tendon's collagen structure — rather than a straightforward inflammatory response. This is an important distinction, because it shapes how the condition should be treated.

Tennis elbow is one of the most common causes of elbow pain, affecting an estimated one to three percent of adults. It is most prevalent in people between the ages of 35 and 55 and affects men and women at similar rates.

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What Structures are Affected?

The primary structure involved is the common extensor tendon, and specifically the extensor carpi radialis brevis (ECRB) — a muscle that helps extend and stabilise the wrist. This tendon attaches at the lateral epicondyle of the humerus (the outer elbow).

Under repeated load, micro-tears develop within the tendon. Over time, the body's attempt to repair these tears results in disorganised collagen, increased blood vessel growth and a breakdown in tendon integrity. This process is referred to as angiofibroblastic degeneration.

In more severe or chronic cases, surrounding structures can also be involved, including adjacent extensor tendons, the elbow joint capsule and, in some cases, the radial nerve.

What Does It Feel Like?

Symptoms typically develop gradually rather than from a single incident. The most common presentation includes:

• Pain and tenderness directly over the outer elbow

• Pain that radiates down the forearm toward the wrist

• Weakness with gripping and lifting

• Pain aggravated by turning a door handle, lifting a kettle or shaking hands

• Stiffness, particularly in the morning or after rest

Symptoms are usually worse with activity and can ease with rest, at least in the early stages. As the condition progresses, even light tasks can become painful.

Time To Heal?

Honest answer: it takes time. Tennis elbow is a tendon condition, and tendons have a relatively slow rate of recovery compared to muscle or bone. Recovery is rarely linear.

Research suggests that with appropriate management, most people experience significant improvement within six to twelve weeks. Full recovery typically takes between six and twelve months, though in persistent cases it can extend to eighteen months or longer.

The good news is that the natural history of the condition is generally favourable. Studies indicate that 80 to 90 percent of people recover fully within one to two years, with or without formal treatment. That said, early and targeted physiotherapy has been shown to reduce pain faster, restore function sooner and lower the risk of recurrence compared to rest alone.

Factors that can slow recovery include:

• Continuing to load the tendon before it has adequately recovered

• Delayed presentation and treatment

• High physical demands at work or in sport

• Smoking, which impairs tendon healing

• Previous corticosteroid injections, which may provide short-term relief but are associated with higher recurrence rates

A Note On Recovery For Tennis Elbow

Tennis elbow can be a frustrating condition, particularly when daily tasks become painful. It is important to understand that slow progress does not mean no progress. Tendons respond to load over weeks and months, not days. Staying consistent with your rehabilitation programme and working closely with your physiotherapist is the most reliable path to a full recovery.

If your symptoms have been present for more than a few weeks, or if they are affecting your work or quality of life, booking an assessment is the right next step.