How to treat Tennis elbow

Belinda Herde

May 11, 2021

Tennis elbow can be a frustrating and chronic condition to treat, with many suffering it’s effects for up to 18 months! Working in professional tennis and also with Grand Slam Physio (Geelong) being located at the indoor tennis centre, we see a great number of elbow injuries. See below how you can get on top and treat your tennis elbow.


‘Tennis elbow’, more specifically referred to as ‘lateral epicondylagia’, is a condition of the wrist extensor tendon which attaches into the outside of the elbow (lateral epicondyle). It gets its name ‘tennis elbow’ as it is frequent in tennis players, as the wrist extensor musculature is placed under repetitive strain, in which force is transmitted through the tendon. Ironically, tennis elbow isn’t that common amongst professional tennis players, but rather in up to 50% of amateur players, but even more commonly in the general population amongst white and blue-collar workers aged between 30-50 (Chard, 1989).


Tendons connect our muscles to bones. As referenced earlier, a tendons role in this connection is the transmission of force from the muscle to the bone to create movement. As such, with repetitive work of a muscle, the load and requirement of the tendon is greater. When the load capacity of a tendon is ‘exceeded’, ‘tendinopathy’ may occur, which among other physiological changes, causes the breakdown, disruption and disorganisation of collagen in the tendon (Cook, 2004).

Common causes after excessive wrist use include:

  • Playing tennis with wet heavy balls
  • Poor backhand technique in tennis
  • String tension too tight
  • Repetitive use in activities of daily living eg. Typing, painting, using tools, etc.
  • Unaccustomed activity eg. home reno

Typical findings:

A Physiotherapist will perform a comprehensive subjective and objective assessment in order to accurately diagnose Tennis Elbow.

Generally, tennis elbow will be activity related, and often presents after a ‘spike’ in activity or ‘load’ (Kjaer, 2009). Furthermore, in respect to the nature of tendons, pain is usually worse first thing in the morning, and will warm up during activity but be sore afterwards (Cook, 2014).

Pain is located on the lateral (outside) elbow and is tender to palpate over the tendon. The wrist extensor muscles in the forearm may be abnormally ‘tight’, or in some chronic cases even reduced in size. Additionally, grip strength is generally weaker on assessment compared to the non-affected side.


Physiotherapy intervention will depend on what stage your ‘Tennis Elbow’ injury is at, but rest assured we can help you regardless of whether this is a new complaint (acute) or longstanding (chronic). Physiotherapy intervention will involve both active (exercise) and passive (manual) techniques to both control pain and improve the load capacity of the tendon by increasing strength (Cook, 2014). This is often across the kinetic chain, so may involve exercise and treatment at one or all of the elbow, wrist and shoulder. It should be noted that research has shown that tendons need at least 12 weeks of strengthening to enable adaptations; although, this definitely doesn’t mean you aren’t able to get improvements in symptoms and function within this time (Bohm, 2015).

Additionally, lifestyle and training advice and modifications will be paramount with the help of your Physiotherapist, as due to the nature of tendons, total rest is not advised and can be even more catabolic to the tendon (Arnoczky, 2007) As such, your Physiotherapist will help develop a plan to keep you in modified activity, with the goal of getting you back doing what you love as soon as possible.

Pronation/ supination exercise

Final note:

Treatment for tennis elbow will be individualised, may require activity modification and require a strengthening program. We pride ourselves on getting patients back to their pre-injury levels with individualised assessment, treatment and exercise programs adapted to your goals and needs. Ben, Belinda and Victoria have worked on the international tennis circuit with the ATP, WTA and Tennis Australia for over 10 years.

Please call us on 52772151 or book online and let us help you to get started towards achieving your goals.