Treating Tennis Elbow

Tennis elbow—clinically known as lateral epicondylalgia—is one of the most common overuse injuries of the upper limb. It affects not just athletes, but also professionals who spend long hours typing, gripping, or using handheld devices and tools. Despite its name, most people who develop tennis elbow have never played tennis. The root cause is not inflammation, as once believed, but rather degenerative changes and disorganized tendon loading in the extensor carpi radialis brevis (ECRB) and other forearm extensors. This shift in understanding has dramatically changed how the condition should be treated.

Modern research, including findings published in British Journal of Sports Medicine and JOSPT, strongly supports active, load-based rehabilitation over passive modalities like rest, ice, or corticosteroid injections. In fact, injections may provide short-term relief but are associated with higher recurrence rates and poorer long-term outcomes. Instead, eccentric and isometric loading programs have been shown to promote collagen remodeling and improve tendon capacity—offering a durable, non-invasive solution.

Our physical therapy approach starts with a thorough evaluation to differentiate true lateral tendinopathy from referred pain (e.g., from the cervical spine or radial nerve), and to identify contributing factors like poor shoulder stability, grip mechanics, or workplace ergonomics. Once a clear diagnosis is confirmed, we introduce a structured loading program that may begin with isometric holds for pain relief, followed by eccentric-concentric wrist extension, forearm supination, and eventually functional, task-specific movements. Pain is monitored, but not avoided entirely—current guidelines support load tolerance as a driver of recovery.

Manual therapy may be used judiciously to reduce soft tissue guarding or address radial nerve sensitivity. We also incorporate neuromuscular re-education to restore efficient arm and grip mechanics, particularly in those whose daily demands involve sustained hand use, travel, or repetitive lifting. Education is a key component—patients learn that pain is not an indication of damage and that graded exposure builds resilience, not harm.

Tennis elbow is not a tendon that needs to rest—it’s a system that needs to be retrained. Through progressive loading, movement re-education, and patient-centered planning, we help individuals recover not just from pain, but from the habits and stressors that caused it. Whether you're lifting weights, traveling with a laptop, or spending long hours on a mouse, evidence-based care can get you back to full function with strength and confidence.