Lateral Elbow Tendinopathy (Tennis Elbow)

What is it?

Lateral elbow tendinopathy is the most common cause of elbow pain, 7 times more than medial. Pain on the lateral aspect of the elbow, typically known as tennis elbow, has an insidious onset with early presentations of pain only posing a problem with aggravating activity. despite the term tennis elbow, research has suggested that 95% of individuals presenting with lateral elbow pain have never actually played tennis. The condition typically affects the extensor muscle group at the elbow (Extensor carpi radialis brevis, extensor digitorum and extensor carpi ulnaris), commonly due to repeated overload of the tendons without adequate recovery.


  • Overuse: a sudden change in training levels and/or loads can have a detrimental impact on the muscle. as well as training overuse, occupational stresses can place additional loads on the flexor musculature.
  • Change in training technique or equipment: in tennis a change or racquet, grip size, playing with a wet ball all has implications on the elbow joint.
  • Changes in work duties: additional typing or writing can increase the stress applied to the lateral tendon group.
  • Neck and thoracic dysfunction: previous or current neck and/or thoracic pain can refer pain into the elbow region.
  • Poor grip strength: poor strength and flexibility in the arm can predispose an individual to lateral elbow pain.

Signs and Symptoms

Individuals usually experience pain on the outside of the elbow, which in the early stages is only symptomatic following aggravating activity, which subsides following cessation of activity. When the issue is ignored the pain is felt in other times of daily life, and in severe cases the pain may keep the individual awake, have difficulty picking up normal items such as a mug, carrying shopping bags and certain movements may be an issue. performing daily activities i.e. work tasks, especially if there is a lot of computer work can become difficult. There may be associated neck and upper back pain, which may cause neural distribution symptoms.


Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the elbow joint and wrist extensor musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain and inflammation is present you may benefit from ice application and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programs for the elbow muscular with particular focus on the extensor muscles, while incorporating flexor, supinator and pronator strength, training not only isometric strength but also looking at the control of movement under load. Focus on building stability in the joint before looking at strength.
  • In patients with associated neck and thoracic pain, mobilizations have been found to be an effective treatment strategy.
  • Evaluating any training errors, correct technique and checking use of appropriate equipment. posture education for desk based workers limit the risk of further weakness through faulty head and neck alignment.

*** Assessment of tendinopathies by a qualified professional is essential to determine the extent of the injury and evaluate the best course of treatment, therapists at sports injury scotland will be able to evaluate your injury and guide you as to the best method of progression ***

What can Sports Injury Scotland do??

Correct diagnosis of a tendinopathy will ensure the individual gains the most appropriate treatment strategy for their injury. management of tendinopathies will vary depending on the level of pain and dysfunction and also the individuals daily activities. Sports massage and mobilizations have been found to be an effective method of reducing the pain associated with lateral elbow tendinopathies, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education and technique evaluation is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.