Wimbledon is back. From 29 June the courts at SW19 are in full swing, and for a fortnight the whole country suddenly has an opinion on backhands. It is also the time of year the phrase "tennis elbow" gets thrown around the most. So here is the thing worth knowing: the large majority of people we treat for tennis elbow have never played a competitive match in their lives.
Tennis elbow is one of the most common elbow complaints we see, and only a small fraction of cases have anything to do with tennis. It is a load problem, not a racquet problem, and understanding that is the key to getting rid of it.
What tennis elbow actually is
The medical name is lateral epicondylalgia, and the older term, lateral epicondylitis, is a little misleading. The "-itis" suggests inflammation, but we now know the problem is mostly not inflammatory. It is a tendinopathy: a wear-and-overload change in the tendons that attach your forearm muscles to the bony bump on the outside of your elbow. Those muscles straighten your wrist and fingers and steady your grip, so they are working almost every time you hold, lift or twist something.
When the demand on that tendon outstrips what it can tolerate, the tissue starts to complain. The result is pain and tenderness on the outside of the elbow, often spreading down into the forearm, and a grip that feels weak and sore.
Who we actually see with it
Far more desk workers than tennis players. The common thread is repetitive gripping and wrist work, and it turns up in:
- Office and laptop workers, from hours of mouse and keyboard with the wrist held in one position.
- Trades and manual work, carpenters, plumbers, decorators, anyone on screwdrivers, drills and hand tools all day.
- Gym-goers, after a jump in heavy pressing, pull-ups, kettlebells or grip work.
- DIY and gardening, the classic "I painted the whole hallway at the weekend" flare-up.
- And yes, racquet sports, usually tied to technique, a heavier racquet or grip, or simply doing far more than usual, which is exactly what a Wimbledon-inspired burst of enthusiasm tends to produce.
The pattern is nearly always the same: too much load, too suddenly, on a tendon that had not been prepared for it.
How to recognise it
- Pain and tenderness over the bony point on the outside of the elbow
- An ache that spreads into the back of the forearm
- Pain when gripping, a kettle, a mug, a doorknob, a handshake
- A weaker grip than usual, because it hurts to squeeze
- Symptoms that build over weeks, rather than arriving with one dramatic injury
Why resting alone is a trap
The instinct is to stop using the arm and wait it out. Complete rest can settle the pain in the short term, but it does not rebuild the tendon, and a tendon that is not being loaded only gets weaker. So the moment you go back to normal life, the very thing that caused the problem causes it again. This is why tennis elbow has a reputation for dragging on for months, not because it is untreatable, but because it is so often mismanaged as "just rest it".
Tendons respond to the right kind of load. The evidence is clear that progressive loading, controlled and graded strengthening of those forearm muscles, is the single most effective thing for lateral elbow tendinopathy. It rebuilds the tolerance of the tissue so it can handle your day again.
What actually helps
- Load management first. We work out which activity is overloading the tendon and adjust it, rather than banning everything you do.
- Progressive strengthening. A simple, specific programme, usually starting with gentle holds and building to heavier work as the tendon tolerates it. This is the part that changes the long-term outcome.
- Hands-on treatment. Soft-tissue work through the forearm, plus assessment of the wrist, shoulder and neck, which often share both the load and the blame.
- Practical tweaks. Mouse and desk setup, tool and grip changes, and a brace or taping to take the edge off in the early painful phase.
- Patience with a plan. Tendons are slow to remodel. Done properly, most cases improve steadily; the plan matters far more than the calendar.
One thing worth flagging: repeated steroid injections are still offered for tennis elbow, and while they can dull the pain for a few weeks, the research shows worse outcomes down the line than a good loading programme. They are not the shortcut they look like.
When to get it looked at
Book in if:
- Elbow or forearm pain has hung around for more than two or three weeks
- Gripping and lifting everyday objects has become painful or weak
- It keeps coming back every time you return to work, training or DIY
- You are not certain it is tennis elbow at all, outer elbow pain can also come from the neck or the joint itself, and it is worth having it properly diagnosed
Tennis elbow rarely fixes itself if the thing that caused it has not changed. We work out what is actually driving it, treat it hands-on, and build you a loading plan to get your grip and your arm back to normal. If an elbow has been niggling through the summer, book in and we'll take a proper look.