Tennis Elbow (Lateral Epicondylitis): Symptoms, Relief, and Recovery

Tennis elbow, known medically as lateral epicondylitis, is a common musculoskeletal condition characterised by pain on the outer part of the elbow. It occurs when the tendons that join your forearm muscles to the bone become inflamed or develop small tears due to repetitive strain.

In the UK, it is estimated that approximately 1% to 3% of the population is affected each year. While the name suggests an injury linked to racquet sports, the vast majority of people diagnosed with the condition have not played tennis recently. Instead, it is often a result of occupational hazards or domestic activities involving repetitive wrist and arm movements.

The symptoms of tennis elbow typically develop gradually. In most cases, the pain begins as a mild ache and slowly worsens over weeks or months. Key indicators include:

• Outer Elbow Pain: A sharp or burning pain on the bony lump on the outside of your elbow (the lateral epicondyle).
• Weakened Grip: Finding it difficult to hold objects, turn a door handle, or open a jar.
• Forearm Stiffness: Difficulty fully extending the arm, especially in the mornings.
• Radiating Pain: The ache may travel down your forearm towards the wrist.

The pain is often aggravated when performing activities that involve lifting, gripping, or twisting, such as using a screwdriver or even holding a heavy coffee mug.

Tennis elbow is an overuse injury. The muscle involved is the Extensor Carpi Radialis Brevis (ECRB), which helps stabilise the wrist when the elbow is straight. When this muscle is overused, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

Common triggers in the UK include:

• Repetitive Manual Labour: Occupations such as plumbing, bricklaying, painting, and decorating.
• Office Work: Prolonged use of a computer mouse and intensive typing.
• Domestic Chores: Heavy gardening (using shears), intensive cleaning, or cooking (chopping ingredients).
• Sports: While not the only cause, racquet sports or weightlifting with poor technique can contribute.

Most cases of tennis elbow will improve with dedicated self-care and time. Following the 'RICE' principles (Rest, Ice, Compression, Elevation) in the early stages can help, though 'Rest' is the most critical component for tendon recovery.

Key self-management strategies include:

• Activity Modification: Identify the specific movement causing the pain and stop or change how you do it for at least two weeks.
• Cold Compresses: Applying an ice pack (wrapped in a towel) to the elbow for 15 minutes several times a day can reduce inflammation.
• Over-the-Counter Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage both pain and swelling. Always follow the pharmacist's advice.
• Supportive Braces: An 'epicondylitis clasp' or elbow strap can take the pressure off the tendon during necessary activity.

If the pain does not subside after a few weeks of rest, professional intervention may be required. The National Institute for Health and Care Excellence (NICE) often recommends physiotherapy as a primary treatment path.

A physiotherapist can provide specific eccentric exercises designed to strengthen the forearm muscles without further damaging the tendon. They may also use techniques such as manual therapy or ultrasound to stimulate healing. In chronic cases that do not respond to conservative treatment, a GP may discuss options such as steroid injections or, rarely, a referral to an orthopaedic surgeon, though surgery is considered a last resort.

While tennis elbow is rarely an emergency, persistent pain can impact your quality of life and ability to work. You should consult an online GP if:

• Self-care measures haven't improved the pain after 4–6 weeks.
• The pain is severe enough to interfere with sleep or basic daily tasks.
• The elbow is hot, red, or significantly swollen (as this may indicate an infection or bursitis).
• You have lost range of motion in the joint.

An online GP can assess your symptoms via video consultation, offer advice on pain management, and provide a sick note if your job is exacerbating the condition. They can also recommend when to see a specialist for imaging like an ultrasound or MRI.