Learn what causes pain on the outside of the elbow, how progressive rehabilitation works and when shockwave therapy may be considered.
Medically Reviewed By: Adam Gavine, BHK, M.Chiro
Original Published: June 2021
Updated On: June 2026
The funny thing about tennis elbow… you don’t actually have to play to get it.
The condition commonly affects people whose work, sport or hobbies involve repeated gripping, lifting or wrist movement. A tennis player may notice pain during a backhand, while a carpenter might feel it when using tools. For someone working at a desk, symptoms might appear when using a mouse, typing or repeatedly lifting a laptop or bag.
Everyday tasks such as opening a jar, turning a door handle, shaking hands or holding a coffee cup can become surprisingly uncomfortable.
Effective tennis elbow treatment usually involves identifying the loads aggravating the tendon, temporarily modifying them and progressively rebuilding the forearm’s capacity. Passive treatments like exercise and stretching may help but what comes next? Keep reading to find out.
What Is Tennis Elbow?
Tennis elbow is a common term for lateral elbow tendinopathy, sometimes called lateral epicondylitis. It affects the tendons attaching the wrist-extensor muscles to the bony area on the outside of the elbow.
These muscles help you:
extend your wrist and fingers
stabilize the wrist while gripping
control a racquet or tool
lift and carry objects
perform repeated hand and forearm movements
The tendon most frequently associated with tennis elbow is the extensor carpi radialis brevis tendon.
Common Symptoms of Tennis Elbow
Symptoms often develop gradually and may include:
pain or tenderness on the outside of the elbow
discomfort extending into the upper forearm
pain when gripping, carrying or twisting
reduced grip strength
pain when extending the wrist against resistance
difficulty using tools, a mouse or a racquet
discomfort when lifting an object with the palm facing down
pain when shaking hands or opening a jar
Some people experience symptoms at rest or at night, particularly when the condition is highly sensitive.
Not all outer-elbow pain is tennis elbow. Joint conditions, nerve irritation, referred pain from the neck and other tendon or muscle injuries may produce similar symptoms. An assessment can help distinguish between these possibilities.
What Causes Tennis Elbow?
Repeated gripping and wrist movement
Tennis elbow is often associated with repeated or forceful use of the forearm muscles.
Activities may include:
tennis and other racquet sports
painting
carpentry
plumbing
gardening
cooking and food preparation
using screwdrivers or power tools
weight training
rowing
prolonged computer or mouse use
Repetition alone is not always the problem. Symptoms are more likely when the demand exceeds the tendon’s current capacity to recover.
A sudden increase in activity
Tennis elbow may begin after:
playing several matches after time away from tennis
rapidly increasing training frequency
starting a new manual job
completing an unusually large home-renovation project
changing racquet, strings or technique
adding high-volume pulling or gripping exercises at the gym
A tendon can adapt to substantial force, but it usually responds better when that force is increased gradually.
Technique and equipment
For tennis players, possible contributing factors include:
late contact with the ball
relying excessively on the wrist
an unsuitable grip size
a racquet or string setup that feels demanding
an abrupt change in racquet weight
repeatedly striking the ball away from the racquet’s centre
increasing court time without sufficient recovery
A qualified tennis coach can help evaluate stroke mechanics. Equipment changes should be individualised rather than based on a universal “tennis elbow racquet”.
Workload and recovery
Sport is only one part of your weekly load. Tennis practice may be well tolerated until it is combined with gardening, gym training, manual work or another gripping-intensive activity.
Sleep, general health, smoking status, stress and recovery opportunities may also influence how well the tendon responds.
Why Does Tennis Elbow Take Time to Improve?
Tendons adapt more slowly than muscles. Pain may improve before the tendon has regained enough capacity for repeated serving, backhands or heavy gripping.
This can create a frustrating cycle:
Pain settles after rest.
The person immediately returns to their previous activity level.
The tendon is exposed to more load than it is ready to tolerate.
Symptoms return.
Complete rest begins again.
Breaking this cycle requires a graded return to activity rather than alternating between full rest and full performance.
Recovery time varies. Some recent cases improve within weeks, while persistent lateral elbow tendinopathy can take several months. Progress is influenced by symptom duration, occupational demands, exercise consistency and whether the aggravating workload can be adjusted.
Evidence-Based Tennis Elbow Treatment
The clinical practice guideline for lateral elbow pain supports assessing pain-free grip strength, elbow and wrist movement, and relevant physical impairments. Progressive resistance exercise is an important component of restoring load capacity.
Modify, rather than eliminate, activity
Complete rest may temporarily reduce pain but does not prepare the tendon to tolerate future demands.
Instead, consider modifying:
the number of tennis sessions or sets
serving volume
forceful backhand practice
heavy pulling or gripping exercises
tool use duration
lifting technique
repetitive mouse or keyboard tasks
The appropriate reduction depends on symptom irritability. A recreational player may temporarily practise shorter sessions, while a manual worker may need to change task rotation or tool setup.
Begin progressive forearm exercise
Rehabilitation commonly targets the wrist-extensor muscles and grip capacity.
Depending on your presentation, a program may include:
isometric wrist-extension holds
controlled wrist-extension exercises
forearm rotation exercises
grip-strength exercises
elbow and shoulder strengthening
pulling and carrying progressions
racquet-specific drills
The starting resistance should be manageable. Exercises can then be progressed through changes in weight, repetitions, speed and frequency.
Some discomfort during rehabilitation may be acceptable, but exercise should not create a substantial or lasting symptom increase. Your response later that day and the following morning provides useful information.
Address the entire upper limb
The elbow does not function in isolation. Shoulder, wrist, neck and upper-back capacity may affect how load is managed during work and sport.
This does not mean poor posture or one “misaligned” joint caused the condition. It means rehabilitation may need to extend beyond the painful tendon when assessment identifies relevant limitations.
Consider taping or a brace
A forearm strap, wrist support or taping technique may provide short-term relief for some people during particular activities.
These tools do not rebuild tendon capacity. They are best viewed as optional aids while exercise and workload changes address the longer-term problem.
Review pain medication appropriately
HealthDirect notes that tennis elbow commonly improves with conservative management but recovery can be slow. Its Australian tennis elbow guidance recommends remaining active while avoiding activities that significantly aggravate the arm.
Speak with a pharmacist or GP before using anti-inflammatory or other pain medication, particularly if you have another medical condition or take prescribed medicines.
Be cautious with corticosteroid injections
A corticosteroid injection may provide short-term pain reduction for some patients, but short-term relief does not necessarily represent improved tendon capacity. Recurrence and less favourable longer-term outcomes have been reported in some research.
Discuss the potential benefits, limitations and risks with an appropriately qualified medical practitioner before proceeding.
Can Shockwave Therapy Help Tennis Elbow?
Shockwave therapy applies mechanical acoustic pulses to the affected area. It may be considered for persistent lateral elbow tendinopathy when an appropriate rehabilitation program and load-management strategy have not produced sufficient progress.
Research findings are mixed. Some studies report improvements in pain and function, while others have found limited benefit compared with sham treatment or other interventions. This means shockwave should not be described as the universally superior treatment or given a guaranteed success rate.
When it is clinically appropriate, shockwave therapy may be used alongside:
progressive resistance exercise
workload modification
manual or soft-tissue treatment
advice about work or sporting technique
a structured return-to-tennis program
Treatment can be uncomfortable, and temporary tenderness may occur. The number of sessions and treatment parameters should be based on the individual presentation.
eturning to Tennis
Returning to the court should be gradual. Feeling better during daily activities does not automatically mean the elbow is ready for a full match.
A progression might include:
Comfortable daily gripping and lifting.
Forearm strengthening with an appropriate resistance.
Shadow swings without hitting a ball.
Short-court hitting at a comfortable pace.
Controlled groundstrokes.
Gradual reintroduction of backhands and volleys.
Reduced-volume serving.
Longer practice sessions.
Match play.
Increase one variable at a time. Avoid simultaneously adding more sessions, longer matches and harder serving.
Practical return-to-court tips
Warm up the shoulder, elbow and wrist before hitting.
Begin with shorter sessions.
Take breaks before technique deteriorates.
Ask a coach to review contact point and stroke mechanics.
Check grip size and racquet setup.
Avoid squeezing the racquet more tightly than necessary.
Monitor symptoms later that day and the following morning.
Maintain forearm and shoulder exercises after returning.
When Should Elbow Pain Be Assessed?
Arrange an assessment if:
pain is worsening despite reducing aggravating activity
grip strength is noticeably declining
symptoms are affecting work or sleep
pain persists for several weeks
the elbow is swollen, hot or red
you cannot fully move the elbow
numbness or tingling develops
pain appears to originate from the neck
symptoms began after a significant fall or impact
Seek prompt medical care for marked swelling, deformity, fever, substantial weakness or loss of sensation.
What to Expect at Back To Function
At Back To Function, Dr Adam Gavine assesses the source of your elbow pain and the loads contributing to it before recommending treatment.
Detailed history
Your consultation may cover:
where and when the pain began
sporting and work activities
recent changes in training or equipment
gripping and lifting demands
previous elbow, shoulder or neck problems
treatments already attempted
your goals for work, exercise or tennis
Physical assessment
The examination may evaluate:
the location of tenderness
pain-free grip strength
wrist and elbow movement
resisted wrist and finger movements
forearm, shoulder and upper-limb strength
nerve-related symptoms
neck movement where relevant
task or racquet mechanics
Imaging is not routinely necessary when the clinical presentation is clear. An X-ray, ultrasound or MRI may be considered when another condition is suspected or symptoms are not progressing as expected.
Individualised treatment
Depending on your findings, care may include:
activity and workload modification
progressive forearm rehabilitation
chiropractic or joint-based treatment where appropriate
Active Release Techniques®
myofascial treatment
kinesio taping
advice about ergonomics or racquet activity
shockwave therapy for selected persistent presentations
Your progress may be measured through grip strength, lifting tolerance, work capacity and return-to-sport function—not pain alone.
Rebuild Capacity, Then Return With Confidence
Tennis elbow is not always caused by tennis, and complete rest is rarely the entire solution. Most people need a plan that reduces excessive tendon load temporarily while progressively rebuilding grip and upper-limb capacity.
Passive treatment may help manage symptoms, but exercise, activity modification and a gradual return to your usual demands remain central to recovery.
If outer-elbow pain is affecting your work, training or time on court, contact Back To Function on 0468 749 223, email adam@backtofunction.com.au, or arrange an assessment at Suite 36/38, 12–14 Waratah Street, Mona Vale.
Dr Adam Gavine provides tennis elbow assessment and rehabilitation for patients from Sydney’s Northern Beaches and the Central Coast.
AUTHOR BIO
Dr Adam Gavine, BHK, M.Chiro, is the Director and Chiropractor at Back To Function. With more than 19 years of clinical experience, he has a special interest in sports rehabilitation and soft-tissue health.
Adam is a full-body certified Active Release Techniques® (ART) provider—one of only a handful in Australia—and co-founder of the Wasabi Method, a shockwave therapy partnership. He is currently completing a PhD at the University of Sydney and services patients across Sydney’s Northern Beaches and the Central Coast.
READ MORE
What Is Tendinopathy and How Do You Manage It? — understanding tendon load and progressive rehabilitation
Shockwave Therapy: How It Works and When It May Help — an introduction to shockwave treatment
Train Smarter, Not Harder — managing training progression and avoiding workload spikes
Go Hard, Then Go Home and Recover — balancing physical activity with recovery
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Tennis elbow is a form of tendinopathy (used to be called tendinitis) that affects the elbow. Luckily, the condition is not terribly complicated to resolve. That’s the good news, the bad news is that it usually takes between 3-6 months to fully resolve depending on the individual and how severe the condition is.
Tennis elbow is an overuse injury to common extensor tendon of the elbow which attaches to the bony protuberance on the outside (lateral) aspect of the elbow. It is commonly due to work relate or a sport that involves excessive, quick, monotonous, repetitive movements of the wrist. Tendons are the bits that attach muscles to bones; most muscles in the body have tendons. Tendons have slightly a different makeup than muscles, and as such they react differently to use and exercise.
Tendons have relatively poor blood circulation compared to muscles, which affects tendons ability to heal and repair. Thus, muscles tend to heal much faster compared than tendons when injured. To make matters worse, is that some tendons such as the proximal hamstring tendon have even poorer blood flow than others.
As with almost all musculoskeletal injuries including tendon problems, there are three tried and tested methods to resolve the problem.
One way is to stop doing the things that caused the problem. We need to identify the cause of the problem, then eliminate or minimise the causative action/activity. In the case of tennis elbow, we know it is an overuse injury, so all we have to do is identify the action that is overloading the elbow and eliminate or minimise said action.
The second method of resolving almost all musculoskeletal problems including tennis elbow is to make the affected area stronger and more resilient. Strength and rehabilitation exercises are what is required in this method. Unfortunately, there are thousands of exercises out there and not all of them are equally effective. In fact, some exercises will perpetuate or even exacerbate a tennis elbow. It is important to get reliable information from a professional before you fully commit yourself in a strength or rehabilitation program.
There are several variables that need to be correctly assessed and coordinated in order for a strength/rehab program to yield the best results. They include the difficulty of the exercise, the load (how heavy the weights or resistance used), the number of repetitions, number of sets, the amount of rest in between sets, how many times per week the program needs to be performed. It truly is an art to designing a safe, appropriate, and effective strength/rehab program. Again, this is why it is so important that you consult an appropriately trained professional to help design a bespoke rehab program for you.
The third method of resolving almost all musculoskeletal problems including tennis elbow is passive therapy. Passive therapy is treatment that is provided by a third party, which can be some form of allied health professional. It may be a form of manual therapy: physiotherapy, chiropractic, osteopathy, acupuncture, massage therapy, myotherapy, or a form of electrotherapy (shockwave therapy, ultrasound therapy, laser therapy, inferential current). It is important to point out that research indicates that one treatment method is not superior to others, in fact most therapies tend to yield very similar outcomes. Different practitioners will possess different skillsets, some of which may better suit your individual needs. So, we recommend you actively seek out a good practitioner in order to increase your chances of a successful outcome. Several recent studies demonstrated superior results with combination therapy (therapy involving two or more treatment modalities) compared to stand-alone therapy (one single therapy done in isolation).
One therapy that I highly recommend for tennis elbow is shockwave therapy. It is a relatively new treatment modality; it was first introduced in the early 90s, however, it has become more readily available in the past decade. Research has demonstrated it to be the most effective electrotherapy on the market. Several studies specifically assessing tennis elbow show a 80-85% success rate at resolving the condition. These numbers are substantially higher than almost any other form of treatment for tennis elbow including manual therapy and exercise therapy.
Each of the three above mentioned methods of resolving tennis elbow are proven to be safe and effective. Moreover, when all three methods are combined the effects are exponential and the results are appropriately matched. I often say to patients: “One + One + One = 12” inferring that when you combine method one with method two and three, they work synergistically to yield exponential results. The great news is that two of the three methods are at your disposal 24/7, you don’t need to go anywhere or see anyone else to help you, which is both empowering and liberating.
At Back to Function Dr Adam Gavine (M. Chiro) integrates several of these treatment modalities to provide patients with the quickest and most effective non-invasive treatment available. If you would like to learn more about our services and techniques, please visit our website www.backtofunction.com.au. Call us if you wish to discuss which treatment options are best suited for your individual needs.
We hoped this information helped shed some light on tennis elbow and its different treatment options.
Your Back to Function Team
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Court availability, fees and booking arrangements can change, so confirm current details with the facility before attending.
Mona Vale Tennis Club
Mona Vale Tennis Club is located at Kitchener Park on Pittwater Road. It offers online court hire and is the closest dedicated tennis facility to central Mona Vale.
This can be a practical location for a graded return because court time can be booked in advance and kept shorter than a full social or competition session.
Bayview Tennis Club
Bayview Tennis Club is located at 1678 Pittwater Road, Bayview, beside Pittwater.
The club provides a nearby option for social play and organised tennis. If returning after elbow pain, consider beginning with controlled hitting rather than immediately joining a long competitive session.
Newport Community Centre Tennis Courts
The Newport Community Centre courts include two synthetic-grass courts managed through Northern Beaches Council.
Casual court hire can make it easier to schedule a short, lower-volume practice with a hitting partner.
North Narrabeen Community and Tennis Centre
The North Narrabeen Community and Tennis Centre has two synthetic-grass courts available through Council.
The venue is also used for tennis coaching, which may be useful if technique or workload progression is contributing to recurring symptoms.
Terrey Hills Tennis Club
Terrey Hills Tennis Club is located at the Terrey Hills Sporting Oval, with access from Yulong Avenue.
The centre includes floodlit synthetic-grass courts and provides another option for players travelling between Mona Vale, Terrey Hills and surrounding Northern Beaches suburbs.
Other Northern Beaches courts
Northern Beaches Council maintains a broader directory of local tennis courts, including community-operated and privately managed facilities.
