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Common Conditions

Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow Symptoms, Common Causes and Treatments

What is Tennis Elbow?

Tennis elbow is a painful condition over lateral elbow due to overuse or degeneration of the forearm muscles and tendons, especially the wrist and finger extensors.

Causes and Factors

  • Overuse of forearm extensor muscle group: Common activities triggering tennis elbow are: prolonged computer work, racquet sports such as tennis, badminton, playing musical instrument, laboring work such as sewing or using a screwdriver, prolonged cooking, painting 
  • Aging: Natural degeneration process leads to weakening of forearm muscles and tendons
  • Other risk factors: Smoking, Obesity

Symptoms of Tennis Elbow

The most common symptoms of tennis elbow include:

  • Pain over the lateral elbow region during wrist movement, especially extension (moving the back of the hand upward)
  • Radiating pain down the lateral forearm and fingers in severe cases
  • Weakness in the affected wrist and hand grip, making it difficult to grasp objects, open jars, or twist a towel

Office Workers' Invisible Killer

The medical term for "tennis elbow" is lateral epicondylitis or lateral epicondylopathy. Despite having "tennis" in its name, the vast majority of patients in Hong Kong have actually never played the sport. It is an overuse injury or degenerative condition affecting the forearm extensor tendons.

For office workers, the following daily habits are the primary culprits behind tennis elbow:

  • “Mouse Hand” (Computer Mouse Strain): Using a mouse for prolonged periods—especially with the wrist suspended in the air or gripping the mouse too tightly—keeps the forearm muscles in a state of chronic tension.
  • Improper Keyboard Positioning: Keeping the wrists extended backward (bent upward) while typing increases stress on the tendons on the outside of the elbow.
  • Lifting Heavy Objects with One Hand: Frequently carrying briefcases, laptop bags, or heavy stacks of documents with a single hand.
  • Strain from Household Chores: Regularly wringing out towels, chopping ingredients, or holding a child (De Quervain’s tenosynovitis [“mommy elbow”] and tennis elbow frequently occur together).
  •  

Eccentric Strengthening Training for Tennis Elbow

Recent medical research indicates that tennis elbow is not merely “inflammation” but is more accurately characterized as tendon “degeneration.” Consequently, simple stretching is insufficient; eccentric exercise must be incorporated to stimulate tendon tissue remodeling.

Water Bottle Eccentric Lowering Exercise (Step 1)

Starting Position: Sit at a table and rest your affected forearm flat on the tabletop, with your wrist and hand hanging over the edge. Hold a lightweight water bottle (approximately 300–500 mL).

Water Bottle Eccentric Lowering Exercise (Step 2)

Assisted Lifting: Use your healthy hand to assist in lifting the wrist of the affected side upward (wrist extension).

Water Bottle Eccentric Lowering Exercise (Step 3)

Slow Lowering (The Critical Step): Release the healthy hand. Using only the strength of the affected wrist, very slowly (taking 3 to 5 seconds) control the descent of the water bottle as it lowers.

 

Frequency: Perform 10–15 repetitions per set, for 2–3 sets daily.

Note: Feeling a mild soreness during training is normal. However, if you experience sharp or stabbing pain, you should reduce the weight or pause the exercise and consult a physical therapist.

Treatment as Physiotherapists

Depending on the severity of the symptoms, different modalities would be used by Physiotherapists for treating tennis elbow.

Acute Phase Treatment

During the acute phase, physiotherapists aim to relieve pain through electrotherapy, cryotherapy, dry needling, and taping/bracing. Gentle stretching is encouraged to mobilize the elbow and reduce pain. Patients are also advised to adjust their lifestyle and use assistive devices at work to prevent further strain. As the pain subsides, the rehabilitation program transitions to active strengthening exercises for the wrist and finger extensor muscles.

Later Stage Treatment

In the later stage, physiotherapists may utilize advanced treatments like shockwave therapy, laser therapy, acupuncture, and interferential current to promote tendon healing and provide pain relief. Manual therapy is used to mobilize the elbow joint and relax the forearm muscles. Progressive exercises targeting the entire upper limb kinetic chain are introduced, including nerve gliding, grip strengthening, and shoulder/wrist muscle strengthening. Emphasizing load management, posture correction, and lifestyle modifications is key to successful tennis elbow rehabilitation and preventing recurrence.

Frequently Asked Questions

Recovery time for tennis elbow varies from person to person, depending heavily on the severity of the strain and whether the patient can adjust their daily habits. Because blood circulation in tendons is poorer than in muscles, the healing process generally takes longer:

  • Early/Mild Cases: If physical therapy is sought early on, combined with proper rest and posture correction, pain is usually significantly reduced within 4 to 6 weeks.
  • Chronic/Recurrent Cases: If the pain has persisted for several months, the tendon may have already undergone degeneration. These cases typically require 8 to 12 weeks or longer of progressive rehabilitation training to rebuild tendon tolerance.

Important Note: Relying solely on rest or anti-inflammatory medication usually only provides temporary pain relief. To achieve a complete cure and prevent recurrence, it is essential to strengthen the forearm muscles through “exercise therapy” under physical therapy guidance; otherwise, relapses are highly likely.

It is common to experience weakness with gripping in case of tennis elbow. This is because grip strength could be significantly limited by pain due to inflammation of the tendon.

Tennis elbow is a type of overuse injury, caused by excessive strain on the forearm tendons and muscles, resulting in pain on the outer part of the elbow. It is a common upper limb condition.

⁠It is recommended to avoid or modify activities that cause pain, but complete inactivity is not advised. Studies have shown that inflamed or injured tendons often benefit from proper loading and movements as long as pain is kept to a minimum. Physiotherapists could help determine the appropriate load and movements that would facilitate recovery.

The key to preventing tennis elbow recurrence includes:

  1. Regularly performing upper limb strengthening exercises
  2. Using assistive devices like braces during activities
  3. Moderating the intensity and frequency of activities

Testimonials & Reviews

I came to them with chronic neck and knee issues, and they didn't just provide massage therapy. They took the time to thoroughly evaluate the source of my problems and develop a comprehensive treatment plan.
Through a combination of targeted hands-on therapy, customized strengthening exercises, and patient education, they helped me regain mobility and address the root causes of my pain. I learned the correct ways to strengthen the muscles and improve my posture to prevent future issues.
The staff is incredibly knowledgeable, taking the time to explain everything and ensure I understood how to continue my progress at home. Thanks to their expertise and dedication, I'm now pain-free and able to return to my regular activities without any limitations.
Arthur Liu
⭐ ⭐ ⭐ ⭐ ⭐
I had never been a believer in physio therapy in the past or that my experience with multiple chain medical physiotherapy center had brought me nothing but temporary improvements. Until I had came across mobilize physiotherapy where they take the extra mile to examine your situation and tailor a physiotherapy session. The physiotherapists at Mobilize not only identifies the root cause and provide massages for pain relievers but also to provide take home exercises for improvements. I was never rush out the door for the next session and they ensure that I had receive the right treatment before the session ends.
I would highly recommend this physiotherapy center.
Edmond Chan
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As someone who regularly goes through the torment of backpain and neck pain, I was recommended by my friend to visit Mobilize Physiotherapy.
Everything - from appointment booking to the physiotherapy session itself - was very professional. Not only did Avery, my physiotherapist. give detailed explanations as he worked through my areas of pain, he taught me a few exercises that improve my core strength, which in turn could reduce my back and neck pain. Now, whenever I experience acute pain, I do these exercises and the pain eases away!
I highly recommend Mobilize Physiotherapy.
William Luk
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Excellent service. The physiotherapists are very professional, easy to communicate with and also give clear instructions on some home exercises that can help ease my pain. As a stay at home mom, I need a lot of strength on my daily routine and whenever I have any pain and problems I go to Avery for therapies and he is always helpful and caring
Highly recommended!
Samantha Lee
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I can't recommend my physio partner enough! They are always patient and provide valuable guidance to help me relieve chronic pain and improve my performance in jiu-jitsu. Their expertise has been invaluable to me. Highly recommended!
Felix Kung
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passionate, precise and comprehensive physiotherapy service, highly recommended for sudden onset or prolonged pain with unknown reason.
Sam Sam
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