Tennis Elbow
Tennis elbow is one of the most common causes of pain on the outer side of the elbow, and despite the name it is far more often brought on by everyday gripping, lifting and repetitive work than by playing tennis. It is a tendon problem, and with the right approach it usually settles well.
At Newhill Osteopathy in Horley we treat a lot of sore, nagging elbows, from a weekend of DIY that has flared things up to a long-running ache that makes lifting a kettle uncomfortable. This page explains the kinds of elbow pain we treat, what tends to cause them, and what an appointment actually involves.
What types of elbow pain can osteopathy help with?
Tennis elbow (lateral epicondylitis)
The classic picture: pain and tenderness on the bony point on the outer side of the elbow, often spreading down into the forearm. It is usually worse when you grip, lift, or straighten the wrist – carrying a shopping bag, turning a door handle, or picking up a mug can all catch you out.
Golfer’s elbow (medial epicondylitis)
The same kind of problem on the inner side of the elbow. You need not play golf to get it – it comes from the muscles that bend the wrist and fingers being overworked, and we treat it in much the same way.
Repetitive strain from work or hobbies
Long hours at a keyboard and mouse, trade work, gardening or a new task done for hours on end can all overload the forearm tendons and set an elbow grumbling.
Pain referred from the neck or shoulder
Not all elbow pain starts at the elbow. A stiff neck or shoulder can refer pain down into the arm, so we always check further up the chain rather than treating the elbow in isolation.
A stiff elbow after an injury
An old knock, a fall or a spell in a sling or cast can leave the elbow stiff and reluctant to move fully. Gently restoring that movement is usually very achievable.
Why does tennis elbow happen?
There is rarely one single cause. It is usually a mix of everyday things:
- Repetitive gripping – the forearm tendons are worked hard and often, with too little recovery in between.
- A sudden increase in activity – a burst of decorating, a house move, or a new job that your arm is not yet used to.
- Stiffness further up the arm – if the shoulder or neck do not move well, the elbow and wrist end up taking the strain.
- Age-related tendon changes – tennis elbow is most common between about 35 and 60, when tendons are a little less forgiving.
- Technique and equipment – in racquet or gym users, a heavy grip, poor form or the wrong kit can play a part.
- Too little recovery – tendons need time to adapt, and they protest when they do not get it.
What happens at your appointment?
- We listen first. Where the pain sits, what brought it on, which movements aggravate it, and what you have already tried.
- We examine you. We test the elbow, wrist and grip, and check the shoulder, neck and nerves too, to make sure we are treating the real source of the problem.
- Hands-on treatment. Soft tissue work to the forearm, gentle mobilisation of the elbow, wrist and neck, and other techniques chosen to suit you. You can say no to anything.
- Practical advice. How to ease the load that is irritating the tendon, a simple exercise plan to build its tolerance back up, and whether a support strap might help you in the meantime.
Simple things you can try at home
- Ease off the particular movements that flare it up, rather than resting the arm completely – tendons recover better when they keep working within comfort.
- Gentle forearm stretches, holding the arm out straight and easing the wrist up and down, kept well within comfort.
- A support strap worn just below the elbow can take some of the pull off the sore tendon while you work.
- Ice for ten to fifteen minutes after an activity that has aggravated it; warmth can be more soothing for a stiff, achy elbow.
- Check your grip – a chunkier handle on tools, pens or a racquet often means less strain on the forearm.
Please see a doctor first if your elbow pain followed a significant fall or accident and the joint is very swollen, bruised or misshapen, if you cannot straighten or bend it properly, if you have numbness, pins and needles or weakness spreading into the hand, or if the joint becomes hot, red and swollen with a fever. These need medical attention rather than osteopathy.
More reading
- Neck pain – because a stiff neck can refer pain into the arm and elbow.
- Expert advice and articles
- All the conditions we treat
You can also see everything we treat on our conditions page.
Frequently asked questions
Is tennis elbow only caused by playing tennis?
Not at all, and the name is a little misleading. Only a small number of the cases we see are down to racquet sports. Far more often it is everyday gripping and lifting that overloads the tendons on the outer elbow – a spell of DIY or decorating, long hours at a keyboard and mouse, gardening, or a job that involves gripping tools. Anything that works the forearm muscles hard and often can bring it on, whether or not you have ever picked up a racquet.
How long does tennis elbow take to settle?
Honestly, longer than most people would like. Tendon problems are slow to change by their nature, so while some settle in a matter of weeks, others take several months, particularly if the aggravating activity carries on in the background. The encouraging part is that the great majority get better without injections or surgery. Getting the load right – easing off what irritates it while gradually building the tendon’s tolerance with specific exercises – is what makes the difference, and we will give you a realistic idea of your own timescale once we have examined you.
Should I rest it completely or keep using it?
Complete rest is rarely the answer and can leave the tendon weaker and slower to recover. The better approach is relative rest: easing right back on the particular movements that flare it up, while keeping the arm moving and gradually loading the tendon in a controlled way. We will help you find that line, so you are doing enough to encourage the tendon to adapt without constantly stirring it up.
Do those elbow straps or braces actually help?
They can, for some people. A strap worn just below the elbow takes a little of the pull off the sore tendon and often makes gripping more comfortable in the short term, which can help you get through work or a task. It is a useful aid rather than a cure though – it does not fix the underlying problem, so it works best alongside a proper plan of load management and exercises rather than on its own.
Should I consider a steroid injection?
It is a fair question, and worth understanding before you decide. A steroid injection can give useful short-term relief from the pain, but the evidence suggests it does not improve things in the longer run, and some studies have found people do slightly less well a year on than those who managed it with exercise and time. For that reason it is usually not the first port of call. We would generally suggest starting with hands-on treatment, load management and a graded exercise plan, and if you are still considering an injection it is worth talking it through with your GP so you can weigh it up properly.
Book an appointment
If elbow pain is getting in the way of work, sport or everyday tasks, we would be glad to help. Call 01293 369 442, email [email protected], or book online.