Lateral elbow pain / ‘Tennis Elbow’

At the bottom of the humerus (upper arm bone) are two bony bumps – the ‘lateral epicondyle’ on the outside of your arm and the ‘medial epicondyle’ on the inside of your arm.

The muscles that straighten your fingers and lift your wrist up (extension) are attached to the bony part on the outside of the elbow (lateral epicondyle). If these muscles are strained, they can become irritated. Micro-tears and other changes can happen in the tendons that attach the muscles to the bone. The symptoms that happen due to these changes may be referred to as ‘lateral epicondylitis’ or ‘Tennis Elbow’.


The condition happens in around 1-3% of the population. It affects men and women equally and tends to occur most often in middle age. The cause of Tennis Elbow / lateral epicondylitis is usually repeated activities that involve strong gripping, heavy lifting or twisting of the forearm. For example:

  • Using tools in the garden or for DIY – such as garden shears, secateurs, screwdriver, paint brush or roller
  • Activities involving repetitive wrist or hand movements such as typing and sewing
  • Racquet sports


The symptoms of Tennis Elbow / lateral epicondylitis are:

  • Pain on the outside of the elbow. This area is often tender to touch
  • The pain may also be felt in the back of your forearm

The pain is worsened by activities such as using hand tools, gripping things (such as a pen), twisting movements of wrist or forearm (such as using door handles or opening a jar) or picking things up. It is usually eased by resting the affected side.


Most people (85-90%) make a full recovery within a year.

There are a range of things you can do to help manage the symptoms and aid recovery:

Activity modification

It is important to keep your elbow, wrist and hand moving as this can reduce the risk of the elbow becoming stiff and muscles weak.

However, in the short term, avoiding or reducing the activities that make the pain worse can help to reduce stressing or irritating the tendons further.

If you need to continue with activities that cause pain (for example for work), try to break up the aggravating movements with rest or movements that do not cause pain.

Pain relief

Paracetamol may help to reduce your pain. Please see current information about paracetamol

Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen may be useful to help reduce your pain. Please see current information about NSAIDs

Topical NSAIDs (applied directly to the affected area) are recommended to try first. Always follow the instructions on the packet and speak to a pharmacist to discuss safe use of NSAIDs especially if you have any underlying health conditions.

Using heat or ice

Using heat over the affected area such as a warm shower, wheat pack or hot water bottle may help relax muscles.

Using ice over the area may also help reduce pain. Never apply ice directly to the skin as it can cause an ice ‘burn’. Instead wrap an ice pack or frozen peas in a damp cloth and place over the area for 10-15 minutes.

When using heat or ice as a treatment make sure that you:

  • Check your skin regularly
  • Stop if there is increased pain, tingling or numbness

If you have any circulatory problems or altered skin sensation you should be cautious about using these treatments.


A support or splint may help to reduce the strain on muscles and therefore may reduce pain.

a) An ‘epicondylitis clasp’ is a splint worn on the upper forearm. It can change the tension in the affected muscles.

b) A wrist brace minimises movement of the wrist and therefore activity in the affected muscles.


Gradual stretching and loading of the affected tendons can help you to make a full recovery. You may feel some discomfort when doing the exercises. However, they should not make your elbow pain and symptoms worse. You should start exercising gently and gradually build up the exercises as you feel able to. Try the basic exercises first. Once these feel easy and comfortable to do (this may be immediately), move on to the exercise progressions.

Basic exercises

Stretch for the muscles that lift your wrist and fingers up:

Straighten your arm out in front of you with your palm facing the floor. Drop your wrist into a bend forward. Place your other hand on the back of the one being stretched. Gently hold or increase the bend at your wrist until you feel a stretch in the back of your forearm towards your elbow. Hold for 30 seconds, then relax. Repeat once or twice a few times a day.

Strengthening the muscles that lift your wrist and fingers up:

With the elbow bent, tuck your elbow in towards your waist. Position your forearm so that your thumb is pointing up towards the ceiling. With your fingers straight, place your other hand on the back of the hand to be exercised. Gently push your affected hand into your other fingers without moving the wrist or fingers (A). Hold for a few seconds. Relax. Repeat as able.

To make this more difficult you can resist over the knuckles of your hand (B) or over the fingers (C). You can also increase the force from the other hand or increase the number of repetitions that you do.

Exercise progression:

For other exercises to gradually load the muscles and tendons please see the link to a video produced by the British Elbow and Shoulder Society:

Steroid Injections

There is very little evidence to support the use of corticosteroid injections for Tennis Elbow. Recent research has shown that steroid injections may make outcomes worse in the longer term and may have a negative impact on the benefits of exercise in Tennis Elbow.

If your symptoms do not improve with conservative treatment (including self-management and Physiotherapy) for 6-12 months, your healthcare practitioner may refer you to an orthopaedic surgeon.

When should I seek help?

Improvements may be gradual over a number of weeks or months rather than on a day-to-day basis – especially if you have had symptoms for a long time.

If your elbow pain is worsening or you are not improving after trying this advice for 6-12 weeks, you should see your healthcare practitioner.

A physiotherapist will be able to provide expert advice and treatment to guide your recovery.

Back to Elbow page