Understanding and Managing Tennis Elbow: A Guide to Building Resilient Tendons
If you’ve ever felt a sharp, nagging ache on the outside of your elbow while gripping your morning coffee, wielding a hammer, or typing at your desk, you’ve likely encountered Lateral Elbow Tendinopathy—more commonly known as Tennis Elbow.
Despite the name, you don’t need to be a regular at the local tennis club to experience it. In fact, tennis elbow frequently affects Kiwi desk workers, tradies, and gym-goers alike. It can be a frustrating, persistent condition, but the good news is that modern physiotherapy and osteopathy have shifted away from "just resting it" toward building a stronger, more resilient elbow.
What is Tennis Elbow?
At its core, tennis elbow is an overuse injury involving the tendons that attach your forearm muscles to the bony bump on the outside of your elbow (the lateral epicondyle). Specifically, it usually involves the extensor carpi radialis brevis (ECRB) muscle (Bisset & Vicenzino, 2015).
In the past, we thought this was just "inflammation." However, research now shows it is more of a degenerative process where the tendon fails to heal correctly after being overloaded (Maffulli et al., 2003). Think of it like a rope that has started to fray because it’s being asked to pull a load it isn't quite strong enough for yet.
The Shift from Rest to Load
The old-school advice was to rest, ice, and wait. Today, we know that tendons actually need progressive loading to heal. While complete rest might make the pain go away temporarily, it may leaves the tendon weaker, meaning the pain returns the moment you head back to the gym or the job site (Malliaras et al., 2013).
To fix tennis elbow, we need to improve the tendon's "load tolerance." This means teaching the tissue to handle tension again through specific, controlled movement.
Step-by-Step Rehab Strategy
A professional rehab programme focuses on three phases: reducing irritability, building strength, and returning to full function.
1. Isometrics (The Pain Reliever)
If your elbow is very sensitive, we start with isometrics—holding a muscle contraction without moving the joint. Research suggests that isometric exercise can have an immediate pain-relieving effect on tendons (Rio et al., 2015).
Start with these gentle loading exercise to help settle the pain, by following the link below.
2. Eccentric and Concentric Loading (The Strength Builder)
Once the initial "flare-up" settles, we move into active ranges of motion. We focus on eccentric loading (the lengthening phase of a movement), which has been shown to be highly effective in treating chronic tendinopathies (Cullinane et al., 2014).
3. Grip and Shoulder Integration
Your elbow doesn't work in isolation. Often, elbow pain is a sign that the shoulder isn't doing enough work or that your grip strength is a bottleneck.
Farmer’s Carries: Simply holding a heavy weight and walking helps build "functional capacity" in the forearm and improves how the shoulder stabilises the arm (Coombes et al., 2015).
Implementation: Your Weekly Programme
Consistency is the "secret sauce" for tendon health. Unlike muscles, tendons have a slower blood supply and take longer to adapt.
Frequency: Perform your rehab exercises 3–4 times per week. Tendons need a "recovery window" of about 24–48 hours between heavy sessions.
Intensity: Use a "Pain Monitoring Model." It is okay to feel a small amount of discomfort (up to a 3/10) during exercise, provided the pain does not get worse the next morning (Silbernagel et al., 2007).
Volume: Aim for 3 sets of 10–15 repetitions for the dynamic movements.
Common Mistakes to Avoid
Aggressive Stretching: Many people try to "stretch out" the pain. However, aggressive stretching can sometimes aggravate the tendon more.
Total Inactivity: Avoiding all movement makes the tendon "stiff" and less capable. Stay active within your pain limits.
The "Quick Fix" Trap: Cortisone injections may provide short-term relief, but long-term studies show they may actually lead to higher recurrence rates compared to physiotherapy (Coombes et al., 2013).
Summary
Tennis elbow is more than just a sore arm; it’s a signal that your forearm’s capacity has been exceeded. By moving away from passive treatments and embracing "strength through range," you can build an elbow that is more resilient than it was before the injury.
If you are struggling with persistent pain, a tailored assessment is key to ensure your programme is perfectly dosed for your specific needs.
This isn’t medical advice and if pain persistant go see someone who can help, or book in
References (APA Format)
Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy, 61(4), 174-181.
Coombes, B. K., Bisset, L., & Vicenzino, B. (2015). Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 938-949.
Coombes, B. K., Bisset, L., Brooks, P., Khan, A., & Vicenzino, B. (2013). Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA, 309(5), 461-469.
Cullinane, F. L., Boocock, M. G., & Trevelyan, F. C. (2014). Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clinical Rehabilitation, 28(1), 3-19.
Maffulli, N., Wong, J., & Almekinders, L. C. (2003). Reactive tendinopathy: is it inflammation or degeneration? Sports Medicine and Arthroscopy Review, 11(2), 80-91.
Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine, 43(4), 267-286.
Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces intracortical inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277-1283.
Silbernagel, K. G., Thomeé, R., Eriksson, B. I., & Karlsson, J. (2007). Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. The American Journal of Sports Medicine, 35(6), 897-906.
Struijs, P. A., & Kerkhoffs, G. M. (2005). Tennis elbow. BMJ Clinical Evidence, 2005, 1117.
Waugh, E. J. (2005). Lateral epicondylalgia: or are we just scratching the surface? Evidence-based treatment for "tennis elbow". Journal of Physiotherapy, 51(4), 213-220.