Tennis Elbow: Symptoms, Exercises and Recovery

Tennis elbow causes pain and tenderness on the outside of the elbow, particularly when gripping, lifting, turning a handle or extending the wrist. Despite its name, most people who develop it do not play tennis.

The condition usually develops when the tendons that attach the forearm muscles to the outer elbow are repeatedly loaded beyond their current capacity. It is also called lateral epicondylitis or, more accurately, lateral elbow tendinopathy.

Most cases gradually improve without surgery. Reducing aggravating activities, continuing gentle movement and progressively strengthening the wrist and forearm are usually more helpful than completely resting the arm. Improvement may begin within several weeks, but full recovery commonly takes three to twelve months.

Seek medical advice promptly if the elbow became painful after a fall or injury, looks deformed, is very swollen, hot or red, or if you develop fever, significant weakness, numbness or persistent tingling.

The exercises below are general examples, not an individual rehabilitation prescription. Stop and seek advice if they cause severe pain, increasing swelling, numbness or a lasting deterioration.

What are the symptoms of tennis elbow?

The main symptom is pain around the bony prominence on the outside of the elbow, called the lateral epicondyle. Pain may spread a short distance down the outer forearm but does not usually extend into every finger.

Common symptoms include:

• tenderness over the outside of the elbow;
• pain when gripping or shaking hands;
• pain when lifting a cup, kettle, bag or saucepan;
• discomfort when turning a key or door handle;
• pain when using a screwdriver, secateurs or hand tools;
• pain when extending the wrist against resistance;
• reduced grip strength because gripping hurts;
• aching after repetitive computer, manual or sporting activity;
• stiffness or discomfort when first using the arm after rest.

The pain can range from a mild inconvenience to a persistent problem that affects work, sleep and ordinary tasks. It often starts gradually, although a sudden increase in unfamiliar gripping or lifting can make symptoms appear quickly.

Activities such as pouring from a kettle may be surprisingly painful because the weight is held away from the body while the wrist muscles stabilise the hand.

What causes tennis elbow?

The muscles that straighten the wrist and fingers join a shared tendon near the outside of the elbow. Repeated gripping and wrist extension place load through this tendon.

Tennis elbow can develop when the amount or intensity of activity increases faster than the tendon can adapt. The affected tendon commonly shows changes in collagen structure and its response to load. It is not simply an acutely inflamed tendon, despite the traditional name “epicondylitis”.

Possible triggers include:

• starting a new manual job or hobby;
• doing more gardening or DIY than usual;
• repeated use of screwdrivers, drills or paintbrushes;
• lifting with the palm facing down;
• frequent forceful gripping;
• computer work with an awkward wrist or mouse position;
• playing racquet sports with unsuitable technique or equipment;
• playing certain musical instruments;
• repetitive food preparation, sewing or craft work;
• returning too quickly to work or sport after a break.

It is particularly common between approximately 40 and 60 years of age, but it can occur at other ages. Sometimes there is no obvious single cause.

In tennis, a late backhand, excessive wrist movement, a tightly strung racquet or unsuitable grip size may increase tendon loading. However, the condition can affect office workers, builders, gardeners, hairdressers, musicians and carers just as easily as players.

How can you tell if it is tennis elbow?

Tennis elbow is usually diagnosed from the pattern of symptoms and a physical examination. A clinician may press around the outer elbow and ask you to grip, extend the wrist or straighten a finger against resistance.

A simple test sometimes used during assessment involves:

1. resting the forearm on a table with the palm facing down;
2. making a gentle fist;
3. trying to lift the hand upwards at the wrist;
4. using the other hand to provide light resistance.

Pain at the outer elbow during this movement may fit tennis elbow, but it does not confirm the diagnosis by itself. Do not repeatedly provoke severe pain to test the tendon.

An X-ray, ultrasound or MRI is not normally required when the symptoms and examination are typical. Imaging may be considered after a significant injury, when movement is restricted, when another diagnosis is suspected or when symptoms persist despite appropriate rehabilitation.

What else can cause pain on the outside of the elbow?

Other possible causes include:

• radial nerve irritation or radial tunnel syndrome;
• pain referred from the neck;
• elbow-joint arthritis;
• ligament injury or instability;
• a fracture following trauma;
• biceps, triceps or other tendon problems;
• inflammatory arthritis;
• infection or gout;
• less commonly, another bone or soft-tissue condition.

Numbness and tingling are not typical features of an isolated tennis elbow. Symptoms extending into the hand, marked neck pain or weakness that is not explained by discomfort may indicate nerve involvement. Our guide to neck pain and related warning signs explains when pain may originate higher in the arm.

A hot, red and very swollen elbow is also not a typical presentation. It needs medical assessment for infection, gout or another inflammatory problem.

What should you do during a painful flare-up?

You do not normally need to stop using the arm completely. The aim is to reduce the most provocative load while maintaining comfortable movement.

For the first few days of a significant flare-up:

• temporarily reduce forceful gripping, lifting and twisting;
• break repetitive work into shorter periods;
• use the other hand for heavier tasks where practical;
• keep the elbow, wrist and fingers moving gently;
• avoid repeatedly testing painful grip strength;
• use cold or warmth if either feels helpful;
• consider suitable short-term pain relief after speaking to a pharmacist.

A wrapped cold pack can be applied for approximately 10 to 15 minutes. Never put ice directly against the skin. Some people prefer warmth, particularly when stiffness is more troublesome than swelling.

Prolonged complete rest can reduce the tendon’s ability to tolerate load. Once the initial flare settles, progressively rebuilding strength is usually more useful than continuing to protect the arm from every movement.

How much pain is acceptable during activity?

A small increase in discomfort during rehabilitation does not necessarily mean that the tendon is being damaged. However, exercise should remain controlled and tolerable.

As a general guide:

• mild discomfort during an exercise may be acceptable;
• pain should not become sharp, severe or progressively worse;
• symptoms should settle reasonably soon after the session;
• the elbow should not be noticeably worse the following morning;
• load should be reduced if pain remains elevated for more than 24 hours.

There is no universal pain score that suits everyone. If you are uncertain, begin below the level that causes symptoms and increase gradually.

Which exercises can help tennis elbow?

Exercise aims to maintain movement and gradually increase the capacity of the wrist-extensor muscles and tendon. Progress is generally measured over weeks rather than days.

The NHS provides videos of exercises for tennis elbow. A physiotherapist can adjust the programme if the exercises below are too easy, too painful or unsuitable for your work or sport.

1. Elbow bending and straightening

1. Sit or stand with the affected arm relaxed.
2. Slowly bend the elbow as far as comfortable.
3. Then straighten it without forcing the final position.
4. Repeat 10 times.

This maintains elbow movement. It should not require a weight.

2. Forearm rotation

1. Keep the elbow at your side and bent to approximately 90 degrees.
2. Start with the thumb pointing upwards.
3. Slowly turn the palm towards the ceiling.
4. Then turn the palm towards the floor.
5. Repeat 10 times in each direction.

Keep the upper arm close to the body so that the movement comes from the forearm rather than the shoulder.

3. Wrist-extensor stretch

1. Hold the affected arm in front of you with the elbow straight and palm facing down.
2. Allow the wrist to bend so the fingers point towards the floor.
3. Use the other hand to gently guide the wrist further down.
4. Stop when you feel a mild stretch along the top of the forearm.
5. Hold for 15 to 30 seconds.
6. Repeat three times.

Do not pull hard or continue if the stretch produces sharp elbow pain, tingling or numbness. Stretching may feel pleasant, but it is not essential to force flexibility into an already irritable tendon.

4. Isometric wrist extension

An isometric exercise loads the muscle without allowing the wrist to move.

1. Rest the affected forearm on a table with the palm facing down.
2. Keep the wrist in a neutral position.
3. Place the other hand over the back of the affected hand.
4. Try to lift the affected hand while the other hand prevents movement.
5. Use gentle-to-moderate effort.
6. Hold for 10 to 30 seconds.
7. Rest, then repeat three to five times.

This can be a useful starting point when lifting a weight through movement is too uncomfortable.

5. Slow wrist-extension strengthening

1. Sit with the forearm supported on a table and palm facing down.
2. Let the hand hang just beyond the edge.
3. Hold a very light weight, such as a small bottle or tin.
4. Slowly lift the back of the hand towards you.
5. Pause briefly.
6. Lower the hand slowly over approximately three to four seconds.
7. Begin with one or two sets of 8 to 12 repetitions.

Start without a weight if necessary. When you can complete the exercise comfortably and the elbow is not worse the next day, increase repetitions or weight in small steps.

6. Eccentric wrist extension

This version emphasises the slow lowering phase.

1. Use the unaffected hand to help lift the affected wrist upwards.
2. Remove the assisting hand.
3. Slowly lower the weight using only the affected side.
4. Take approximately three to five seconds to lower it.
5. Repeat 8 to 12 times.

Eccentric exercise is one option rather than a uniquely curative technique. A programme that progresses to controlled lifting and lowering is usually more practical than concentrating indefinitely on only one phase of movement.

7. Grip strengthening

1. Hold a soft ball, rolled towel or sponge.
2. Squeeze gently without bending the wrist.
3. Hold for approximately five seconds.
4. Relax fully.
5. Repeat 8 to 10 times.

Grip work may be introduced after basic wrist exercises are tolerable. Avoid maximal squeezing during a painful flare.

8. Forearm rotation with resistance

1. Hold a light hammer or similar object upright near the end of its handle.
2. Support the forearm and bend the elbow to 90 degrees.
3. Slowly rotate the forearm so the object moves towards the palm-down position.
4. Return to the middle and then towards palm-up.
5. Perform 8 to 12 controlled repetitions.

Holding the object farther from its head creates greater resistance. Begin close to the head and only increase the lever when the movement is comfortable.

How often should the exercises be performed?

Gentle movement can usually be performed daily. Strength exercises may begin every other day, particularly when the tendon is easily aggravated.

A simple starting programme might include:

• comfortable elbow and forearm movement each day;
• one wrist stretch once or twice daily if it feels helpful;
• isometric wrist extension once daily during a painful stage;
• slow strengthening two or three times a week;
• at least one recovery day between harder sessions.

There is no need to complete every exercise at once. Two well-chosen exercises performed consistently are often more useful than a long routine abandoned after several days.

How should work and everyday activities be modified?

Activity modification means finding a tolerable way to continue important tasks, not permanently avoiding the use of the arm.

Helpful adjustments may include:

• lifting with both hands;
• keeping objects close to the body;
• lifting with the palm facing upwards where practical;
• using lighter tools with wider handles;
• reducing grip force;
• using a trolley instead of carrying heavy loads;
• alternating tasks rather than repeating one movement for hours;
• taking short, regular breaks;
• using power tools instead of manual alternatives where safe;
• adjusting mouse position and keyboard height;
• avoiding holding a phone or tablet in one position for long periods.

Check whether you are gripping tools much harder than necessary. People frequently continue using excessive force even after a task has become familiar.

If symptoms are work-related, an occupational-health adviser, physiotherapist or occupational therapist may suggest temporary changes. Complete absence from work is not always necessary, but heavy repetitive duties may need to be reduced while capacity is rebuilt.

Can you continue playing tennis?

You may be able to continue at a reduced level if symptoms remain mild and settle afterwards. During a significant flare, temporarily reduce serving, forceful backhands and long sessions.

Consider reviewing:

• backhand technique;
• racquet weight;
• grip size;
• string tension;
• training frequency;
• the condition of tennis balls;
• warm-up and strength preparation.

A coach can help identify technique issues, while a physiotherapist can assess strength and guide a graded return. Return to full play progressively rather than testing recovery with one long competitive session.

Do braces, painkillers or physiotherapy help?

Elbow straps and wrist supports

A forearm strap, sometimes called an epicondylitis clasp, may reduce pain during gripping for some people. It is normally positioned around the upper forearm rather than directly over the painful bony point.

A wrist splint may help when repetitive wrist movement cannot easily be avoided. Neither device repairs the tendon by itself, and continuous use can become a substitute for rebuilding strength.

Ask a physiotherapist or pharmacist how to position a support. Stop using it if it causes numbness, tingling, colour change or increasing pain.

Paracetamol and anti-inflammatory medicines

Paracetamol or a topical anti-inflammatory gel may provide short-term relief for some people. Oral anti-inflammatory medicines such as ibuprofen are not suitable for everyone.

Speak to a pharmacist or clinician before using an NSAID if you have:

• a history of stomach ulcer or gastrointestinal bleeding;
• kidney, heart or liver disease;
• asthma affected by aspirin or NSAIDs;
• a bleeding disorder;
• treatment with anticoagulants;
• pregnancy or the possibility of pregnancy;
• other medicines that may interact.

Medication can make movement more comfortable but does not restore tendon capacity. Avoid using pain relief simply to push through a sudden large increase in workload.

Physiotherapy

Physiotherapy may help when symptoms have not improved after approximately six weeks of sensible self-management, when the diagnosis is uncertain or when work and sport require a more specific programme.

A physiotherapist may assess:

• the neck, shoulder, elbow and wrist;
• grip and forearm strength;
• the movements that provoke symptoms;
• workstation or tool use;
• sport technique and training load;
• how quickly resistance should be progressed.

Exercise and activity management are central parts of rehabilitation. Massage, taping or manual therapy may provide temporary relief, but they should not normally be the only treatment.

Our guide to private physiotherapy costs in the UK explains typical appointment prices and what to ask before booking. In some areas, you can self-refer to an NHS musculoskeletal physiotherapy service without seeing a GP first.

Do injections, shockwave therapy or surgery work?

Corticosteroid injections

A steroid injection can reduce pain in the short term, but this does not necessarily produce better recovery. NICE Clinical Knowledge Summaries advises against offering corticosteroid injection for tennis elbow because short-term relief is associated with worse outcomes at around six months.

Repeated steroid injections can also weaken tendon tissue and cause skin thinning or colour change. A quick reduction in pain may encourage someone to overload a tendon before its capacity has recovered.

PRP and autologous blood injections

Platelet-rich plasma, or PRP, is prepared from the patient’s blood and injected around the tendon. Autologous blood injection uses a smaller preparation process.

Evidence is inconsistent, treatment protocols vary and improvement cannot be guaranteed. These injections are usually paid for privately and may cost several hundred pounds per treatment.

Ask how an injection is expected to improve outcomes beyond a well-designed rehabilitation programme, what the complete price includes and what will happen if it does not help. Our guide to regenerative treatments for orthopaedic conditions discusses the limitations of PRP and similar procedures.

Shockwave therapy

Extracorporeal shockwave therapy delivers repeated energy pulses to the affected area. It may be offered for persistent tennis elbow after simpler treatments have not helped.

Results vary, and the procedure can be uncomfortable. NICE guidance on shockwave therapy for refractory tennis elbow notes uncertainty around its effectiveness. It should be discussed as one possible option rather than presented as a guaranteed cure.

Surgery

Surgery is rarely required. It may be considered when symptoms remain significantly limiting after six to twelve months or longer despite an appropriate diagnosis, activity modification and progressive rehabilitation.

Procedures generally aim to remove or release abnormal tendon tissue. Risks include infection, nerve injury, stiffness, persistent pain, weakness and a prolonged rehabilitation period. Surgery does not guarantee complete recovery, so another cause of pain should be excluded first.

How long does tennis elbow take to recover?

Recovery varies according to how long symptoms have been present, the amount of unavoidable loading, general health and how steadily rehabilitation is progressed.

A broad timeline may look like this:

Stage	Possible progress
First one to two weeks	Reduce aggravating load, maintain movement and begin gentle isometric exercise
Two to six weeks	Gradually introduce slow strengthening and improve everyday tolerance
Six to twelve weeks	Many people notice meaningful improvement, although gripping may still provoke symptoms
Three to six months	Strength and work or sporting capacity may continue to improve
Six to twelve months	Longstanding cases may require this long to settle substantially

Some mild cases settle within weeks, while others last longer than a year. Slow recovery does not necessarily mean that the tendon is permanently damaged.

Recovery is rarely completely linear. A busy day, heavy lift or rapid training increase can cause a temporary flare. Respond by reducing load for several days rather than abandoning rehabilitation altogether.

When can you return to full work or sport?

Before returning to unrestricted activity, you should ideally be able to:

• move the elbow and wrist normally;
• grip everyday objects with little or no pain;
• complete strengthening exercises without a lasting flare;
• tolerate movements similar to your work or sport;
• recover normally by the following day;
• increase duration and intensity in stages.

Do not use pain alone as the only measure. The arm also needs sufficient strength and endurance for the task you are returning to.

When should you see a GP or physiotherapist?

Arrange a routine assessment if:

• you are unsure whether the pain is tennis elbow;
• symptoms are worsening rather than settling;
• pain regularly wakes you or occurs without using the arm;
• there is significant weakness;
• you cannot perform normal work or self-care;
• home management has not helped after approximately six weeks;
• symptoms repeatedly return;
• you have neck pain, numbness or tingling;
• both elbows or several joints are affected;
• you have already had injections or surgery without improvement.

Seek more urgent help if:

• the elbow became painful after a fall or forceful injury;
• you heard a snap and developed sudden weakness or bruising;
• the elbow looks deformed;
• you cannot move the joint;
• the elbow is hot, red and markedly swollen;
• you have fever or feel generally unwell;
• the hand becomes cold, pale, blue or very swollen;
• you develop sudden or progressive numbness or loss of power.

These features may indicate a fracture, tendon rupture, infection, nerve problem or another condition requiring different treatment.

Frequently asked questions

Is tennis elbow a form of arthritis?

No. Tennis elbow is a tendon problem affecting the attachment of the wrist-extensor muscles. Arthritis primarily affects the joint itself, although both conditions can occur at the same time. See our guide to osteoarthritis and rheumatoid arthritis.

Can you get tennis elbow without playing tennis?

Yes. Most cases are associated with work, hobbies, computer use, gardening, DIY or another repetitive gripping activity rather than tennis.

Should you rest tennis elbow completely?

Usually not. Temporarily reduce painful loading, but continue comfortable movement and gradually rebuild strength. Prolonged complete rest can leave the arm less prepared for normal activity.

Should tennis-elbow exercises hurt?

Mild, controlled discomfort may be acceptable if it settles soon and the elbow is not worse the next day. Sharp, severe or escalating pain means the exercise or load should be reduced.

What is the best exercise for tennis elbow?

There is no single best exercise. Isometric wrist extension can be a comfortable starting point, followed by progressively loaded wrist-extension and grip exercises.

How heavy should the exercise weight be?

Begin with no weight or a very light object. Choose resistance that allows slow, controlled repetitions without a significant flare later that day or the following morning.

How often should you exercise tennis elbow?

Gentle movement can usually be performed daily. Strengthening may start two or three times a week with recovery days between sessions. The programme should be adjusted according to symptoms.

Can a massage cure tennis elbow?

Massage may temporarily reduce discomfort or muscle tension, but it does not reliably restore tendon capacity by itself. Progressive exercise and sensible load management remain important.

Does an elbow strap help?

A correctly positioned forearm strap may reduce pain during gripping for some people. It is an optional aid rather than a cure and should not replace rehabilitation.

Is heat or ice better for tennis elbow?

Either may provide short-term comfort. Cold can help after an aggravating activity, while warmth may feel better for stiffness. Use whichever is more helpful and protect the skin.

Can tennis elbow cause hand weakness?

Pain can inhibit grip and make the hand feel weak. Marked weakness, dropping objects, numbness or tingling may indicate nerve involvement and should be assessed.

Does tennis elbow show on an X-ray?

Usually not. X-rays show bone and may help identify arthritis, fracture or another cause. Tennis elbow is normally diagnosed without imaging.

Does tennis elbow need an MRI?

Most cases do not. MRI or ultrasound may be considered when the diagnosis is uncertain, symptoms persist or surgery is being discussed.

Can tennis elbow heal on its own?

Yes. Most cases eventually improve without surgery, but modifying aggravating activity and progressively strengthening the arm may make recovery easier and reduce recurrence.

Why does tennis elbow keep returning?

Recurrence may follow a sudden return to heavy work or sport, insufficient strength, repetitive technique problems or failure to change an aggravating setup. Sometimes the original diagnosis needs to be reconsidered.

Can you have tennis elbow in both arms?

Yes, particularly when work or hobbies load both arms. Symptoms in multiple joints, morning stiffness or swelling may justify assessment for a wider inflammatory condition.

When is surgery considered?

Surgery is usually reserved for persistent, disabling symptoms lasting at least six to twelve months despite appropriate non-surgical treatment. Only a small minority of people require it.