Tennis Elbow Isn’t Just for Tennis Players: Understanding Lateral Elbow Pain and How Physical Therapy Can Help

If you’ve ever felt pain on the outside of your elbow when lifting a coffee mug, carrying groceries, shaking someone’s hand, opening a jar, or working on your computer, you may have experienced tennis elbow.

Despite its name, up to 90–95% of people diagnosed with tennis elbow have never played tennis. It’s one of the most common tendon injuries seen in adults and affects everyone from office workers and parents to mechanics, gardeners, weightlifters, golfers, and pickleball enthusiasts.

The good news? Most people recover without surgery when they follow an evidence-based rehabilitation program focused on progressive exercise, education, and activity modification.

At Rooted Motion Physical Therapy, we believe understanding why you’re hurting is the first step toward lasting recovery. Let’s explore what tennis elbow really is, why it develops, and how physical therapy can help you get back to doing what you love.

What Is Tennis Elbow?

Tennis elbow, also called lateral elbow tendinopathy or lateral epicondylalgia, is a condition affecting the tendon that connects your forearm muscles to the outside of your elbow.

These muscles help you:

• Grip objects

• Lift with your hand

• Extend your wrist

• Twist doorknobs

• Open jars

• Carry grocery bags

• Use tools

• Swing a racquet or golf club

• Type on a keyboard

• Control a computer mouse

Every time you grip something, these muscles and tendons are working. When they are repeatedly asked to do more work than they can tolerate, the tendon can become irritated and painful.

Why Does It Hurt?

One of the biggest misconceptions is that tennis elbow is an inflammatory condition. For many years, it was believed that the tendon became inflamed. Modern research tells us something different: most persistent cases involve changes in the tendon’s structure rather than ongoing inflammation.

Imagine a Rope

Think of your tendon like a climbing rope made from thousands of tiny fibers. A healthy rope has fibers neatly lined up, making it strong and efficient. Now imagine repeatedly pulling on that rope every day without giving it enough time to recover.

• The fibers become disorganized.

• The rope does not transmit force as efficiently.

• The tendon becomes more sensitive to loading.

The key idea The rope is not broken—but it needs the right amount of loading to remodel and become stronger again. This is why complete rest usually is not the answer.

Why the Name “Tennis Elbow” Is Misleading

Although the condition was first described in tennis players, today’s common contributors include:

• Computer and mouse use

• Construction, plumbing, electrical work, and woodworking

• Gardening and painting

• Weightlifting, CrossFit, and rock climbing

• Pickleball, golf, and racquet sports

• Parenting young children

In reality, repetitive or forceful gripping is often the biggest contributor—not tennis itself.

Common Symptoms

• Pain on the outside of the elbow

• Tenderness near the outer bony area

• Pain while opening jars or lifting a mug

• Difficulty carrying groceries or shaking hands

• Weak grip strength

• Discomfort using tools

• Pain after prolonged typing or mouse use

• Symptoms that gradually worsen over weeks or months

Many people notice that symptoms are worse the day after heavy activity rather than during the activity itself.

Why Rest Alone Usually Does Not Work

One of the most common things we hear is, “I’ve been resting it for months, but it still hurts.”

Unlike a muscle strain, tendons require appropriate loading to regain capacity. The key is not no load—it is the right load.

What Does the Research Recommend?

The 2022 JOSPT Clinical Practice Guideline for lateral elbow pain emphasizes:

• Patient education

• Progressive strengthening

• Activity modification

• Manual therapy when appropriate

• Improving upper-extremity strength and function

• A gradual return to work, recreation, and sport

Current evidence generally does not support relying only on passive treatments such as ultrasound or electrical stimulation. Active participation in rehabilitation is the cornerstone of recovery.

Exercise Is Medicine for Tendons

One of the strongest treatments for tennis elbow is a carefully progressed strengthening program. Rehabilitation usually advances through stages rather than beginning with heavy loading. Where you start, and how quickly you move, should follow how your elbow responds — the stages below are a common route, not a fixed protocol.

Phase 1: Reduce Pain

• Gentle stretching

• Isometric wrist-extension exercises

• Temporary activity modification

These strategies can calm symptoms while preserving tendon capacity.

Phase 2: Build Tendon Capacity

• Eccentric and progressive wrist-extension strengthening

• Grip strengthening

• Forearm rotation exercises

• Shoulder strengthening

• Scapular stabilization

These strategies can calm symptoms while preserving tendon capacity.

Phase 3: Return to Activity

• Lifting and carrying

• Work-specific tasks

• Sport-specific drills

• Power development

• Endurance training

The goal is not simply to reduce pain. It is to restore strength, confidence, and the capacity needed to prevent recurrence.

Why There Is No Single Right Programme

Recovery from tennis elbow varies more than almost any other tendon problem. Some people settle quickly with little more than clear advice and a change to whichever task is provoking it. Others have symptoms that persist regardless of what they try. Research on managing this condition has moved toward matching the starting point to the person rather than putting everyone through the same progression.

Broadly, the milder the problem and the fewer complicating factors, the less is needed — sometimes advice and load reduction are genuinely enough. Where symptoms are more severe, or where neck or shoulder pain is present alongside the elbow, the evidence generally points toward starting more gently and progressing more slowly, not toward working harder. One recent trial of heavy resistance training for tennis elbow found fewer than a third of participants could tolerate it, mostly because it aggravated their pain.

If the stages above are not helping after six to twelve weeks, that is information rather than failure. It usually means the plan needs changing rather than repeating.

Is Some Pain During Exercise Okay?

Mild discomfort during rehabilitation is often acceptable when it is carefully monitored.

• Mild pain—approximately 3–4 out of 10—may be acceptable during exercise.

• Symptoms should return to their usual baseline within about 24 hours.

• If pain becomes significantly worse or lasts beyond the next day, the intensity may need to be adjusted.

A physical therapist can help match the exercise dosage to your individual irritability, strength, and goals.

Everyday Tips That Can Help

• Carry heavy objects with two hands.

• Avoid gripping harder than necessary.

• Take breaks during repetitive tasks.

• Alternate hands when possible.

• Increase activity gradually rather than all at once.

• Warm up before sports or heavy work.

• Strengthen the shoulder and upper back—not just the forearm.

Do Braces, Injections, or Surgery Work?

Braces

A counterforce strap or sleeve worn around the forearm may make a gripping task more comfortable straight away, and one study found this improved pain-free grip compared with a dummy brace. Another, more tightly blinded study found that grip improved just as much in its control condition, suggesting the brace itself may not be doing the work. Both looked only at immediate effects, so neither tells us whether wearing one changes anything over weeks.

What the evidence agrees on is narrower and more useful: if you are going to wear something, an elbow strap or sleeve is a better choice than a wrist splint, which in one study did not improve pain-free grip at all and reduced maximum grip. Treat any of them as something that helps you keep using the arm, not as a substitute for the strengthening.

Corticosteroid Injections

Steroid injections may provide short-term pain relief, but they may not improve long-term outcomes and can be associated with recurrence. The risks and benefits should be discussed with a qualified medical provider.

Platelet-Rich Plasma (PRP)

Evidence for PRP remains mixed. Some individuals may benefit, but results have been inconsistent across studies.

Surgery

Surgery is typically reserved for the relatively small number of people who continue to have significant symptoms after an extended period of well-managed conservative care.

Why Choose Physical Therapy Early?

Early treatment may help prevent months of persistent pain. A physical therapist can identify factors contributing to your symptoms, including:

• Grip weakness

• Shoulder or upper-back weakness

• Movement and lifting mechanics

• Training errors

• Work-related demands

• Sport-specific technique

• Load-management problems

Instead of treating only the painful elbow, physical therapy addresses the reasons the tendon became overloaded.

The Rooted Motion Difference

At Rooted Motion Physical Therapy, we take a personalized, one-on-one approach to care. Our goal is not simply to reduce pain—it is to help you move with confidence again.

When you work with us, you can expect:

• A comprehensive movement assessment

• Individualized rehabilitation based on current evidence

• Hands-on treatment when appropriate

• Progressive strengthening tailored to your goals

• Education that helps you understand your condition

• Guidance for returning safely to work, recreation, and sport

• Convenient concierge mobile physical therapy delivered where you are

Because recovery is not just about healing an elbow—it is about helping you get back to living your life.

Ready to Get Back to the Activities You Love?

Whether your elbow pain started on the pickleball court, in the gym, at work, or while carrying groceries, you do not have to navigate recovery alone.

Evidence-based physical therapy can help reduce pain, restore strength, and improve confidence so you can return to the activities that matter most.

Move Better. Live Rooted. Contact Rooted Motion Physical Therapy to schedule your one-on-one evaluation and begin a personalized recovery plan.

References

1. Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral Elbow Pain and Muscle Function Impairments: Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. 2022;52(12):CPG1-CPG111.

2. Coombes BK, Bisset L, Vicenzino B. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. Journal of Orthopaedic & Sports Physical Therapy. 2015;45(11):938-949.

3. Cullinane FL, Boocock MG, Trevelyan FC. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clinical Rehabilitation. 2014;28(1):3-19.

4. Soliman EFF, Nagra D, Goh SL, et al. Isometric Exercises for Tendinopathies: A Systematic Literature Review. Clinical Therapeutics. 2026. doi:10.1016/j.clinthera.2026.04.027

5. Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine. 2015;49(19):1277-1283.

6. Bisset LM, Collins NJ, Offord SS. Immediate Effects of 2 Types of Braces on Pain and Grip Strength in People With Lateral Epicondylalgia: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(2):120-128.

7. Jafarian FS, Demneh ES, Tyson SF. The Immediate Effect of Orthotic Management on Grip Strength of Patients With Lateral Epicondylosis. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(6):484-489.

Educational disclaimer: This article is for educational purposes and is not a substitute for an individual evaluation by a licensed healthcare professional. Seek prompt medical evaluation for severe pain, significant weakness, numbness, or symptoms following trauma.