What is Tennis Elbow or Lateral Epicondylalgia?

By Steven TranSydney CBD Chiropractor

Location of tennis elbow pain anatomy of the forearm
Source: Bruce Blaus

Annoying burning elbow pain impacting your daily routine? You may have tennis elbow. What is tennis elbow? What are the symptoms? What are some causes of tennis elbow? How to diagnose tennis elbow? What can you do right now for tennis elbow? In this blog we will answer all your burning questions about tennis elbow or lateral epicondylalgia.

What is tennis elbow?

Tennis elbow is also known as lateral epicondylalgia or lateral epicondylitis. It is a classic repetitive strain injury, that is a combination of chronic exhaustion and irritation in the muscles and tendons on the back of the arm and the outside of the elbow.

This tendon can become painful with activities such as gripping, pruning and tennis. Many people find that their symptoms continue for months to years if not assessed and treated early.

What are the symptoms of tennis elbow?

The symptoms of tennis elbow typically develop gradually, without specific injury or trauma associated with the symptoms. The pain can start as a mild discomfort and slowly worsens over time.

Common signs and symptoms of tennis elbow include:

  • Pain with gripping or lifting an object
  • Twisting a door knob or shaking hands
  • Pain or burning on the outer region of your elbow
  • Weak grip strength

If you think you may have a tennis elbow type injury it is important to be professionally assessed. Your chiropractor, osteopath or physiotherapist will be able to provide adequate assessment and guide you in the treatment and management of your elbow condition.

What are the causes of tennis elbow?

Tennis elbow is commonly caused by excessive or repetitive activity that loads the extensor tendons of the wrist. Examples of these activities are gripping, racquet sports (tennis, squash or badminton) or jobs or hobbies that require repetitive arm movements (carpentry, typing or painting). The constant and repetitive strain on the tendons can eventually cause microscopic tears in the tissue. This can lead to an inflammatory response causing gradual pain in the tendon area, often days after the increase in loading. If left untreated, the tendon will often not heal and the pain and dysfunction can become more debilitating.

Who are at risk of Tennis elbow?

A study by Van Rijn et al., 2010, identified 3 major risk factors:

  1. Handling tools heavier than 1kg
  2. Handling loads heavier than 20kg at least 10 times per day
  3. Repetitive movements for more than 2 hours per day.

Other contributing factors are misalignments, reduced flexibility, muscle imbalances, strength deficits, overuse, training faults and psychological factors.

Diagnosis of tennis elbow

A health professional such as a chiropractor, osteopath or physiotherapist may perform a number of specific assessment tests to help diagnose tennis elbow. Some of these tests are explained below:

Cozen test

  • Resisted wrist extension (patient will attempt to extend the wrist against practitioner’s resistance)
  • The test is positive if symptoms are reproduced
Sydney CBD chiro cozen test for tennis elbow pain

Middle finger test

  • Resisted extension of just the middle finger (the patient will attempt to extend the middle finger against practitioner’s resistance)
    • The test is positive if symptoms are reproduced
Sydney CBD chiro middle finger extension test for tennis elbow pain

Mills test

  • Performed to check for nerve involvement
    • The test may indicate other injuries, such as radial nerve entrapment, and cervical radiculopathy.
Sydney CBF chiro mills test for tennis elbow pain

If the results of testing are unclear, further imaging such as an ultrasound or MRI would be recommended to identify any tendon tears or inflammation.

How is Tennis Elbow treated?

Your Chiropractor, Osteopath or Physiotherapist, will be able to diagnose your elbow pain and will provide a treatment plan for your condition. This may involve hands on techniques: Massage, Dry Needling, Instrument Assisted Soft Tissue Manipulation, taping, stretching and joint manipulation and may include the following advice and education:

Ice and heat:

Ice and heat can help temporarily reduced pain, however loading the tendon will provide optimal and lasting results. If you require help with pain, it is recommended to use ice or heat for 10 to 15 minutes at a time, several times a day. Always put a thin cloth between the ice and your skin. Keep using ice as long as it relieves pain.


Guided and graded loading (strength work) of the tendon has been proven to give the greatest results. Exercises selection is important in the early phase of treatment as not everyone pain levels or capacity is the same. Your clinician will assess where your baseline is and progress you from there. Research has suggested that working through a pain level below 4/10 on a pain scale is ok. As you progress with the exercise program the pain should drop. To get your tendon to optimal health and strength, the rehab can take 8-16 weeks.

Here are two great exercises for Tennis Elbow:

Corticosteriod injections for tennis elbow:

Corticosteriod injection alone in tendon injuries is not a complete solution. However, in extreme cases of tennis elbow; where patients cannot progress with load management and symptoms are excruciating, cortisone is considered as a pain relief strategy. This will allow patient to continue with their prescribed rehab to allow the tendon to appropriately heal.

How long until my tennis elbow feels better?

If you do nothing differently, tennis elbow can take as long as 12 months in 80 per cent of cases to resolve. Targeted chiropractic/osteopathic/physiotherapy management of tennis elbow typically begins to give people immediate short-term relief. People usually find improved functions within 2-3 weeks, and in many cases are completely rid of symptoms within 12-16 weeks

Physio, osteo and chiro assessment of the elbow for tennis elbow pain


 Van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford). May 2009;48(5):528-36. A1http://rheumatology.oxfordjournals.org/content/48/5/528.full.pdf (accessed 17 Nov 2010)

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