Tennis Elbow

Same problem, opposite sides of the same joint. The quickest way to tell them apart is where it hurts. Tennis elbow is the tendon on the outside, the muscles that pull your wrist backwards ². It bites when you grip, lift with your palm down, or turn a doorhandle.

Golfer's elbow is the tendon on the inside instead ², same mechanism and timeline, different muscle group, so different exercises. You can have both at once, and plenty of people do.

Tennis elbow is diagnosed from your story and an examination. No scan to start with. Your doctor will ask about your symptoms, examine your arm and may measure your grip strength ¹. A physio can do a thorough examination too, and use it to build a rehab program around you ².

Scans come later, if at all. An X-ray, an ultrasound or sometimes an MRI may be needed ¹, and NSW Health guidance is specific about the timing: your doctor may consider further investigation if the pain hasn't gone after six weeks of treatment ².

The first job is confirming it's the tendon and working out which movements are feeding it. Australian guidance splits the plan into the first six weeks and everything after ².

First six weeks: settle the load, don't stop moving. Avoid what provokes pain: if you feel pain, you're probably irritating the tendon, and that risks ongoing problems ². But that's relative rest, not a sling: stay active and don't immobilise the limb ⁶. Gentle daily stretching within pain-free limits starts here ²: arm straight out, fingers pointing down, other hand pressing the back of that hand. Hold 30 seconds, repeat three times, once a day ^1,2.

Then load it, with actual numbers. Once the wrist moves with little or no pain, strengthening starts ². The resisted wrist extensor exercise is the backbone: forearm supported, moving the wrist into extension against a band or small weight, on this progression ⁶:

The exercise shouldn't provoke pain beyond about 2 out of 10, and if moving the wrist hurts you start with a static (isometric) hold instead ^2,6. The first six to eight weeks are worth supervising ⁶.

Hands-on work, alongside the exercise. The Australian program combines exercise with specific elbow glide techniques, graded at the highest level of evidence ⁶. That's the role Manual Therapy plays. It doesn't replace loading the tendon. It makes the loading more tolerable.

What physiotherapy realistically adds. Professional-body guidance says a program involving exercise beats wait-and-see, short and long term ⁶. A large Australian trial was more qualified: at four weeks, physiotherapy patients were far more likely to be recovered or much improved (39% vs 10%), but by one year the groups had converged (91% vs 88%) ³. It speeds the early phase and avoids the injection's recurrence penalty. It isn't the difference between recovering and not.

Tennis elbow treatment runs along The Well Motion Recovery Path™. You step up a phase when your arm handles the work of the one before, whatever the calendar says.

• Reset: the opening weeks. Load changes, the daily stretch and a fitted brace ², with static holds if moving the wrist is too sore ^2,6. Expect to keep using the arm, just differently ⁶. We move you on once the wrist moves with little or no pain ².
• Rebuild: the longest phase. The resisted wrist extensor program, with Manual Therapy alongside it and strength work for the rest of the arm ⁶. Expect slow gains and the odd flare after a heavy day. We move you on when the arm does what your daily tasks ask of it without the pain building.
• Return: back to the tools, the keyboard, the racquet or carrying a child. We test those tasks at the loads you really use. You leave with a home program and changes to how you grip and lift ^1,2.

How long it usually takes. Australian guidance puts recovery at six to twelve months ^1,6. In one Australian trial, 88 to 96% of people had recovered or much improved at one year ³. None of these sources gives a separate timeframe for getting back to sport or heavy work, so we judge that on what your arm can do.

Relapse is the one part of this that has been trialled. The rest follows the known risk factors:

• Think hard before a steroid injection. In a Brisbane trial, 54% of people given a steroid injection recovered early and then relapsed within the year, against 12% given a placebo injection ³. An earlier trial saw the same pattern: 47 of the 65 people who did well after an injection later went backwards ⁹. That's a conversation to have with your doctor.
• Break up heavy, repetitive arm work. French workers whose jobs combined hard physical effort with more than two hours a day of elbow bending or extreme wrist bending developed tennis elbow at about three times the rate of other workers ⁷. Take regular breaks on repetitive jobs ¹.
• Change your grip on the court or the course. Use a two-handed backhand in tennis, and put grip tape or padding on your golf clubs ².
• Stop smoking. Pooled studies put the odds of tennis elbow about 1.5 times higher in people who smoke or used to ⁸. Whether quitting lowers the risk hasn't been tested.