How come everyone has Tennis Elbow?

How come everyone has Tennis Elbow (Lateral Epicondylopathy)?

As stated in our previous article, people in the medical field tend to have a preference for certain diagnoses when it comes to certain locations of the body. This is true for the elbow with the majority of patients being told that they suffer from tennis elbow. This condition shares broad similarities to other conditions that effect the elbow so it is wise that you seek a physiotherapist for a thorough examination and management plan.

So what is Tennis Elbow?

Occurs in 1-3% of the general population(1), usually beginning as inflammation at the insertion of the extensor tendons of the forearm. Associated with overuse or prolonged gripping activities such as hammering, weightlifting, driving and racquet sports (You guessed it, Tennis!). Without the right healing and recovery, this can lead to a chronic tendon problem characterised by weakness and degeneration as well as chronic pain.

Signs and Symptoms?

Localised pain over the outside of the elbow which worsens with gripping and resisted wrist extension. Most patients also complain of a weak grip strength.

So if it’s a muscle issue, why is it taking so long to heal?

In chronic cases, inflammation will no longer be present but changes may occur with your central neural mechanisms as well as tendinosis-like tissues changes may be present(2). To avoid long term pain and disability, it is wise to seek treatment early.

So can physiotherapy fix my elbow?

First of all, your physio will perform tests with you to help reach a correct diagnosis. The treatment is broad as your physio will need to help manage the inflammation in the acute stage as well as looking long term to try and work out what triggered this and how to change this so to prevent re-injury or continued aggravation. Many treatments exist ranging from soft tissue work, dry needling, mobilisations, electrotherapies as well as strengthening and stretching regimes to help relieve pain and help your elbow return to previous functional levels.

So if it’s not Tennis Elbow, then what is it?

Golfer’s Elbow (Medial Epicondylopathy)

This condition shares many similar symptoms with Tennis Elbow but the inflammation originates on your common flexor tendon at the inside of your elbow and can travel down your forearm. Normally occurring in 30 to 50 year olds, both men and women have an equal chance of getting this. This too is related to work related activities and treatment is similar to Tennis Elbow, with a holistic management plan required.

Cervical Radiculopathy

Often the pain may be coming from a different source rather than the site of the pain. This can occur in the neck with the pain travelling down to the elbow. A nerve root on leaving the cervical spine may get irritated or compressed causing pain to radiate down to the elbow. Your physiotherapist will be able to assess and treat the root of the problems at the neck rather than just the symptoms at the elbow.

Trigger points

The common extensor origin is focal point of a lot of trigger point pain referrals which can cause a wrong diagnosis. Three muscles; Brachialis, Extensor Digitorum and Triceps, all refer over the elbow causing significant pain. Your physiotherapist can perform soft tissue techniques to decrease the amount of referred pain and free up the elbow.


1. Shiri, R., Viikari‐Juntura, E., Varonen, H. et al (2006) ‘Prevalence and determinants of lateral and medial epicondylitis: a population study’, American Journal of Epidemiology, 1641065–1074.1074

2. Kraushaar, B. S. and Nirschl, R. P. (1999) ‘Tendinosis of the elbow (tennis elbow) Clinical features and findings of histological, immunohistochemical, and electron microscopy studies’, Journal of Bone and Joint Surgery America, 81259–278.27

Matt Winter