Tennis elbow is a very common source of pain on the outer side of the elbow. Despite its name, many people who develop it have never held a tennis racket. Office workers, manual labourers, hobby gardeners, home bakers and new parents all can end up with the same pattern: pain when lifting, gripping, pouring, or twisting with the hand palm-down.
This article explains tennis elbow in everyday language—what it is, why it happens, how it affects daily activities, and what a realistic path of management often looks like. It focuses on understanding and practical support, rather than promising quick cures.
What is tennis elbow?
Tennis elbow is the everyday name for lateral epicondylalgia (previously called lateral epicondylitis). It describes pain around the bony bump on the outer side of the elbow, where the forearm extensor tendons attach. These tendons help you extend your wrist and straighten your fingers, especially when you grip or lift with the palm facing down.
Over time, repeated load or a sudden increase in activity can irritate this tendon area. Instead of a pure “inflammation”, research suggests the tissue often shows features of tendinopathy—changes in the tendon structure and its ability to handle load. The result is pain and reduced tolerance when you try to grip, lift or twist.
People usually notice pain:
- When lifting a kettle, pot, or shopping bag
- When pouring drinks or turning a door handle
- When gripping tools, a mouse, or sports equipment
- When extending the wrist or fingers against resistance
The pain is often sharp with certain movements and dull or aching at rest after heavy use.
How tennis elbow starts and develops
Sometimes tennis elbow follows a clear event: painting a house over one weekend, trimming the garden for several hours, or starting a new sport or gym routine involving repeated gripping. Other times it comes on gradually, without a single injury, during a period of more work at the computer, more manual tasks, or a change in equipment.
In the early stage, symptoms may be mild: a bit of soreness after activity that settles overnight. As the tendon becomes more irritated, pain may appear earlier in a task and linger longer afterwards. People start to notice that once-simple activities—like lifting a pan with one hand, wringing a cloth or shaking hands firmly—bring on a familiar sting at the outer elbow.
If this pattern continues for weeks or months without adjustment, the tendon can become low-tolerance and reactive. Even light tasks may feel painful, leading to frustration and worry. Some people then stop using the arm as much as possible, while others push through pain, hoping it will eventually disappear on its own. Both extremes can quietly prolong the problem.
Everyday impact: more than “just” an elbow
Although tennis elbow affects a small area, its impact on daily life can be surprisingly large. Painful gripping and lifting can change:
- How you carry groceries, lift cookware, or open jars
- How you type, use a mouse or hold a phone
- How you perform work tasks that require tools or repetitive hand use
- How you participate in hobbies such as racquet sports, golf, gardening, crafts or playing musical instruments
Some people start compensating by overusing the other arm, which can lead to fatigue or symptoms on that side as well. Others become hesitant to use the affected arm at all, worried that any movement will “damage the tendon further”. Sleep may be disturbed if rolling onto the painful side or resting the arm in certain positions triggers discomfort.
Emotionally, long-lasting elbow pain can lead to irritability, loss of confidence in the arm, and concern about work, sport or long-term function. Knowing that the condition is common and usually manageable—with time and a structured approach—can be an important first step in reducing fear.
Diagnosis: making sure it really is tennis elbow
Tingling, numbness, widespread arm pain or pain centred more on the neck, shoulder or inner elbow may point to other conditions. That’s why a proper assessment by a health professional is important.
A clinician will usually:
- Ask about where the pain is, how it started and what activities trigger it
- Press around the outer part of the elbow to locate tender spots
- Ask you to extend your wrist or middle finger against resistance, or grip an object, to see if this reproduces pain
- Check neck, shoulder, elbow and wrist movement and sensation to rule out other causes
Imaging (like ultrasound or MRI) is not always necessary, especially in typical cases. When it is done, it may show changes in the tendon such as thickening or altered signal. However, similar changes can appear even in people without symptoms, so imaging is usually interpreted together with the physical examination and your symptom story—not in isolation.
A more modern view: load tolerance, not “weakness” or “inflammation only”
Older explanations of tennis elbow focused mainly on inflammation. While inflammation can be part of the picture, current understanding sees it more as an issue of tendon load tolerance. The tendon has been asked to do more than it can comfortably handle, too quickly, for too long, or without enough recovery.
This perspective is important because it changes the management focus. Rather than relying only on rest or anti-inflammatory measures, treatment aims to:
- Reduce aggravating overload in the short term
- Gradually reintroduce and build up load in a planned way
- Support the whole system—posture, shoulder strength, work setup, pacing—so the tendon is less overworked in the long run
Rest alone can reduce pain for a while, but if you then jump back into the same level of activity without preparation, symptoms often return. A structured plan gives the tendon space to calm down while also teaching it to handle everyday demands again.
Conservative management: what often helps
Most cases of tennis elbow are initially managed without surgery. Elements of conservative care may include:
Short-term symptom relief
During more painful phases, strategies such as temporary activity modification, ice or heat, and pain-relieving medication prescribed or recommended by a doctor can help keep symptoms manageable. Some people find a soft forearm strap or brace useful during certain tasks, though this should be one tool among many, not a permanent solution.
Load modification
Reducing or adapting the most provocative activities is often necessary at first. That might mean changing how you lift (using two hands, keeping the load closer to the body), alternating tasks between arms, or limiting prolonged gripping. The idea is to dial down the load enough to calm the tendon, but not to stop using the arm entirely.
Targeted exercise
Gradual strengthening of the wrist extensors and surrounding muscles (forearm, shoulder, scapular stabilisers) is a key part of modern management. This may start with isometric holds (gentle static contractions) and progress to slow, controlled loading, and eventually more functional tasks. Exercises are usually progressed over weeks, adjusting based on symptoms and tolerance.
Physiotherapists and occupational therapists can design and supervise these programmes so that loads increase in a safe, structured way, rather than in random bursts.
Injections, procedures and when they are considered
For some people, especially when pain has persisted for a long time and significantly affects sleep or work, doctors may discuss options such as corticosteroid injections, platelet-rich plasma (PRP) or other procedures. Research suggests that while steroid injections can provide short-term pain relief, they may not always offer better long-term outcomes than good conservative management, and in some cases may be associated with higher recurrence when used repeatedly.
Because evidence is mixed, these interventions are generally considered on a case-by-case basis, taking into account severity, duration, work demands, other treatments tried and personal preferences. Surgery is reserved for a small minority of cases that do not settle with well-executed non-surgical care and where other diagnoses have been ruled out.
Any decision about injections or surgery should be made after a clear discussion with your healthcare provider about risks, potential benefits and realistic expectations.
How occupational therapy can help with tennis elbow
Occupational therapists look at how tennis elbow affects your everyday activities, not just the tendon itself. They pay attention to work tasks, home duties and hobbies that repeatedly load the outer elbow.
An OT’s role may include:
- Analysing how you grip and lift objects at home and at work, identifying unnecessary strain
- Suggesting alternative ways to carry, pour, use tools, or handle devices to reduce peak loads on the tendon
- Adjusting workstation setup (keyboard, mouse, screen, chair) and advising on pacing and micro-breaks during repetitive tasks
- Integrating your exercise programme into real activities so it feels practical and sustainable, rather than an extra burden
- Helping you plan a graded return to hobbies or sports that have been limited by pain
By focusing on your real-life context, occupational therapy helps ensure that improvements made in the clinic are supported by day-to-day habits, rather than undone by a return to the same overload patterns.
Balancing protection and use
One of the trickiest parts of managing tennis elbow is finding the balance between protecting the tendon and keeping the arm working. Total rest for weeks can make the tendon and muscles weaker and more sensitive. Ignoring pain and pushing through every task can keep the area irritated and grumpy.
The middle ground usually looks like this:
- Avoid or modify high-load, high-irritation tasks in the short term
- Maintain comfortable general use of the arm in less provocative positions
- Gradually reintroduce more challenging loads under supervision, in a planned way
- Monitor symptoms over 24 hours (not just during exercise) to decide whether to progress, maintain or temporarily reduce load
This kind of thoughtful progression can feel slow compared to “quick fix” promises, but it often leads to a more stable, resilient elbow over time.
When to seek further medical advice
You should seek prompt medical assessment if:
- Pain is severe and sudden after a specific trauma, such as a fall or direct blow
- There is obvious deformity, major loss of motion, or a sense that the joint is unstable
- Numbness, tingling or weakness suggest involvement of nerves beyond the local tendon
- Self-management and conservative care have been ongoing for a reasonable period, but symptoms are steadily worsening or significantly limiting work or daily life
A review does not necessarily mean you will need injections or surgery, but it helps clarify the diagnosis, rule out other conditions and refresh the management plan.
A realistic, hopeful outlook
Tennis elbow can be surprisingly disruptive, especially when it affects work, household responsibilities and favourite activities. It is understandable to feel impatient or discouraged when pain appears with such ordinary tasks as lifting a kettle or using a mouse.
The encouraging perspective is that many people do improve with a combination of time, load management, targeted exercise and practical changes to how they use their arms. The tendon is not “ruined”; it is irritated and asking for a different relationship with load.
With support from rehabilitation professionals—particularly occupational therapists and physiotherapists—and a willingness to adjust routines, it is often possible to move towards an elbow that is more tolerant, a hand that feels more trustworthy, and a daily life that is less dominated by that sharp, familiar pain on the outside of the joint.
This article is for general education and does not replace individual medical advice. For personalised assessment and recommendations, please consult your healthcare provider or rehabilitation team.
