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Tennis elbow is typically caused by an increase in activities that load the tendon. Examples of these activities are gripping, tennis, pruning and DIY. The tendon responds to this increase in activity by becoming swollen and begins a process of trying to make itself stronger so that it can perform the task in the future. However, this process does not always work perfectly and, in some people, the tendon gradually becomes painful, often days after the increase in loading. If left untreated, this pain and dysfunction can become more debilitating.

The diagnosis of tennis elbow is made by a combination of symptoms and signs. The symptoms include pain on the outside of the elbow and are aggravated by gripping or lifting with the palm turned downwards. In more chronic cases, the elbow may become stiff after periods of rest, such as first thing in the morning. Pain with gripping (like a handshake) and tenderness on the bony point on the outside of the elbow may be a sign that you have tennis elbow.

Other conditions, such as elbow joint arthritis and radial nerve entrapment, can give symptoms similar to tennis elbow, and your physiotherapist can assess whether this is the case. There are also times when your neck may be the source of your tennis elbow.

Accurate diagnosis is crucial in the selection of the best treatment for tennis elbow. Your physiotherapist will be able to accurately assess and differentiate the source of your elbow pain. Once your physiotherapist has established the source of your pain, they will discuss the best management of your condition and a plan to return you to being pain-free.

Part of your physiotherapy management may include some hands-on treatment. Your physiotherapist will teach you how to do this yourself. They may also perform a manual technique called mobilisation with movement (MWM), which has been demonstrated to assist with the pain of tennis elbow.

Another treatment that your physiotherapist will use is exercises with weights, which will help relieve the pain, increase the ability of the tendon to cope with load and increase the strength of your forearm muscles. This will be something that your physiotherapist will progress as you get stronger. You will probably need to do this for 12 weeks.

Your physiotherapist may fit you with a tennis elbow brace or use strapping to relieve the pain in the short term, but this will not be the solution to your problem and is not a substitute for exercise.

Finally, your physiotherapist will discuss some of the treatment options that you can talk about with your doctor, such as the use of topical medications. New research has indicated that corticosteroid injections result in worse long-term outcomes compared to physiotherapy or placebo injections.

Research has demonstrated that although tennis elbow resolved in most people within 12 months, physiotherapy gave better outcomes. The research also discussed some of the benefits of manipulation and manual therapy, and physiotherapy’s ability to reduce the pain associated with tennis elbow. Your physiotherapist will be able customise your management to give you an optimal treatment program.

There are many things that you can do at home to help reduce the pain of tennis elbow.

• Ice can be an extremely valuable tool. Generally, an ice pack is applied for 8–10 minutes, until the skin goes numb to touch. It’s important to have a damp towel or something similar between your skin and the ice pack to avoid an ice burn, and to remove the ice if you feel like your skin is burning. There is no rule as to how often you might use an ice pack, but 3–4 times a day is a good place to start. People with medical conditions that effect their circulation or those who are hypersensitive to cold should seek professional advice as to whether ice is safe to apply.
• Modifying your activity is also a great way to reduce your pain. Try picking things up from underneath rather than on top (ie, with palm facing up). Swap hands for gripping tasks as much as you can, or if possible eliminate them entirely.
• You can try a tennis elbow brace from the pharmacy as a pain-reliever or wear a wrist brace. People often don’t consider using a wrist brace for tennis elbow, but it can prevent you from doing many of the tasks that aggravate the elbow and allow the tendon to rest.
• Finally, massaging your forearm muscles can help relieve some of the pain and tightness.

As with all injuries, accurate diagnosis is a crucial part of best management.

If you do nothing differently, tennis elbow resolves by 12 months in 80 per cent of cases. Targeted physiotherapy management of tennis elbow typically begins to give people short-term relief immediately. People usually find improved function within 2–3 weeks, and in many cases are completely rid of symptoms within 12–16 weeks.