Tennis elbow

What it is

Lateral epicondylalgia is a degenerative tendinopathy of the common extensor origin, usually extensor carpi radialis brevis, where it attaches to the outside of the elbow. Despite the name epicondylitis, biopsy shows disorganised collagen and new vessel growth rather than inflammatory cells.

Most people who get it have never played tennis. It is an overload problem in the wrist extensors, which grip, stabilise and lift - and the load can come from a keyboard, a screwdriver, a kettle, a toddler or a new gym programme just as easily as from a racquet.

What it feels like

• Pain on the bony point on the outside of the elbow, sometimes spreading down the forearm
• Worst gripping, lifting with the palm down, turning a door handle or shaking hands
• Tender to press on one specific spot
• Grip strength noticeably reduced by the pain
• Aching after use rather than during it, and stiff first thing

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Overload of the wrist extensor tendons

The extensors stabilise the wrist during every grip. Repeated or sustained gripping loads their common attachment at the elbow, and when the load exceeds the tendon's capacity it degenerates.

A failed healing response

The tendon responds to repeated overload with disorganised collagen and new vessel and nerve ingrowth rather than repair. That is why it is painful, why it is not inflammatory, and why it needs loading rather than rest.

A sudden increase in gripping activity

Decorating, a new job, a house move, a new gym programme, a weekend of DIY. The tissue tolerance was fine for the old load and not for the new one.

Sustained low-level gripping

A mouse, a steering wheel, a phone, tools. Prolonged low-grade contraction is as much of a problem as high force, and it is far more common.

Weak shoulder and scapular muscles

The forearm works harder when the shoulder does not stabilise the arm well. Shoulder weakness is a consistent finding in people with stubborn tennis elbow and is frequently the missing piece.

Poor grip mechanics or equipment

A racquet grip that is too small, tools with poor handles, or a keyboard and mouse setup that keeps the wrist extended all increase the load per hour.

Age

Most common between thirty-five and fifty-five, when tendon collagen turnover is declining but activity is still high. It is uncommon in the young.

Neck referral - the imitator

A cervical nerve root problem can refer pain to the outer elbow. Elbow pain with neck symptoms or arm numbness deserves that consideration.

Smoking and metabolic factors

Smoking, diabetes and obesity are all associated with tendinopathy and with slower recovery, through effects on tendon blood supply and collagen.

Who tends to get it

• Adults between thirty-five and fifty-five
• Anyone whose work or hobby involves repeated or sustained gripping
• People who have recently increased manual work or gym training
• Racquet players, particularly with poor technique or grip size
• Smokers and people with diabetes, in whom recovery is slower

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineElbow Relief (Tennis & Golfer)

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Numbness in the ring and little finger means the ulnar nerve, not the tendon; night pain and swelling needs review

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Tennis elbow is slow. Most cases resolve over six to twelve months, and progressive loading speeds it up and reduces recurrence compared with rest or injection. Corticosteroid injections produce good short-term relief and worse outcomes at one year than exercise or even than doing nothing, which is worth knowing before accepting one. Pain that spreads, comes with numbness, or is accompanied by neck symptoms is worth a different assessment.

Prevalence basis: Elbow disorder epidemiology

Others the same routine covers

These share the Elbow Relief (Tennis & Golfer) routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.