Tennis elbow: treatment, symptoms and how long it lasts

The NHS suggests avoiding or reducing activities that worsen symptoms, using paracetamol or an anti-inflammatory gel, applying a hot or cold pack wrapped in a towel for up to 20 minutes every 2 to 3 hours, doing simple exercises such as bending and straightening the arm, and trying a forearm strap or a wrist or elbow brace from a pharmacy. It warns not to smoke or go near naked flames when using ibuprofen gel because it is flammable.

NHS inform adds practical ways to modify activity: change how you grip or lift an object, reduce the weight you carry and take regular breaks. The Chartered Society of Physiotherapy (CSP) suggests reducing or modifying aggravating activities for two to four weeks, for example using a computer mouse instead of a laptop trackpad, or a thicker grip on a racquet, and then gradually strengthening the muscles around the wrist and elbow. It says anti-inflammatory medicine such as ibuprofen can be tried if you have no conditions, such as asthma or a stomach ulcer, that make it unsuitable.

Braces and straps get a measured verdict from NHS inform: some people find an elbow support helpful in the short term, but overall there is limited evidence to support their use.

The NHS recommends seeing a GP if you still have elbow pain after resting the elbow and trying self-care for at least 2 weeks. In many areas you can get physiotherapy from NHS community musculoskeletal (MSK) services without a GP referral. The NHS says a GP may give anti-inflammatory tablets, that physiotherapy may help if symptoms have not improved after 6 weeks of home treatment, and that surgery may be an option if you still have tennis elbow after 6 to 12 months.

The sources differ in tone on some physiotherapy techniques, which is a useful reminder to ask your therapist for their reasoning:

The NHS says tennis elbow usually gets better after resting your arm for a few weeks, but it can sometimes last longer, and its overview says it can sometimes last over a year. The NHS suggests physiotherapy if symptoms have not improved after trying treatments at home for 6 weeks, and says surgery may be an option if you still have tennis elbow after 6 to 12 months.

The CSP suggests reducing or modifying aggravating activities for two to four weeks and then gradually strengthening the muscles around the wrist and elbow. NHS inform says following the advice should bring gradual improvements over time.

Despite the name, most people who develop tennis elbow have never played the game. NHS inform describes it as pain around the outside bony part of the elbow that can extend down into the forearm, also called lateral epicondylitis or lateral epicondyle tendinopathy. It most often affects the dominant arm, and the tendons involved help lift the hand backwards.

The NHS says the tendons in the elbow become inflamed, while NHS inform explains that repeated use of the muscles that lift the wrist can lead to changes in the tendon, often because it is overloaded. Describing it as tendon overload, rather than simple inflammation, helps explain why rest alone does not always cure it and why gradual strengthening plays a part in recovery.

The main symptom is pain on the outside of the elbow. The NHS says it may be worse when lifting or bending the arm, gripping objects or moving the wrist, and that you may also notice tenderness or swelling in the elbow, pain in the forearm and difficulty fully straightening the arm. NHS inform adds difficulty with twisting movements such as opening jars, restricted movement at the elbow and tenderness to the touch.

Everyday jobs can become surprisingly difficult: lifting a full kettle, shaking hands, turning a key or wringing out a cloth. If the pain is sharp after an injury, or if the elbow is hot, red and swollen, or the joint is stuck, that is not typical tennis elbow and needs a clinician's opinion.

The NHS says you can get tennis elbow from activities that involve gripping and repeatedly twisting the wrist and forearm, including computer work such as typing or using a mouse, manual tasks such as sewing or using a screwdriver, and leisure activities such as tennis or playing a musical instrument. NHS inform lists gripping, writing, lifting, pulling and twisting as relevant movements.

NHS inform also names factors that can affect tendon health in general: smoking, obesity, a high-fat diet, high cholesterol and diabetes (type 1 and 2). These do not mean you are to blame, but they offer another reason to look at overall health if tendon problems keep returning.

NHS inform says tennis elbow can sometimes mean time off work, depending on the condition and your role, but that you do not need to be symptom free before you consider returning, and that returning as soon as you are able can help recovery. Gradually returning to normal daily activities builds strength and stamina, and it reports that following the advice should bring gradual improvements over time.

Practically, that means adjusting rather than stopping: reducing repetitive gripping, breaking tasks into shorter spells, and discussing workstation changes with your employer. The CSP adds that successful treatment depends on an accurate diagnosis, so persistent pain deserves proper assessment rather than repeated self-treatment.

The NHS recommends seeing a GP if you still have elbow pain after resting the elbow and trying self-care for at least 2 weeks. In many areas you can use NHS community MSK services without a GP referral.

If the pain is sharp after an injury, or the elbow is hot, red and swollen, or the joint is stuck, that is not typical tennis elbow and needs a clinician's opinion. Persistent pain deserves proper assessment, because the CSP says successful treatment depends on an accurate diagnosis.

NHS MSK services can often see you without a GP referral, and you can ask your GP about physiotherapy if self-referral is not available locally. Waits for NHS physiotherapy vary between areas.

Private physiotherapy or orthopaedic consultation can shorten the wait for assessment and offer ultrasound scanning if the diagnosis is uncertain. Given the limited and mixed evidence for several procedures, ask any clinician what outcome they expect, how many sessions they propose, and what the alternatives are before agreeing to injections or additional therapies.