Tennis elbow exercise rehabilitation: activity changes and graded strengthening

NHS inform describes tennis elbow, or lateral epicondylitis, as pain and tenderness on the outside of the elbow that may spread down the forearm, with difficulty gripping, twisting objects and restricted movement. It is commonly an overuse injury from repetitive gripping and hand movements, not only racquet sport.

Arthritis UK says tennis and golfer's elbow are most common between the ages of 40 and 50. NHS inform lists smoking, obesity, high-fat diet, high cholesterol and diabetes among risk factors affecting tendon health.

The first treatment in NHS inform is activity modification. It suggests adjusting your grip or lifting technique, reducing the weight you carry, taking regular breaks during aggravating activities and starting an exercise programme.

In practice this means identifying the tasks that reproduce the pain, such as lifting with the palm down, repetitive screwdriver or mouse use, or carrying bags by the hand, and finding a way to spread the load. Complete rest is not the aim.

• Hold objects closer to the body and use both hands where possible.

• Take short breaks from repetitive gripping tasks.

• Consider whether tool handles, keyboard or mouse set-up are adding strain.

The NHS says self-care includes paracetamol, anti-inflammatory gels, hot or cold packs for 20 minutes every 2 to 3 hours, and simple arm exercises. NHS inform adds that elbow supports have limited evidence, while Arthritis UK describes splints or clasps for support and prefers gentle exercises once initial pain eases, because prolonged rest causes stiffness.

The NHS suggests seeing a GP if pain persists after at least two weeks of rest and self-care. Arthritis UK also advises seeking help for tingling, numbness or weakness, which suggest a nerve problem rather than tendon pain, and emergency care for a suspected fracture or signs of infection.

The NHS says physiotherapy may be considered after 6 weeks of unsuccessful home treatment, and includes massage, stretching and strengthening exercises and ultrasound therapy. Arthritis UK also describes physiotherapy for strength-building and occupational therapy to modify movements.

None of the pages used here set out a repetition-by-repetition programme, so the exact exercises and their progression are chosen by the treating physiotherapist. The general principle matches other tendons: gradual loading of the forearm muscles with discomfort allowed in a tolerable range. The NHS notes many areas offer musculoskeletal services you can refer yourself to.

NHS inform says corticosteroid injections may be considered if conservative measures fail but have limited benefit, with concerns about tendon damage. Arthritis UK describes steroid injections as short-term relief only, not recommended long term, and says platelet-rich plasma injections have shown promise for reducing pain more effectively than steroids.

Those descriptions come from patient information pages rather than guidelines, so discuss the evidence and risks with your clinician before agreeing to an injection. Injections are usually seen as an aid to exercise rather than a stand-alone solution.

NHS inform says you do not need to be symptom-free before returning to work, and that gradual return helps build strength and stamina. Occupational adjustments, such as task rotation, are often more helpful than time off.

The NHS describes surgery as an option for symptoms persisting after 6 to 12 months. Since many cases settle within about a year without it, the decision is made with a specialist after a full trial of exercise-based treatment.