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Lateral epicondylitis is a condition characterized by degenerative changes and microtears along the tendon that attaches to the outer part of the elbow.
It is not simply an inflammatory condition, but rather a tendinopathy, where the tendon fails to heal properly due to repetitive strain and overuse.
Causes and Risk Factors
In most cases, lateral epicondylitis develops due to overuse of the forearm muscles that are responsible for extending the wrist and fingers.
Common causes include:
- Repetitive movements: prolonged use of a mouse or keyboard
- Poor technique: in activities such as tennis or weightlifting
- Sudden increase in load or activity level
Main Symptoms
Symptoms often develop gradually and may include:
- Pain and tenderness on the outer side of the elbow
- Weak grip strength, even when holding light objects (e.g. a glass)
- Stiffness, particularly in the morning
- Significant pain increase during resisted wrist or finger extension
Physiotherapy Approach and Rehabilitation
Phase 1: Pain Management
- Avoid movements that provoke significant pain
- Therapeutic exercise and joint mobilization for immediate pain relief
- Use of a brace or support to reduce load on the tendon insertion
Phase 2: Therapeutic Exercise
- Isometric exercises: muscle contraction without joint movement
- Progressive strengthening exercises (eccentric/loading exercises) to improve tendon capacity
- Stretching exercises to enhance flexibility of the wrist extensor muscles
Phase 3: Return to Daily Activities
- Education on safe return to work activities
- Gradual load progression, allowing a safe and confident return to sports and daily life
Conclusions
Lateral epicondylitis is a condition that requires patience, as recovery may take weeks or even months, depending on its chronicity.
Early physiotherapy intervention can:
- Reduce pain more rapidly
- Promote more effective tendon healing
- Accelerate return to normal function
References
- Buchanan, B.K. and Varacallo, M. (2024). Tennis Elbow (Lateral Epicondylitis). StatPearls Publishing.
- Cakar, H., Ozturk, A. and Atalay, A. (2024). Comparative study on functional outcomes in Tennis Elbow, Journal of Rehabilitation Medicine.
- Cochrane Library (2024). Manual therapy and exercise for treating tennis elbow: a systematic review.
- JOSPT (2022). Lateral Elbow Pain and Muscle Function Impairments: Clinical Practice Guidelines.
- Shahzad, K., Ahmed, N. and Khan, M. (2025). Clinical study on regenerative approaches for chronic lateral epicondylitis, International Journal of Physiotherapy.
- Stasinopoulos, D. and Johnson, M.I. (2022). Lateral elbow tendinopathy: a review of the evidence, Physiotherapy Theory and Practice.
Tsakmakis F. Apostolos
BSc (Hons), MSc, Physiotherapist
