Tennis elbow causes pain and tenderness on the outside of your elbow. You may also have pain in your forearm and in the back of your hand.

The pain of tennis elbow can range from mild discomfort while using your elbow, to severe pain that can be felt when your elbow is still.

The pain is often worse when you use your arm, particularly for twisting movements. Repetitive wrist movements, such as extending your wrist and gripping, can also make the pain worse.

If you have tennis elbow, you will usually experience:

• pain on the outside of your upper forearm, just below your elbow – the pain may also travel down your forearm towards your wrist 
• pain when lifting or bending your arm
• pain when writing or gripping small objects – for example, when holding a pen
• pain when twisting your forearm – for example, when turning a door handle or opening a jar
• pain and stiffness when fully extending your arm

An episode of tennis elbow will usually last between 6 months and 2 years. However, the majority of people (90%) will make a full recovery within a year.

Tennis elbow is often an overuse injury. It occurs when the muscles and tendons in your forearm are strained due to a repetitive or strenuous activity.

Tennis elbow can also sometimes occur after banging or knocking your elbow.

If the muscles and tendons in your forearm are strained, tiny tears and inflammation can develop near the bony lump (lateral epicondyle) on the outside of your elbow.

You may get tennis elbow if your forearm muscles are not used to doing a certain activity, such as gardening or decorating. However, even if you use your forearm muscles frequently, you can still injure them.

Activities that can cause tennis elbow

You can develop tennis elbow by doing any form of activity that involves repeatedly twisting your wrist and using your forearm muscles. Examples include:

• playing racquet sports – such as tennis, badminton or squash (see below)
• throwing sports – such as the javelin or discus 
• using shears while gardening
• using a paintbrush or roller while decorating
• manual work – such as plumbing or bricklaying
• activities that involve fine, repetitive hand and wrist movements – such as using scissors or typing 
• other activities that involve repeatedly bending the elbow – such as playing the violin

Playing racquet sports increases your risk of developing tennis elbow, particularly if you play for the first time in a long time. However, despite its name, only 5 out of 100 people actually get tennis elbow from playing racquet sports.

Tennis elbow is a self-limiting condition, which means it will eventually get better without treatment.

However, it can often last for several weeks or months, because tendons heal slowly. In some cases, tennis elbow can persist for more than a year.

A number of simple treatments can help alleviate the pain of tennis elbow. The most important thing you can do is rest your injured arm and stop doing the activity that caused the problem (see below).

Holding a cold compress, such as a bag of frozen peas wrapped in a towel, against your elbow for a few minutes several times a day can help ease the pain.

Invasive treatments, such as surgery, will usually only be considered in severe and persistent cases of tennis elbow, where non-surgical approaches have not been effective.

Avoiding or modifying activities

If you have tennis elbow, you should stop doing activities that strain affected muscles and tendons.

If you use your arms at work to carry out manual tasks, such as lifting, you may need to avoid these activities until the pain in your arm improves.

Alternatively, you may be able to modify the way you perform these types of movements so they do not place strain on your arm.

Talk to your employer about avoiding or modifying activities that could aggravate your arm and make the pain worse.

Painkillers and NSAIDs

Taking painkillers, such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help ease mild pain and inflammation caused by tennis elbow.

As well as tablets, NSAIDs are also available as creams and gels (topical NSAIDs). They are applied directly to a specific area of your body, such as your elbow and forearm.

Topical NSAIDs are often recommended for musculoskeletal conditions, such as tennis elbow, rather than anti-inflammatory tablets. This is because they can reduce inflammation and pain without causing side effects, such as nausea and diarrhoea.

Some NSAIDs are available over the counter without a prescription, while others are only available on prescription. Your GP or pharmacist will be able to recommend a suitable NSAID.  

Read more about non-prescription and prescription-only medicines.

Physiotherapy

Your GP may refer you to a physiotherapist if your tennis elbow is causing more severe or persistent pain. Physiotherapists are healthcare professionals who use a variety of methods to restore movement to injured areas of the body.

Your physiotherapist may use manual therapy techniques, such as massage and manipulation, to relieve pain and stiffness, and encourage blood flow to your arm. They can also show you exercises you can do to keep your arm mobile and strengthen your forearm muscles. 

The use of an orthoses – such as a brace, strapping, support bandage or splint – may also be recommended in the short term.

Read more about physiotherapy.

Steroid injections

Steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems.

Some people with tennis elbow may be offered steroid injections when other treatments haven't worked.

The injection will be made directly into the painful area around your elbow. You may be given a local anaesthetic first to numb the area and reduce the pain.

Steroid injections are only likely to provide short-term relief and their long-term effectiveness has been shown to be poor. If they are helping, you may be offered up to 3 injections in the same area, with at least a 3 to 6 month gap between them.

Shockwave therapy

Shockwave therapy is a non-invasive treatment, where high-energy shockwaves are passed through the skin to help relieve pain and promote movement in the affected area.

How many sessions you will need depends on the severity of your pain. You may have a local anaesthetic to reduce any pain or discomfort during the procedure.

The National Institute for Health and Care Excellence (NICE) states that shockwave therapy is safe, although it can cause minor side effects, including bruising and reddening of skin in the area being treated.

Research shows that shockwave therapy can help improve the pain of tennis elbow in some cases. However, it may not work in all cases, and further research is needed.

PRP injections

Platelet rich plasma (PRP) is a newer treatment that may be offered by a surgeon in hospital to treat tennis elbow.

PRP is blood plasma containing concentrated platelets that your body uses to repair damaged tissue. Injections of PRP have been shown to speed up the healing process in some people but their long-term effectiveness is not yet known.

The surgeon will take a blood sample from you and place it in a machine. This separates the healing platelets so they can be taken from the blood sample and injected into the affected joints. The procedure usually takes about 15 minutes.

Surgery

Surgery may be recommended as a last resort treatment in cases where tennis elbow is causing severe and persistent pain. The damaged part of the tendon will be removed to relieve the painful symptoms.

It is often difficult to prevent getting tennis elbow.

However, not putting strain on the tendons of your elbow will help you to avoid the condition or prevent your symptoms getting worse.

Self care advice

Listed below are some measures you can take to help prevent tennis elbow developing or recurring:

• if you have tennis elbow, stop doing the activity that is causing pain, or find an alternative way of doing it that does not place stress on your tendons
• avoid using your wrist and elbow more than the rest of your arm. Spread the load to the larger muscles of your shoulder and upper arm
• if you play a sport that involves repetitive movements, such as tennis or squash, getting some coaching advice to help improve your technique may help you avoid getting tennis elbow
• before playing a sport that involves repetitive arm movements, warm up properly and gently stretch your arm muscles to help avoid injury
• use lightweight tools or racquets and enlarge their grip size to help you avoid putting excess strain on your tendons
• wear a tennis elbow splint when you are using your arm, and take it off while you are resting or sleeping to help prevent further damage to your tendons. Ask your GP or physiotherapist for advice about the best type of brace or splint to use
• increasing the strength of your forearm muscles can help prevent tennis elbow. A physiotherapist can advise you about exercises to build up your forearm muscles