Tennis Elbow & Golfer's Elbow | Home Physiotherapy | Physio to Home
Tennis elbow affects 1–3% of adults annually and is one of the most mismanaged musculoskeletal conditions. North Tasmania's home physiotherapist explains the tendinopathy model, what works, and what makes it worse.
Tennis elbow affects 1–3% of adults annually and is one of the most mismanaged musculoskeletal conditions. North Tasmania's home physiotherapist explains the tendinopathy model, what works, and what makes it worse.
Micheal Ghattas
3/6/2026 · 7 min read
Tennis Elbow and Golfer's Elbow: A Physiotherapy Guide for North Tasmania
By Michael Ghattas, DPT | AHPRA Registered Physiotherapist | 18 Years Experience
Physio to Home, North Tasmania | Last reviewed: March 2026
Tennis elbow — lateral epicondylalgia — is one of the most common upper limb presentations in musculoskeletal physiotherapy. Despite its name, only a minority of sufferers have ever played tennis. It is overwhelmingly an occupational and activity-related overuse condition, affecting manual workers, tradespeople, keyboard users, and anyone who performs repetitive gripping or wrist extension tasks. Its counterpart, golfer's elbow (medial epicondylalgia), affects the inner side of the elbow and is equally unrelated to the sport that names it.
Both conditions are tendinopathies — degenerative rather than inflammatory — and both respond to the same fundamental therapeutic approach: graded progressive loading of the affected tendon. Both are also frequently mismanaged with passive treatments alone, which is why they so often become chronic.
Understanding the Anatomy: What Is Actually Injured
Tennis elbow (lateral epicondylalgia) involves the common extensor tendon at its origin on the lateral epicondyle of the humerus — the bony prominence on the outer side of the elbow. The extensor carpi radialis brevis (ECRB) is the most commonly affected component, though the extensor digitorum and extensor carpi radialis longus are also involved in many cases.
Golfer's elbow (medial epicondylalgia) involves the common flexor tendon at the medial epicondyle — the inner elbow prominence — with the pronator teres and flexor carpi radialis most commonly implicated.
In both conditions, the tendon pathology follows the tendinopathy model: repetitive load exceeding the tendon's current capacity produces micro-failure in the collagen matrix, triggering a disordered healing response characterised by disorganised collagen, neovascularisation, and neurogenic sensitisation at the tendon insertion. This is not inflammation in the traditional sense — which is why anti-inflammatory treatments produce only partial and temporary relief.
Recognising Tennis Elbow and Golfer's Elbow
Tennis elbow: pain at the outer elbow, typically localised to the lateral epicondyle and proximal forearm; aggravated by gripping, lifting with the palm down, turning a screwdriver, shaking hands, carrying shopping bags; tender to palpation at the lateral epicondyle.
Golfer's elbow: pain at the inner elbow; aggravated by gripping, wrist flexion, and pronation activities; often associated with activities involving forceful finger flexion (gripping tools, carrying heavy loads).
Both can radiate into the forearm and, in severe cases, produce weakness in grip strength significant enough to affect daily activities — difficulty opening jars, carrying a kettle, using a mouse.
What the Evidence Says About Treatment
The evidence on elbow tendinopathy has shifted significantly over the past decade, moving away from passive treatments toward active, loading-based rehabilitation.
Corticosteroid injection produces meaningful short-term pain reduction (4–8 weeks) but is associated with significantly worse long-term outcomes than physiotherapy alone at 12 months — a finding replicated across multiple randomised trials, most notably the landmark Coombes and colleagues study published in *The Lancet* (2010), which found that a single corticosteroid injection was associated with worse outcomes at 1 year compared to physiotherapy alone and to wait-and-see. Injection may be appropriate as a short-term pain bridge but should always be followed by active rehabilitation.
Progressive loading exercise — specifically eccentric and heavy slow resistance training of the wrist extensors (for tennis elbow) or flexors (for golfer's elbow) — is the most evidence-supported intervention for chronic elbow tendinopathy, consistent with the broader tendinopathy literature.
Isometric exercise deserves specific mention because of its dual role: it provides an immediate analgesic effect that makes it useful for acute pain management, and it provides a low-load entry point into the progressive loading programme when pain is severe. The cortical inhibition mechanism by which isometric contractions reduce tendon pain has been characterised by Rio and colleagues in the *British Journal of Sports Medicine*.
Manual therapy directed at the cervical and thoracic spine has been shown in randomised controlled trials — notably by Vicenzino and colleagues at the University of Queensland — to produce immediate reductions in lateral elbow pain and hyperalgesia. The mechanism involves descending inhibitory pain modulation from cervical mobilisation. This is clinically important: the elbow pain is treated, in part, through the neck.
How Physiotherapy Manages Elbow Tendinopathy at Home
Stage 1 — Pain management and load reduction (weeks 1–2)
The initial goal is reducing the provocative load on the tendon while maintaining movement. This does not mean rest — it means identifying the specific activities most loading the tendon and modifying them temporarily while the programme begins. Isometric wrist extension exercise (pressing the back of the hand against a fixed surface and holding) provides immediate pain relief and is the starting point for the home programme.
Stage 2 — Progressive loading (weeks 2–8)
A systematic eccentric loading programme for the wrist extensors or flexors — using a light weight (500g–1kg initially) performing slow, controlled wrist extensions or flexions through full range — is the core of rehabilitation. The load is increased every 1–2 weeks as pain and tolerance improve. At Physio to Home, this programme uses a light dumbbell or a resistance band, both readily available at home.
Stage 3 — Functional and grip-specific rehabilitation (weeks 6–12)
As tendon load tolerance improves, exercises progress toward the specific grip and forearm patterns that are provocative in daily activity or work. For a manual worker, this means gradual reintroduction of tool use. For a keyboard user, it means addressing workstation ergonomics and progressive return to full-duration desk work.
Cervical assessment and treatment
Given the evidence for cervical contribution to lateral elbow pain, a cervical assessment is included in the evaluation of all tennis elbow presentations at Physio to Home. In many patients with concurrent neck stiffness or cervicogenic headache, addressing the cervical component produces rapid improvements in elbow symptoms.
Frequently Asked Questions
I've had three cortisone injections and my tennis elbow keeps coming back. What now?
This is one of the most common presentations in tendinopathy physiotherapy. Each injection may have produced temporary relief, but the underlying tendon pathology was not addressed. A structured progressive loading programme — consistently applied over 8–12 weeks — is the intervention most likely to produce durable resolution. The tendon needs load, not suppression.
How long will it take to get better?
Acute tennis elbow (less than 3 months duration) typically responds well within 6–8 weeks of a consistent loading programme. Chronic cases (over 6 months) take longer — 12–16 weeks is realistic — and may require more intensive rehabilitation including manual therapy. The most important prognostic factor is consistency of the loading programme between physiotherapy visits.
Can I keep working while treating tennis elbow?
In most cases, yes — with appropriate load modification. Reducing grip force, using ergonomic tools, and temporarily avoiding the most provocative tasks where possible allows most people to remain at work throughout rehabilitation. A physiotherapist can provide a workplace modification letter for employers if needed.
Ready to Treat Your Elbow Pain at Home in North Tasmania?
Tennis elbow and golfer's elbow are treatable — but they require the right effective approach, not passive waiting. Physio to Home provides AHPRA-registered tendinopathy assessment and home physiotherapy across North Tasmania.
Book your home visit today →
About the Author
Michael Ghattas, DPT | AHPRA Registered Physiotherapist | 18 Years Experience
Founder, Physio to Home — North Tasmania's home physiotherapy service.
References
Coombes BK, Bisset L & Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy. *The Lancet*, 2010.
Vicenzino B, et al. Specific manipulative therapy treatment for chronic lateral epicondylalgia. *Physical Therapy*, 2001.
Rio E, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. *British Journal of Sports Medicine*, 2015.
Karanasios S, et al. Exercise interventions in lateral elbow tendinopathy: a systematic review. *Journal of Hand Therapy*, 2021.
Australian Physiotherapy Association. Clinical guidelines for elbow tendinopathy. APA, 2023.