Pain on the outside of the elbow when gripping. Slow to settle, and the treatment is loading rather than resting.
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Tennis elbow is pain on the outer side of the elbow, where the tendons of the forearm muscles attach to the bone. It hurts to grip, lift, turn a door handle or shake hands.
Two things about the name are misleading. Most people who get it have never played tennis — it is far more common in manual work, DIY, and any repetitive gripping. And the "-itis" is wrong: this is not inflammation. It is a degenerative change in the tendon, which is precisely why anti-inflammatories give only limited, short-lived relief.
That matters, because it changes the treatment. The evidence-based approach is loading the tendon, not resting it. Complete rest weakens the tendon further and is one of the commonest reasons people are still in pain a year later.
And one thing worth knowing before anyone offers you an injection: steroid injections give good short-term relief but worse outcomes at six and twelve months than doing nothing or doing exercises. That is a consistent finding across trials, and it is rarely explained at the point the injection is offered.
The honest headline: this takes months, and it does get better. Most people recover within six to twelve months.
The same condition on the inner side of the elbow, hurting on gripping and on bending the wrist. Same causes, same treatment, same timescale.
Repeated load causes small-scale disorganisation and degeneration in the tendon where it attaches to the bone. The tendon does not heal in the way a cut does — it remodels in response to load, which is why controlled loading is the treatment and rest is not.
Because there is little true inflammation, anti-inflammatories help the pain a little and do nothing for the underlying problem.
Almost always the same three things:
Tennis elbow is a clinical diagnosis made from the history and the location of the pain, and a video consultation covers it well — you can show us where it hurts and demonstrate what provokes it, which is most of the assessment.
None are needed in a typical case. Ultrasound or MRI is reserved for diagnostic uncertainty, or where surgery is being considered — and, as with back pain, tendon changes appear on scans in plenty of people with no symptoms at all, so imaging can mislead more than it helps.
Blood tests only where inflammatory arthritis is a possibility.
This is the opposite of what most people assume, and it is the part that works.
They work well for a few weeks and then leave people worse off. Trials consistently show poorer outcomes at six and twelve months than exercise alone, and repeated injections weaken the tendon further.
We will discuss this openly rather than simply offering one — there are situations where short-term relief matters enough to accept the trade-off, but it should be a decision made with the full picture.
Physiotherapy first. For pain persisting beyond about a year despite proper loading: shockwave therapy, PRP injections, or surgery — though the great majority never reach that point.
Tennis elbow is not an emergency. Seek urgent medical attention for:
Book an appointment for:
Tendons need load, not rest. The instinct to protect the elbow completely is understandable and counterproductive — an unloaded tendon becomes weaker and less able to tolerate the demands you eventually put back on it.
Some discomfort during and after exercise is expected and acceptable. The guide is whether it settles within 24 hours. If it does, the load was right.
Most people recover within six to twelve months. That is slow, and it is genuinely frustrating, but it is the natural history — and the great majority get there without injections or surgery.
Progress is not linear. Flares after busy days are normal and are not a setback in the underlying recovery.
Tennis elbow gets better on its own in the majority of people, though it takes six months to two years — and that timescale is the single most useful thing to know, because it explains why so many treatments appear to work.
The treatment with the best evidence is eccentric strengthening exercise, which is free, can be done at home, and needs months of persistence. NHS physiotherapy is free with self-referral in many areas.
A counterforce brace costs a few pounds over the counter and helps some people with activity-related pain.
The important evidence point concerns steroid injections. They provide good short-term relief — and randomised trials have found worse outcomes at one year in people who had them compared with those who did exercise or waited. That is counterintuitive, it is well replicated, and it is worth knowing before paying for one.
Where money is wasted: repeated injections, and platelet-rich plasma or similar treatments sold privately with limited evidence.
Where a consultation is genuinely worth paying for is confirming the diagnosis — elbow pain is sometimes referred from the neck, and posterior interosseous nerve entrapment mimics it — and setting expectations honestly so that persistence with exercise replaces treatment-shopping.
Pain with weakness, night pain, or a history of trauma warrants a different assessment.
NICE Clinical Knowledge Summary, Tennis elbow (lateral epicondylitis), is the principal reference. It notes the condition is usually self-limiting over 6 months to 2 years and recommends activity modification, analgesia and exercise as first-line.
CKS advises that corticosteroid injection provides short-term relief but may be associated with worse longer-term outcomes and higher recurrence — the basis for the point above, which reflects randomised trial evidence.
CKS recommends topical NSAIDs for symptom relief, and a counterforce orthosis as an option.
CKS covers the differential diagnosis — including cervical radiculopathy, radial tunnel syndrome and elbow joint pathology — which underpins the diagnostic point above.
NICE IPG313 covers extracorporeal shockwave therapy for refractory tennis elbow, noting evidence of efficacy is inconsistent.
No — and this is the single most important thing on the page. Tendons respond to load; complete rest weakens them and prolongs the problem. Reduce and modify the aggravating activity, but keep using the arm and start a proper strengthening programme. Prolonged rest is one of the commonest reasons people are still in pain a year later.
Think carefully first. Injections give good relief for a few weeks, but trials consistently show worse outcomes at six and twelve months than exercise alone — and repeated injections weaken the tendon further. That trade-off is rarely explained at the point one is offered. There are situations where short-term relief is worth it, but it should be a deliberate choice.
Longer than anyone wants to hear: six to twelve months for most people. The good news is that the great majority recover fully without injections or surgery. Progress is not linear — flares after busy days are normal and do not mean you have undone anything.
A little, briefly — but the name is misleading. Tennis elbow is not really inflammation; it is tendon degeneration, which is why anti-inflammatories relieve pain without changing the problem. A topical gel is preferable to tablets, and the loading exercises are what actually treat it.
Some discomfort is expected and acceptable — the guide is whether it settles within 24 hours. If it does, the load was right. Pain that is severe during the exercise, or still worse the next day, means reduce the weight rather than stop altogether.
Most people with it do not. It is far more common in manual work, DIY and any repetitive gripping — plumbing, plastering, hairdressing, butchery, decorating, and keyboard and mouse work. The usual trigger is a recent increase in activity rather than the activity itself.
For many people, yes — an epicondylitis clasp worn on the forearm just below the elbow can reduce pain during activity, and it is inexpensive. It is a support while you rebuild the tendon, not a treatment on its own, and it does not replace the exercises.
Later than you would think. Keep going for at least three months after the pain has gone — the tendon continues rebuilding long after it stops hurting, and stopping at the point of comfort is where most recurrences come from.
August 24, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
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