Tennis Elbow: What the Research Says About Diagnosis, Treatment and Recovery.

If your elbow has been aching on the outside for weeks, gripping things has started to feel harder than it should, and you've never picked up a tennis racquet in your life, you're not imagining things and you're not alone.

Tennis elbow is one of the most misunderstood conditions we see in the clinic, partly because of its name.

This article draws on a recent evidence review by Kevin James, our Senior Osteopath and Clinical Supervisor, who pulled together the current research on lateral elbow tendinopathy for our team's professional development. We wanted to share what that research says, because a lot of what people believe about tennis elbow doesn't hold up.

What tennis elbow actually is

The clinical name for tennis elbow is ‘lateral elbow tendinopathy’, and a 2026 literature review explains why clinicians now prefer this term to "lateral epicondylitis" [1]. The old name implies inflammation is the whole story. It isn't. Lateral elbow tendinopathy involves the tendons where your forearm muscles attach on the outside of the elbow, and it's better understood as a load-related problem: the tendon hasn't adapted to the demands being placed on it, rather than being simply "inflamed".

That distinction matters, because it changes what a sensible recovery plan looks like.

Who gets tennis elbow

Despite the name, tennis is a minor player here. The research consistently links this condition to repetitive or forceful gripping, wrist extension and forearm rotation, whether that's from work, sport or everyday tasks. Trades, hospitality, hairdressing, gardening, screen-heavy desk jobs with a lot of typing and mouse use, and even carrying shopping or small children or golf, can all load the tendon in the same way a tennis backhand does.

It's estimated to affect around one to three percent of the general population, and it tends to peak during middle age [1]. If you've never swung a racquet and you've still ended up with this, that fits the pattern the research describes, not an exception to it.

Why one test, or one scan, rarely tells the whole story

A common expectation walking into a clinic is that a single test, or a scan, will confirm

exactly what's wrong. Tennis elbow doesn't work that way, and the research is clear on why.

Diagnosis is based on the overall clinical picture: your history, how your symptoms behave, what aggravates and eases them, and how the elbow responds to examination and loading. Individual tests can support that picture, but isn't the full picture. A 2022 systematic review by Karanasios, looked at how accurate these tests really are, and found most of the underlying studies carried a high or unclear risk of bias, meaning no single test performs well enough to stand alone as a definitive answer [2].

Imaging tells a similar story. Ultrasound and MRI can show tendon thickening or structural changes, but structural findings don't reliably match up with symptoms, as the same review found [2]. Plenty of people have tendon changes on a scan with no pain at all. Because of this, imaging is generally reserved for situations where something else might be going on, such as locking, significant swelling, restricted movement, a traumatic injury, or symptoms that aren't settling despite a proper rehab program, rather than being a routine step for a typical presentation.

When it might not be tennis elbow at all

Because "elbow pain on the outside" is a broad description, it's worth knowing that not every case is lateral elbow tendinopathy. In a study of 170 people presenting with lateral-sided elbow pain, Zwerus found, that just over half were ultimately diagnosed with tennis elbow, while nearly half had something else going on, including joint conditions, cartilage problems, and instability [3].

Certain features tend to point away from a straightforward tennis elbow diagnosis: being under 30, symptoms that came on suddenly rather than gradually, joint locking or catching, visible swelling, or a noticeably restricted range of movement. None of this is something to self-diagnose from a symptom list online. It's part of why a proper assessment matters more than guessing from what you've read (including this article).

What doesn't help as much as you'd think

A few widely held beliefs about tennis elbow are worth addressing directly, because acting on them can slow you down rather than speed things up.

"I just need to rest it completely." Pain during a movement doesn't mean that movement is damaging the tendon further. Complete rest isn't usually necessary or helpful. What the evidence supports instead is relative rest: temporarily easing off the specific loads that flare things up, while keeping the rest of your activity going and gradually rebuilding capacity.

"A cortisone injection will fix it." Corticosteroid injections can provide fast relief in the short term, and that's genuinely useful for some people. But research consistently finds this relief doesn't always last, with some trials showing higher rates of recurrence and worse outcomes in the medium to longer term compared with a structured rehab approach [4, 5]. It's a reasonable option to discuss, with the trade-offs on the table, rather than an automatic first move.

"A scan or a fancy machine will sort it out." Shockwave therapy, laser, botulinum toxin and similar treatments have all been studied, and the honest answer is that the evidence for most of them is mixed, inconsistent or simply not strong enough yet to call them reliably effective. They may have a role for some people in some circumstances, but none of them replace progressive, well-managed loading of the tendon.

"I'll just follow an exercise video I found online." A 2025 review by Heales looked at tennis elbow exercise content on TikTok and found the overall quality was very poor, regardless of whether the person posting identified as a health professional, and that views and likes didn't reflect quality at all [6]. If you're using exercise as your main strategy, and you should be, it's worth getting the dosage, progression and technique checked by someone who can tailor it to you.

The Balance Health approach

None of this means tennis elbow is untreatable or that you're stuck waiting it out. It means the foundations that actually work are less flashy than a quick fix, but they're well supported.

We start with education: understanding what's actually going on in the tendon, and why pain during a load-sensitive condition doesn't equal ongoing damage. From there, we look at modifying the specific loads that are aggravating things, at work, at the gym, or at home, while keeping you as active as possible elsewhere.

Progressive, individualised loading is the backbone of rehab. A large 2023 review spanning over 200 studies and more than 12,000 participants across tendon conditions including tennis elbow, found there isn't one single "correct" exercise protocol proven superior to all others [7]. What matters is a program that gradually increases what the tendon can tolerate, built around your specific grip strength, function and goals. We track this with simple, repeatable measures like pain-free grip strength, so you and your practitioner can both see real progress.

Hands-on treatment can have a place too. Manual therapy, dry needling, or taping - we treat it as a helpful adjunct alongside your exercise program, not a stand-alone fix or a "correction" to something structurally wrong.

If your symptoms have been hanging around for a while, we'll also ask about sleep, stress, workload and general recovery. These factors are associated with more persistent presentations, and addressing them is part of a complete plan, not a sign that the pain "isn't real" or "isn't physical".

What to expect in recovery

It's common for symptoms to run for six to eighteen months, and sometimes longer, even with good management [1]. That's frustrating to hear, but it's realistic, and it's far better than expecting a two-week fix and feeling like something has gone wrong when it doesn't happen.

Consistency matters more than intensity here. Sticking with a program that fits your schedule and doesn't flare things up too much tends to matter as much as the specific exercises you're doing.

What to do next

If this sounds like what you're dealing with, the most useful next step is an assessment that looks at the whole picture: your history, your specific loads at work and at home, and how your elbow is actually behaving, rather than chasing one test or one treatment in isolation.

Book a consultation with our team and we'll build a plan around what's realistic for your life, not a generic handout.

This article is for general education only and is not a substitute for personalised medical advice. If you're experiencing elbow pain, please see a qualified practitioner for an individual assessment.

With thanks to Kevin James, Senior Osteopath and Clinical Supervisor at Balance Health Phillip Island, whose review of the current lateral elbow tendinopathy research informed this article.

References

1. Biedroń E, Pitra M, Chmura J, Zieliński M, Fibiger G, Plutecki D, Dubrowski A, Możdżeń K, Walocha JA, Fibiger W, Kozioł T. A literature review of lateral epicondylitis: diagnosis, risk factors, management and treatment. Life. 2026;16(7):1043.

2. Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, Tsepis E, Gioftsos G. Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET): a systematic review. Journal of Hand Therapy. 2022;35(4):541-551.

3. Zwerus EL, Keijsers R, Colaris JW, The B, van den Bekerom MPJ, Eygendaal D. Clinical diagnosis of lateral-sided elbow pain: predictors for recognizing a diagnosis other than tennis elbow. Journal of Shoulder and Elbow Surgery. 2026;35(5):1303-1308.

4. Sharma S, Berwal P, Verma N, Pandey AK, Saxena S, Gamad N. Physical therapy intervention versus corticosteroid injection for lateral elbow tendinopathy. Does slow and steady win the race? A systematic review. Shoulder & Elbow. 2024;16(1 Suppl):59-73.

5. Lowdon H, Chong HH, Dhingra M, Gomaa AR, Teece L, Booth S, Watts AC, Singh HP. Comparison of interventions for lateral elbow tendinopathy: a systematic review and network meta-analysis for Patient-Rated Tennis Elbow Evaluation pain outcome. Journal of Hand Surgery. 2024;49(7):639-648.

6. Heales LJ, Gunasinghe B, Melrose E, Lorraway J, Obst SJ. A systematic review of the quality and engagement of TikTok videos of resistance exercises for the management of lateral elbow tendinopathy. Journal of Hand Therapy. 2025;38(4):834-840.

7. Cooper K, Alexander L, Brandie D, Brown VT, Greig L, Harrison I, MacLean C, Mitchell L, Morrissey D, Moss RA, Parkinson E, Pavlova AV, Shim J, Swinton PA. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. Health Technology Assessment. 2023;27(24):1-389.

8. Coombes BK, Hams A, Tenbrink R, Love A, Bisset LM. Mobilisation-with-movement induces analgesia during exercise but exercise alone is not analgesic in people with lateral elbow tendinopathy: an assessor-blinded, randomised crossover trial. Musculoskeletal Science and Practice. 2025;80:103421.