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  • The lateral forearm and elbow pain associated with extensor tendinopathy is more commonly referred to as ‘tennis elbow’.

  • Extensor Tendinopathy is a condition which affects the area 1-2 cm distal to the lateral epicondyle of the humerus.

  • The muscles affected are the extensor muscles of the forearm – chiefly the Extensor Carpi Radialis Brevis (ECRB) muscle.  When these muscles are overused, chronic degenerative changes can take place.  This involves a pathological process called ‘Tendinosis’.

  • Tendinosis – see page (Achilles, patellar, ECRB, RC)

  • Tennis elbow usually begins as an irritation and inflammation of the extensor tendons of the forearm where they attach to the humerus.

  • If these activities continue, then the inflammatory nature of Tennis elbow turns into a chronic tendon problem that is characterised by pain, weakness and degeneration of the tendon. Once this elbow problem is chronic, it can be very persistent and much more difficult to treat.

Signs & Symptoms

  • Lateral elbow pain, from the lateral epicondyle to the forearm extensor bulk.

  • Gradual onset or specific to an incident

  • Aggravated by lifting heavy items or gripping things

  • Aggravated with repeated activity (playing tennis, laboring)

  • Tenderness and thickening on palpation of the lateral elbow and forearm muscles

  • Pain is reproduced with resisted wrist extension

What Causes It?

  • Overuse of wrist extensor muscles (weeding, typing, inappropriate racquet grip/weight)

  • Despite the name, Tennis Elbow doesn’t just affect tennis players. Although racquet sports players are more prone to the condition and account for approximately 5% of all sufferers, it is more often associated with work-related activities, such as those who carry out repetitive activities. Tennis elbow is equally common in men and women, peaking in prevalence between the ages of 30 and 50.

  • Tendinosis explanation

How to Self Manage

  • Follow the R.I.C.E. protocol

  • Trial a short course of Non Steroidal Anti Inflammatory Drugs to combat the initial inflammation

  • Stretch the forearm extensors by .. .

  • On resumption of activities, a compression strap can be effective at reducing the stress on the painful area whilst allowing the user to continue with activities.


  • Tendinosis is a condition whch take s a long time to treat, especially if the pain is chronic prior to seeking initial management.

  • If conservative management is unsuccessful then an xray may be deemed necessary to exclude bony degeneration or calcification.

  • Ultrasound imaging may be useful for imaging the tendon integrity and to assess any bursa type irritation.

  • A surgical option is to ‘scrape’ the tendon to remove the degenerative tendon.

  • Your GP may suggest a corticosteroid injection to the area to reduce your pain

How Physio Helps

  • Determine if your lateral elbow pain is extensor tendinopathy, whilst excluding other causes (cervical/thoracic referral, nerve entrapment, other elbow conditions)

  • Assess for contributing factors

  • Review recent training and activities to identify areas for modification (eg tennis racquet size, weight, grip, string tension).

  • Liaise with coach RE racquet and or technique.

  • Provide advice about work activities and workstation set-up

  • Provide manual therapy which may include soft tissue release of the forearm muscles, dry needling and/or acupuncture, stretching of muscles and nerves, ultrasound, and possible brace prescription

  • Provide a progressive eccentric loading program which is absolutely key to successful rehabilitation.

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