Pain on the outside of your elbow that bites when you lift a kettle, shake a hand or grip a screwdriver is almost always tennis elbow — known medically as lateral epicondylalgia or lateral epicondylitis.
Most people who get it have never held a racquet. And there is one piece of research every person with this condition deserves to know about before they agree to an injection.
At a glance
- Where: outer side of the elbow, often spreading into the forearm
- Worst with: gripping, lifting a cup, turning a door handle, using a mouse or a drill
- How common: around 1–3% of adults, most often between 35 and 55
- The injection question: a cortisone injection gives short-term relief but produced worse one-year outcomes and more recurrences in a major Australian trial
- Referral needed: no — you can book a physiotherapist directly
What tennis elbow actually is
The muscles that lift your wrist and straighten your fingers share a common tendon, and it attaches to the bony bump on the outside of your elbow — the lateral epicondyle. One tendon, a lot of jobs. Every time you grip, those muscles pull on it.
Tennis elbow is what happens when that attachment is asked for more than it can currently give.
The "-itis" ending in epicondylitis suggests inflammation, and for years treatment followed that logic. When researchers examined the tissue, they found something different: not an inflamed tendon but a degenerative, disorganised one — collagen in disarray, new blood vessels growing in, and very few inflammatory cells.
That single finding reshaped the treatment, and it explains the next section.
The cortisone question — the most important thing on this page
Cortisone injections for tennis elbow feel like they work. In the short term, they genuinely do.
In 2013 a randomised controlled trial run through Australian universities and published in JAMA followed 165 people with tennis elbow for a full year. They received a corticosteroid injection, physiotherapy, both, or neither.
At one year, the people who had a corticosteroid injection had lower rates of complete recovery and higher rates of recurrence than those who did not. The short-term relief was real. It came at the cost of the long-term result.
“Nobody is saying an injection is never appropriate — that is a conversation with your doctor about your situation. What I am saying is that if you have one, you should be told what the year looks like, not just the fortnight. Most people are never told, and that is the part I find hard to accept.”
Anand VaghasiyaPhysiotherapist and Director, UpPlus Physiotherapy SeatonThe practical takeaway is not "refuse injections". It is that a tendon which has lost capacity needs that capacity rebuilt, and an injection does not rebuild anything. If pain relief is needed to get a loading programme started, that is a reasonable use. As a standalone fix, the evidence does not support it.
Who actually gets tennis elbow?
In a normal week at our Seaton clinic, the people arriving with outer elbow pain are far more likely to be:
- Tradespeople — drills, screwdrivers, spanners, repeated gripping and twisting
- Office workers — long hours on a mouse and keyboard with no variation
- Warehouse and retail staff — repeated lifting and carrying
- Hairdressers, chefs, cleaners, painters — sustained grip, often overhead or at awkward angles
- Gardeners, especially after a big weekend of pruning
- New gym-goers who added rows, pull-ups or heavy carries
- Parents lifting a child that keeps getting heavier
- And racquet players, throwers and climbers
The trigger is nearly always a change: more of something, heavier, faster, or after time off. Tendons cope well with hard work they are used to and badly with sudden change.
What it feels like
- Pain or burning on the outer elbow, tender to press on the bony point
- Pain gripping — a kettle, a mug, a door handle, a tool
- Pain lifting the wrist or straightening the fingers against resistance
- Weak grip; dropping things
- Morning stiffness in the elbow
- An ache running down the top of the forearm
Tennis elbow or golfer's elbow?
Simply which side hurts. Hold your arm out with the palm up: the outer side — away from your body — is tennis elbow. The inner side is golfer's elbow, and we have a separate guide to that.
What else it could be
Outer elbow pain is not always the tendon. Pain referred from the neck, irritation of the radial nerve, and elbow joint problems can all mimic it — which is why an assessment beats a self-diagnosis. If you also have neck or shoulder symptoms, pins and needles, or the pain does not change at all with grip, say so at your appointment.
How it is diagnosed
Clinically, in almost every case — from your history and a physical examination. A physiotherapist will ask what changed in the weeks beforehand, press over the lateral epicondyle, test wrist and finger extension against resistance, measure grip strength, and screen your neck, shoulder and the radial nerve.
Scans are usually unnecessary. Ultrasound and MRI show tendon changes in plenty of people who have no pain at all, so imaging frequently adds cost and anxiety without changing the plan. It earns its place when the story does not fit, after a specific injury, or when progress stalls.
Physiotherapy management may include
- Finding the cause. Identifying the change in load that started it, and modifying — not stopping — in the short term.
- A graded loading programme. The centrepiece. Wrist and forearm exercises started where your tendon can cope and built up deliberately over weeks. Isometric holds are often used early because they load the tendon without movement and many people tolerate them well.
- Grip and forearm strengthening, progressed as symptoms allow.
- Shoulder and shoulder-blade work where weakness higher up is increasing what arrives at the elbow.
- Hands-on treatment — soft tissue work, joint mobilisation, sometimes dry needling — to make movement more comfortable so the loading can progress, rather than as treatment in its own right.
- Workplace and equipment changes — mouse and desk setup, tool grip size, taking the load in a different position.
- A counterforce brace or taping in some cases, short term.
- Shockwave therapy may be considered where pain has persisted despite loading and activity change over a reasonable period. It is used alongside the exercise programme, not in place of it.
- A flare-up plan, so one bad week does not undo a good month.
How long does tennis elbow take to heal?
Honestly: months rather than weeks in most cases. Many people notice real change within six to twelve weeks of consistent loading; recent, mild cases can be quicker, and long-standing ones slower.
Function usually improves before pain fully disappears. Waiting until you are pain-free before returning to what you value tends to mean waiting a very long time, so the plan is built around a graded return rather than avoidance.
What you can do today
- Keep using the arm, with the aggravating load reduced rather than removed.
- Carry with the palm up where you can — it takes load off the extensor tendon.
- Use two hands, a trolley, or a bigger softer grip on tools.
- Break up sustained gripping. Pauses matter more than people expect.
- Read pain as information. Discomfort that settles within 24 hours is usually acceptable; pain climbing over days means too much, too soon.
When to get it looked at
Book an assessment if it has lasted more than a few weeks, is affecting work or sleep, or your grip is weakening. See a doctor promptly instead if the elbow is hot, red and swollen, if you have a fever, if it followed a significant fall, or if you cannot use the arm.
Getting seen in Adelaide's west
You do not need a referral to see a physiotherapist in Australia. If your GP has written a Chronic Condition Management Plan, we bulk bill those sessions in full. We claim every registered Australian health fund on the spot through HICAPS, and handle NDIS, DVA and work injury claims. If it started at work, a ReturnToWorkSA claim may cover the treatment rather than you.
We are at 177 Trimmer Parade, Seaton SA 5023 with free off-street parking, seeing people from Findon, Fulham Gardens, West Lakes, Woodville, Grange, Henley Beach, Royal Park and Kidman Park. Our physiotherapists speak English, Hindi and Gujarati — see languages we speak.
More on our tennis elbow page, or book online. You can also call 0403 907 587.
This article is general information, not individual medical advice, and nothing here is a recommendation for or against any particular medical treatment for your situation. Decisions about injections are for you and your doctor. Elbow pain has several possible causes and the right approach depends on examination findings. Fees and funding arrangements are correct at the time of writing.
