Tennis Elbow - symptoms, causes and management

What is tennis elbow?

Tennis elbow is a condition which is known medically as lateral epicondylalgia. ‘Epicondyl’ refers to the anatomical landmark on the outside of the elbow and ‘algia’ refers to the presence of pain. With tennis elbow pain can be felt on the outside of the elbow which in some cases can spread down towards the forearm or wrist.   Tennis elbow used to be known as epicondylitis with ‘itis’ referring to inflammation, but we now know that there is little in the way of true inflammation especially with persistent long term symptoms.  Instead the source of pain comes from strain and overload on the tendon causing it to breakdown at a cellular level (ref).

What causes tennis elbow?

Tennis elbow starts when the tendons which run from the muscles on the back of the forearm into the elbow are overloaded or strained.  This causes micro-tears in the tendon where it inserts into the elbow leading to pain. 
Tennis elbow can be brought on by an acute injury or sudden movement producing high forces through the tendon, but more commonly the onset is gradual over time with repetitive movements requiring lots of wrist and hand movement or gripping, e.g. gardening, cleaning, DIY, manual work or typing. 

How do I recognise the symptoms?

Typically, symptoms of pain on the outside of the elbow can be made worse by:
·         Bending or fully straightening the arm
·         Holding heavy objects or opening cans and bottles
·         Typing or writing for long periods of time
·         Using heavy items for prolonged periods such as a drill
·         Twisting or doing rotational movement in with the arm e.g. racquet sports
·         Pain can be produced by touching the outside of the elbow

What can I do to manage the pain?

There are a number of different things you can do to help yourself. The most important of all is reducing the weight that goes through the injury site, or the amount of work you are doing with your arm.  Working through the pain is rarely advisable as this will continue to overload and place stress on the injured tissue.

Other useful adjuncts for relieving pain include the use of analgesia such as paracetamol or non-steroidal anti-inflammatory medication.  Using ice packs can also be useful for symptomatic relief of pain even though there may be little in the way of actual inflammation.  
You shouldn’t take ibuprofen or aspirin if you’re pregnant or have asthma, indigestion or an ulcer until you’ve spoken to your doctor or pharmacist. Medication can have side-effects so you should read the label carefully and check with your pharmacist if you have any queries. Always seek medical advice if needed before taking medication.

How can Physiotherapy help?

A Physiotherapy assessment can help by pinpointing the cause of symptoms and ensuring you get an accurate diagnosis.  Once this have been obtained an appropriate treatment plan can be put together.  Physiotherapy treatments include using tape or straps which take pressure off the injured tissue and can be worn during activities that typically cause discomfort.  Soft tissue massage, elbow mobilisation, acupuncture and shockwave therapy can also be used for pain relief and to promote healing.  Long term management with specific strengthening exercises is strongly supported by research and this often forms the foundation of management in physio.

Medical management - Steroid injections

If you don’t respond to conservative treatment your GP or physio may suggest a steroid injection could be of benefit. Injections can work extremely well for some and for others can have little impact.  Your physio can help with referring you on for a steroid injection if they think you would benefit from this and discuss the pros and cons.

Don’t just put up with symptoms – get the injury checked out!

Whatever you do, don’t just sit and rest the injury.  Rest on its own is rarely useful for persistent symptoms and if anything can lead to making things worse as the muscles and tendon loose strength.  So don’t delay, book an appointment on 01462 431033 or contact us for further information on assessment and treatment.  Click here for more information about Physio Three Sixty.

Anthony Cahill
​Specalist MSK Physiotherapist, Physio Three Sixty, Hitchin
Shoulder pain and the signs of rotator cuff injury

Injury to the rotator cuff is common among all age groups and is characterised by a pain or ache from the top of the shoulder that typically spreads down the middle of the upper arm.  Most of the time pain is brought on by trauma or a sudden movement causing a strain and damage to the rotator cuff muscle or tendon.  Symptoms can also develop gradually over time through repetitive movements or overuse.

What makes up the rotator cuff?

The rotator cuff is made up of 4 muscles (supraspinatus, infraspinatus, teres minor and subscapularis), starting from the shoulder blade (scapula) and attaching onto the long bone of the arm (humeral head). The shoulder joint has a wide range of movement, which can make it prone to injury in certain positions if excessive force is applied.


What are the symptoms?

Pain is typically intermittent or only present when making certain movements with the arm, though in more severe cases pain can be there most of the time. Reaching out for things at waist to shoulder height tend to produce a sudden catch, particularly with added weight.  Carrying bags on the affected side if often uncomfortable too.

What can I do to improve my symptoms?

Non-steroidal anti-inflammatory drugs (NSAIDs) can be useful in the early stages when taken 48 or more after the symptoms started.  It is always wise to check with your GP or local pharmacist if you would like advice or guidance on taking a course of NSAIDs.  Often within 4-6 weeks symptoms can spontaneously resolve with general activity, but if they persist you should attend a physiotherapy consultation, either through your GP or self referral.

What can physiotherapy do to help?

A Physiotherapy consultation will help to determine an accurate diagnosis and put together an appropriate management plan to improve symptoms.  Applying tape and using massage or acupuncture can be used for relieving pain.  These can be used along with a graded exercise programme to build strength back into the shoulder. The exercises provided will be tailored to your particular goals, e.g. some may want to get back to high level sport, and for others day to day function.

How long does it take to get better?

For mild cases 4-8 weeks, for moderate strains 8-16 weeks and more severe injury can take six months or more to resolve.

What if my shoulder pain doesn’t improve?

It is important to keep a healthcare professional posted on the progress you make with your symptoms.  If you do not make the expected progress it may be appropriate to be referred for a specialist opinion with an Orthopaedic Consultant.  A chartered physiotherapist or GP will be able to provide advice on this.

Don’t put up with symptoms – get the injury checked out!

Whatever you do, don’t just sit and rest the injury.  Rest on its own is never useful for persistent shoulder pain, and if anything can lead to making symptoms worse as the muscles loose strength and the shoulder gets stiff which makes the road back to health even longer.  So don’t delay, book an appointment and get the shoulder checked out.

​Specialist MSK Physiotherapist - Anthony Cahill
​Physio Three Sixty, Hitchin

Running analysis for injury prevention

Running analysis for injury prevention, Hitchin

This month we have shared a video of a running analysis done recently in clinic.  The video demonstrates how the way we run can
explain the injuries we have and how to go about improving this.  Have you had a running injury before that didn't get better with physio alone? A gait
analysis will likely reveal why.  Sometimes all you need to do is modify your technique for injuries to resolve...

Anthony Cahill - Specialist MSK Physiotherapist
Physio Three Sixty, Hitchin

Top tips for managing acute low back pain

Tips on how to manage acute low back pain from Physio Three Sixty, Hitchin


What is acute low back pain?

Acute pain refers to symptoms that have been present for up to six weeks.  Pain lasting longer than  six weeks refers to sub-acute pain and anything longer than three months is termed persistent or chronic pain. Acute low back pain is typically brought on through injury, repetitive strain or postural problems and can present as a focal point in the low back or which radiates into one or both buttocks or even into the thigh& hip area.  For some people their symptoms will be a mild level of discomfort and for others much more intense.  Sensations of being sharp, hot, burning, aching or dull are all common descriptors of low back pain.

How long will an episode last?

The prognosis for recovery from low back pain is good.  Fifty percent of episodes nearly completely resolve within two weeks, and 80% by six weeks (Manchikanti, 2000).  The duration and severity of a single episode cannot be predicted based on the onset, location of pain, or even the initial severity. The initial pain may resolve within several days, while moderate or mild symptoms may persist for a few weeks.

What can I do to help myself?

Movement it best.  When we are in pain our instinct can often be to rest or stop moving for a few days, but we have known for some time that resting can be counterproductive.  General activity and the right kind of exercise results in a quicker recover and better prognosis than doing nothing at all.  This will help with blood flow and nutrients flowing to the affected area, inhibiting inflammation and reducing muscular tension. Many individuals with low back pain find that they can perform their usual, but more controlled cardiovascular activities, such as walking, in spite of the pain and often feel better after the activity.

Should I take medication?

Over the counter medication such as paracetamol and Non-steroidal anti-inflammatory drugs can be useful for managing low back pain.  If you are unsure about what to take you should seek advice from a pharmacist or a GP.  If over the counter analgesia does not provide any benefit it would be appropriate to make an appointment to see your GP who may prescribe an alternative medication for pain relief.

Top exercises for Acute LBP

As a general rule any movement is good, even if just walking for a few minutes at a time.  Range of movement exercises can be excellent for reducing muscle tension and relieving pain, and Arthritis Research UK provide an excellent guide on how these can be done by following the link below.  The key is to avoid excessive rest or staying in the same position for prolonged periods of time without moving.

What do I do if things don’t improve?

If you continue to struggle with pain despite taking the above steps it is worth seeking a professional opinion with a Chartered Physiotherapist.  By undergoing aa physical examination, a Physiotherapist will be able to determine if other treatments such as manual therapy or acupuncture will be useful, and as to which exercises are most appropriate to carry out.  You can visit your GP to enquire about getting referred or you can refer yourself directly to a clinic such as Physio Three Sixty in Hitchin.
Manchikanti, L., 2000. Epidemiology of low back pain. Pain physician, 3(2), pp.167-192.
Specialist Physiotherapy and Sports injury management


"Wouldn't hesitate to recommend Physio Three Sixty. Got an appointment when I needed one and without having to wait. Friendly and professional service. My running injury was resolved by treatment on the day….


With vast experience across the public and private sectors in musculoskeletal physiotherapy, we have treated thousands of different injuries.  Check out our list of commonly treated conditions.


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